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Bive BZ, Sacheli R, Mudogo CN, Zakayi PK, Bontems S, Lelo GM, Hayette MP. Correlation of antifungal susceptibility and sequence types within Cryptococcus neoformans VNI from HIV patients, and ERG11 gene polymorphism. J Mycol Med 2023; 33:101428. [PMID: 37651769 DOI: 10.1016/j.mycmed.2023.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/21/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Here we tested the correlation between minimum inhibitory concentrations (MICs) of major antifungal agents and sequence types (STs) within Cryptococcus neoformans VNI isolates, and explored the ERG11 gene of included strains. MATERIALS AND METHODS We analysed 23 C. neoformans strains categorised into two groups according to the distribution of the ST profile in Kinshasa clinics (Democratic Republic of Congo): major ST [ST93 (n = 15)], and less common STs [ST659 (n = 2), ST5 (n = 2), ST4 (n = 1), ST 53 (n = 1), ST31 (n = 1), and ST69 (n = 1)]. The MICs of the major antifungal agents [amphotericin B (AMB), 5-fluorocytosine (5FC) and fluconazole (FCZ)] were determined following EUCAST guidelines. ERG11 gene sequences were extracted from whole genome sequence of the isolates and compared with the wild-type gene sequence of the C. neoformans VNI. RESULTS Although major ST isolates appeared to have lower median MICs for AMB and 5FU than less common ST isolates (0.50 vs. 0.75 mg/L for AMB, 2 vs. 4 mg/L for 5FU, respectively), FCZ susceptibility was similar in both groups (4 mg/L) (p-value >0.05). The susceptibility profile of C. neoformans strains separately considered did not significantly affect the patients' clinical outcomes (p-value >0.05). Furthermore, two structural modalities of the ERG11 gene were observed: (1) that of the reference gene, and (2) that containing two exonic silent point substitutions, and one intronic point substitution located in a sequence potentially involved in pre-mRNA splicing (c.337-22C > T); with no association with the MICs of the isolates (p-value >0.05). CONCLUSIONS The lack of association/correlation found in this study calls for further investigations to better understand the mechanisms of C. neoformans resistance to antifungal agents.
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Affiliation(s)
- Bive Zono Bive
- Molecular Biology Service, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo; Department of Clinical Microbiology, National Reference Center for Mycosis, Center for Interdisciplinary Research on Medicines, University of Liege, Liege, Belgium.
| | - Rosalie Sacheli
- Department of Clinical Microbiology, National Reference Center for Mycosis, Center for Interdisciplinary Research on Medicines, University of Liege, Liege, Belgium
| | - Celestin Nzanzu Mudogo
- Molecular Biology Service, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Pius Kabututu Zakayi
- Molecular Biology Service, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Sébastien Bontems
- Department of Clinical Microbiology, Laboratory of Virology and Immunology, Center for Interdisciplinary Research on Medicines, University of Liege, Liege, Belgium
| | - Georges Mvumbi Lelo
- Molecular Biology Service, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marie-Pierre Hayette
- Department of Clinical Microbiology, National Reference Center for Mycosis, Center for Interdisciplinary Research on Medicines, University of Liege, Liege, Belgium
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Espinel-Ingroff A, Cantón E. Methods for Antifungal Susceptibility Testing of the Cryptococcus neoformans/ C. gattii Complex: Strengths and Limitations. J Fungi (Basel) 2023; 9:jof9050542. [PMID: 37233253 DOI: 10.3390/jof9050542] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
When method-dependent categorical endpoints are available, namely either BPs or ECVs, MICs could aid in selecting the best treatment agent(s). BPs can categorize an isolate as either susceptible or resistant while the ECVs/ECOFFs can distinguish the wild type (WT, no known resistance mechanisms) from the Non-WT (NWT, harboring resistant mechanisms). Our literature review focused on the Cryptococcus species complex (SC) and the available methods and categorization endpoints. We also covered the incidence of these infections as well as the numerous Cryptococcus neoformans SC and C. gattii SC genotypes. The most important agents to treat cryptococcal infections are fluconazole (widely used), amphotericin B, and flucytosine. We provide data from the collaborative study that defined CLSI fluconazole ECVs for the most common cryptococcal species or genotypes and modes. EUCAST ECVs/ECOFFs are not yet available for fluconazole. We have summarized the incidence of cryptococccal infections (2000-2015) where fluconazole MICs were obtained by reference and commercial antifungal susceptibility tests. This occurrence is documented all over the world and those fluconazole MICs are mostly categorized by available CLSI ECVs/BPs as "resistant" instead of non-susceptible strains, including those by the commercial methods. As expected, the agreement between the CLSI and commercial methods is variable because SYO and Etest data could yield low/variable agreement (<90%) versus the CLSI method. Therefore, since BPs/ECVs are species and method dependent, why not gather sufficient MICs by commercial methods and define the required ECVs for these species?
