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Mundo W, Berning A, Koullias Y, Chastain DB, Stone N, Franco-Paredes C, Henao-Martínez AF, Vargas Barahona L. Disseminated Cryptococcal Disease in A Patient With Chronic Chylothorax and a Pleurovenous Catheter, a Case Report With Autopsy Findings. Open Forum Infect Dis 2021; 8:ofab258. [PMID: 34189175 PMCID: PMC8233570 DOI: 10.1093/ofid/ofab258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/14/2021] [Indexed: 11/14/2022] Open
Abstract
Cryptococcus species are ubiquitous in the environment with a global distribution. While causing disease predominantly in immunocompromised hosts such as those with advanced HIV, HIV-uninfected patients are increasingly recognized as being affected. The most common forms of infection are cryptococcal pneumonia and meningitis. HIV-uninfected patients and extrapulmonary infections have worse outcomes, likely due to delayed diagnosis and treatment. Cryptococcus infections involving chylothorax or chyloabdomen have rarely been reported in humans. We describe a case of fulminant disseminated cryptococcosis with fungemia, peritonitis, and empyema in a patient with chronic chylothorax treated with an indwelling pleurovenous shunt. Key autopsy findings included cryptococcal organisms identified on calcified lymphadenopathy, pleural adhesions, and pericardium. We discuss the importance of identifying patients with nontraditional risks factors for cryptococcal disease, such as lymphopenia and hypogammaglobulinemia, and the potential implications of pleurovenous catheters in Cryptococcus dissemination.
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Affiliation(s)
- William Mundo
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amber Berning
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Yiannis Koullias
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel B Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, Georgia,USA
| | - Neil Stone
- Hospital for Tropical Diseases, University College London Hospitals, London, UK
| | - Carlos Franco-Paredes
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Hospital Infantil de México, Federico Gómez, México City, México
| | - Andrés F Henao-Martínez
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lilian Vargas Barahona
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Cogliati M, Desnos-Ollivier M, McCormick-Smith I, Rickerts V, Ferreira-Paim K, Meyer W, Boekhout T, Hagen F, Theelen B, Inácio J, Alonso B, Colom MF, Trilles L, Montagna MT, De Donno A, Susever S, Ergin C, Velegraki A, Ellabib MS, Nardoni S, Macci C, Trovato L, Dipineto L, Akcaglar S, Mlinaric-Missoni E, Bertout S, Vencá ACF, Sampaio AC, Criseo G, Ranque S, Çerikçioğlu N, Marchese A, Vezzulli L, Ilkit M, Pasquale V, Polacheck I, Lockhart SR. Genotypes and population genetics of cryptococcus neoformans and cryptococcus gattii species complexes in Europe and the mediterranean area. Fungal Genet Biol 2019; 129:16-29. [PMID: 30953839 DOI: 10.1016/j.fgb.2019.04.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 02/06/2023]
Abstract
A total of 476 European isolates (310 Cryptococcus neoformans var. grubii, 150 C. neoformans var. neoformans, and 16 C. gattii species complex) from both clinical and environmental sources were analyzed by multi-locus sequence typing. Phylogenetic and population genetic analyses were performed. Sequence analysis identified 74 sequence types among C. neoformans var. neoformans (VNIV), 65 among C. neoformans var. grubii (56 VNI, 8 VNII, 1 VNB), and 5 among the C. gattii species complex (4 VGI and 1 VGIV) isolates. ST23 was the most frequent genotype (22%) among VNI isolates which were mostly grouped in a large clonal cluster including 50% of isolates. Among VNIV isolates, a predominant genotype was not identified. A high percentage of autochthonous STs were identified in both VNI (71%) and VNIV (96%) group of isolates. The 16 European C. gattii species complex isolates analyzed in the present study originated all from the environment and all belonged to a large cluster endemic in the Mediterranean area. Population genetic analysis confirmed that VNI group of isolates were characterized by low variability and clonal expansion while VNIV by a higher variability and a number of recombination events. However, when VNI and VNIV environmental isolates were compared, they showed a similar population structure with a high percentage of shared mutations and the absence of fixed mutations. Also linkage disequilibrium analysis reveals differences between clinical and environmental isolates showing a key role of PLB1 allele combinations in host infection as well as the key role of LAC1 allele combinations for survival of the fungus in the environment. The present study shows that genetic comparison of clinical and environmental isolates represents a first step to understand the genetic characteristics that cause the shift of some genotypes from a saprophytic to a parasitic life style.
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Affiliation(s)
- Massimo Cogliati
- Dip. Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.
| | - Marie Desnos-Ollivier
- Institut Pasteur, Molecular Mycology Unit, National Reference Center for Invasive Mycoses & Antifungal, CNRS UMR2000, Paris, France
| | | | | | - Kennio Ferreira-Paim
- Molecular Mycology Research Laboratory, Center for Infectious Diseases, Faculty of Medicine and Health, Sydney Medical School, Westmead Clinical School, Marie Bashier Institute for Emerging Infectious Diseases and Biosecurity, University of Sydney, Westmead Hospital, (Research and Educational Network) Westmead Institute for Medical Research, Westmead, NSW, Australia; Department of Microbiology, Federal University of Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Center for Infectious Diseases, Faculty of Medicine and Health, Sydney Medical School, Westmead Clinical School, Marie Bashier Institute for Emerging Infectious Diseases and Biosecurity, University of Sydney, Westmead Hospital, (Research and Educational Network) Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Teun Boekhout
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands; Institute of Biodiversity and Ecosystem Dynamic (IBED), University of Amsterdam, Amsterdam, the Netherlands
| | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands
| | - Bart Theelen
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands
| | - Joäo Inácio
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Beatriz Alonso
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK; Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Hospital Gegorio Marañón, Madrid, Spain
| | | | | | | | | | | | | | - Aristea Velegraki
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Cristina Macci
- National Research Council, Research Institute on Terrestrial Ecosystems (IRET), Pisa, Italy
| | | | | | | | | | - Sebastien Bertout
- Unité Mixte Internationale "Recherches Translationnelles sur l'infection à VIH et les Maladies Infectieuses", Université de Montpellier, Montpellier, France
| | - Ana C F Vencá
- Instituto de Higiene e Medicina Tropical, Lisbon, Portugal
| | - Ana C Sampaio
- Universidade de Trás-os-Montes e Alto Douro, CITAB, Quinta dos Prados, Vila Real, Portugal
| | - Giuseppe Criseo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Italy
| | - Stéphane Ranque
- Aix-Marseille University, IRD, APHM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | | | - Anna Marchese
- Sezione di Microbiologia del DISC, Università di Genova-IRCCS Policlinico San Martino Genova, Genova, Italy
| | - Luigi Vezzulli
- Dipartimento di Scienze della Terra, dell'Ambiente e della Vita (DISTAV), Università di Genova, Genova, Italy
| | - Macit Ilkit
- University of Çukurova Sarıçam, Adana, Turkey
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