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Affiliation(s)
| | - Emilia Cantón
- Severe Infection Research Group, Health Research Institute Hospital La Fe, 46026 Valencia, Spain
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Drakulovski P, Krasteva D, Bellet V, Randazzo S, Roger F, Pottier C, Bertout S. Exposure of Cryptococcus neoformans to Seven Commonly Used Agricultural Azole Fungicides Induces Resistance to Fluconazole as Well as Cross-Resistance to Voriconazole, Posaconazole, Itraconazole and Isavuconazole. Pathogens 2023; 12:pathogens12050662. [PMID: 37242332 DOI: 10.3390/pathogens12050662] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Cross-resistance to medical azoles by exposure to azole pesticides is well documented for Aspergillus family fungi but is poorly evaluated for other environmental pathogen fungi, particularly for yeasts belonging to the Cryptococcus neoformans/Cryptococcus gattii species complexes. METHODS One thousand C. neoformans yeast were exposed to various concentrations of seven different commonly used azole pesticides. Clones surviving exposure were picked randomly, and their minimal inhibitory concentrations (MICs) of fluconazole, voriconazole, posaconazole, itraconazole and isavuconazole were assessed. RESULTS Depending on the pesticide used for exposure, up to 13.3% of selected Cryptococcus colonies showed a phenotype of resistance to fluconazole, and among them, several showed cross-resistance to another or several other medical azoles. Molecular mechanisms involved in the resistance setups seem to be dependent on ERG11 and AFR1 gene overexpression. CONCLUSION Exposure to any of the seven azole pesticides tested is capable of increasing the MIC of fluconazole in C. neoformans, including up to the level of the fluconazole-resistant phenotype, as well as generating cross-resistance to other medical azoles in some cases.
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Affiliation(s)
- Pascal Drakulovski
- Laboratoire de Parasitologie et Mycologie Médicale, UMI 233 TransVIHMI, University of Montpellier, IRD, INSERM U1175, 15 Avenue Charles Flahaut, 34093 Montpellier, France
| | - Donika Krasteva
- Laboratoire de Parasitologie et Mycologie Médicale, UMI 233 TransVIHMI, University of Montpellier, IRD, INSERM U1175, 15 Avenue Charles Flahaut, 34093 Montpellier, France
| | - Virginie Bellet
- Laboratoire de Parasitologie et Mycologie Médicale, UMI 233 TransVIHMI, University of Montpellier, IRD, INSERM U1175, 15 Avenue Charles Flahaut, 34093 Montpellier, France
| | - Sylvie Randazzo
- Laboratoire de Parasitologie et Mycologie Médicale, UMI 233 TransVIHMI, University of Montpellier, IRD, INSERM U1175, 15 Avenue Charles Flahaut, 34093 Montpellier, France
| | - Frédéric Roger
- Laboratoire de Parasitologie et Mycologie Médicale, UMI 233 TransVIHMI, University of Montpellier, IRD, INSERM U1175, 15 Avenue Charles Flahaut, 34093 Montpellier, France
| | - Cyrille Pottier
- Laboratoire de Parasitologie et Mycologie Médicale, UMI 233 TransVIHMI, University of Montpellier, IRD, INSERM U1175, 15 Avenue Charles Flahaut, 34093 Montpellier, France
| | - Sébastien Bertout
- Laboratoire de Parasitologie et Mycologie Médicale, UMI 233 TransVIHMI, University of Montpellier, IRD, INSERM U1175, 15 Avenue Charles Flahaut, 34093 Montpellier, France
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Bongomin F, Ekeng BE, Kibone W, Nsenga L, Olum R, Itam-Eyo A, Kuate MPN, Pebolo FP, Davies AA, Manga M, Ocansey B, Kwizera R, Baluku JB. Invasive Fungal Diseases in Africa: A Critical Literature Review. J Fungi (Basel) 2022; 8:jof8121236. [PMID: 36547569 PMCID: PMC9853333 DOI: 10.3390/jof8121236] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Invasive fungal diseases (IFDs) are of huge concern in resource-limited settings, particularly in Africa, due to the unavailability of diagnostic armamentarium for IFDs, thus making definitive diagnosis challenging. IFDs have non-specific systemic manifestations overlapping with more frequent illnesses, such as tuberculosis, HIV, and HIV-related opportunistic infections and malignancies. Consequently, IFDs are often undiagnosed or misdiagnosed. We critically reviewed the available literature on IFDs in Africa to provide a better understanding of their epidemiology, disease burden to guide future research and interventions. Cryptococcosis is the most encountered IFD in Africa, accounting for most of the HIV-related deaths in sub-Saharan Africa. Invasive aspergillosis, though somewhat underdiagnosed and/or misdiagnosed as tuberculosis, is increasingly being reported with a similar predilection towards people living with HIV. More cases of histoplasmosis are also being reported with recent epidemiological studies, particularly from Western Africa, showing high prevalence rates amongst presumptive tuberculosis patients and patients living with HIV. The burden of pneumocystis pneumonia has reduced significantly probably due to increased uptake of anti-retroviral therapy among people living with HIV both in Africa, and globally. Mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidiomycosis have also been reported but with very few studies from the literature. The emergence of resistance to most of the available antifungal drugs in Africa is yet of huge concern as reported in other regions. IFDs in Africa is much more common than it appears and contributes significantly to morbidity and mortality. Huge investment is needed to drive awareness and fungi related research especially in diagnostics and antifungal therapy.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
- Correspondence:
| | - Bassey E. Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar P.O. Box 540281, Nigeria
| | - Winnie Kibone
- Department of Medicine, School of Medicine, Makerere University, Kampala P.O. Box 7072, Uganda
| | - Lauryn Nsenga
- Department of Medicine, School of Medicine, Kabale University, Kabale P.O. Box 317, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis’s Hospital Nsambya, Kampala P.O. Box 7176, Uganda
| | - Asa Itam-Eyo
- Department of Internal Medicine, University of Calabar Teaching Hospital, Calabar P.O. Box 540281, Nigeria
| | | | - Francis Pebalo Pebolo
- Department of Reproductive Health, Faculty of Medicine, Gulu University, Gulu P.O. Box 166, Uganda
| | - Adeyinka A. Davies
- Department of Medical Microbiology and Parasitology, Olabisi Onabanjo University Teaching Hospital, Sagamu P.O. Box 121102, Nigeria
| | - Musa Manga
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4114 McGavran-Greenberg, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Bright Ocansey
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Richard Kwizera
- Translational Research Laboratory, Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala P.O. Box 7178, Uganda
- Makerere Lung Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda
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Bive BZ, Sacheli R, Situakibanza Nani-Tuma H, Kabututu Zakayi P, Ka A, Mbula Mambimbi M, Muendele G, Boreux R, Landu N, Nzanzu Mudogo C, M’Buze PR, Moutschen M, Meyer W, Mvumbi Lelo G, Hayette MP. Clinical epidemiology and high genetic diversity amongst Cryptococcus spp. isolates infecting people living with HIV in Kinshasa, Democratic Republic of Congo. PLoS One 2022; 17:e0267842. [PMID: 35587939 PMCID: PMC9119562 DOI: 10.1371/journal.pone.0267842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/14/2022] [Indexed: 11/19/2022] Open
Abstract
Neuromeningeal cryptococcosis (NMC) is a life-threatening opportunistic infection in advanced HIV disease patients (AHDP). It is caused by Cryptococcus spp. complexes and mainly occurs in sub-Saharan Africa. In this study, we performed molecular characterization and antifungal susceptibility profiling of Cryptococcus isolates from AHDP in Kinshasa (DRC). Additionally, we investigated a possible association between NMC severity factors and the Cryptococcus neoformans (Cn) multilocus sequence typing (MLST) profiles. We characterized the isolates using PCR serotyping, MALDI-TOF MS, internal transcribed spacer (ITS) sequencing, and MLST. Susceptibility testing for the major antifungal drugs was performed according to the EUCAST guidelines. Parameters associated with NMC severity, such as hypoglycorrhachia (< 50 mg/dL), increased cerebral spinal fluid opening pressure (> 30 cm H2O), and poor therapeutic outcome were compared with the Cn MLST sequences type (ST). Twenty-three out of 29 Cryptococcus isolates were identified as serotype A using PCR serotyping (79.3%; 95% IC: 65.5-93.1), while six (20.7%; 95% IC: 6.9-34.5) were not serotypable. The 29 isolates were identified by ITS sequencing as follows: Cryptococcus neoformans (23/29, 79.3%), Cutaneotrichosporon curvatus (previously called Cryptococcus curvatus) (5/29, 17.2%), and Papiliotrema laurentii (Cryptococcus laurentii) (1/29, 3.5%). Using the ISHAM MLST scheme, all Cn isolates were identified as molecular type VNI. These comprised seven different STs: ST93 (n = 15), ST5 (n = 2), ST53 (n = 1), ST31 (n = 1), ST4 (n = 1), ST69 (n = 1), and one novel ST that has not yet been reported from other parts of the world and was subsequently assigned as ST659 (n = 2). Of the included strains, only Papiliotrema laurentii was resistant to amphoterin B (1/29, 3.5%), 6.8% (2/29) were resistant to 5-flucytosine (the single Papiliotrema laurentii strain and one Cryptococcus neoformans isolate), and 13.8% (4/29) to fluconazole, including two of five (40%) Cutaneotrichosporon curvatus and two of 23 (8.7%) C. neoformans strains. We found a significative association between poor therapeutic outcome and a non-ST93 sequence type of causative strains (these concerned the less common sequence types: ST53, ST31, ST5, ST4, ST659, and ST69) (87.5% versus 40%, p = 0.02). Molecular analysis of Cryptococcus spp. isolates showed a wide species diversity and genetic heterogenicity of Cn within the VNI molecular type. Furthermore, it is worrying that among included strains we found resistances to several of the commonly used antifungals.
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Affiliation(s)
- Bive Zono Bive
- Faculty of Medicine, Department of Basic Sciences, Molecular Biology Service, University of Kinshasa, Kinshasa, The Democratic Republic of Congo
- Centre for Interdisciplinary Research on Medicines, University of Liege, Liege, Belgium
| | - Rosalie Sacheli
- Centre for Interdisciplinary Research on Medicines, University of Liege, Liege, Belgium
- National Reference Centre for Mycosis, University Hospital Centre of Liege, Liege, Belgium
| | - Hippolyte Situakibanza Nani-Tuma
- Faculty of Medicine, Department of Internal Medicine/Department of Tropical Medicine, Infectious Diseases Service, University of Kinshasa, Kinshasa, The Democratic Republic of Congo
| | - Pius Kabututu Zakayi
- Faculty of Medicine, Department of Basic Sciences, Molecular Biology Service, University of Kinshasa, Kinshasa, The Democratic Republic of Congo
| | - Alex Ka
- Molecular Mycology Research Laboratory, Faculty of Medicine and Health, Centre for Infectious Diseases and Microbiology, Sydney Medical School, Westmead Clinical School, Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead Hospital-Research and Education Network, Westmead Institute for Medical Research, Sydney, Australia
| | - Marcel Mbula Mambimbi
- Faculty of Medicine, Department of Internal Medicine/Department of Tropical Medicine, Infectious Diseases Service, University of Kinshasa, Kinshasa, The Democratic Republic of Congo
| | - Gaultier Muendele
- Internal Medicine Department, Advanced HIV Disease Management Unit, Centre Hospitalier Mère et Enfant de NGABA, Kinshasa, The Democratic Republic of Congo
| | - Raphael Boreux
- Centre for Interdisciplinary Research on Medicines, University of Liege, Liege, Belgium
| | - Nicole Landu
- Internal Medicine Department, Advanced HIV Disease Management Unit, Centre Médical et Evangélique Révérend LUYINDU, Kinshasa, The Democratic Republic of Congo
| | - Celestin Nzanzu Mudogo
- Faculty of Medicine, Department of Basic Sciences, Molecular Biology Service, University of Kinshasa, Kinshasa, The Democratic Republic of Congo
| | - Pierre-Robert M’Buze
- Internal Medicine Department, Advanced HIV Disease Management Unit, Centre Hospitalier Roi Baudouin 1er, Kinshasa, The Democratic Republic of Congo
| | - Michel Moutschen
- Department of Infectious Diseases and General Internal Medicine, University Hospital Centre of Liege, Liege, Belgium
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Faculty of Medicine and Health, Centre for Infectious Diseases and Microbiology, Sydney Medical School, Westmead Clinical School, Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead Hospital-Research and Education Network, Westmead Institute for Medical Research, Sydney, Australia
- Curtin Medical School, Curtin University, Perth, Australia
| | - Georges Mvumbi Lelo
- Faculty of Medicine, Department of Basic Sciences, Molecular Biology Service, University of Kinshasa, Kinshasa, The Democratic Republic of Congo
| | - Marie-Pierre Hayette
- Centre for Interdisciplinary Research on Medicines, University of Liege, Liege, Belgium
- National Reference Centre for Mycosis, University Hospital Centre of Liege, Liege, Belgium
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Sina S, Mohammad JM, Reza S, Anita M, Soudabeh E, Hadi M. Determination of parasitic burden in the brain tissue of infected mice in acute toxoplasmosis after treatment by fluconazole combined with sulfadiazine and pyrimethamine. Eur J Med Res 2021; 26:65. [PMID: 34193287 PMCID: PMC8243906 DOI: 10.1186/s40001-021-00537-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 06/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND/AIMS One of the opportunistic pathogens which cause serious problems in the human immune system is Toxoplasma gondii, with toxoplasma encephalitis (TE) seen in patients affected by it. The treatment of these patients is limited, and if not treated on time, death will be possible. METHODS In this study, the effects of the treatment with different doses of fluconazole (FLZ) in combination with the current treatment of acute toxoplasmosis on reducing the mortality rate and the parasitic load in the murine model in vivo were studied. The mice were treated with different doses of fluconazole alone, sulfadiazine, and pyrimethamine plus fluconazole. A day after the end of the treatment and 1 day before death, the mice's brains were collected, and after DNA extraction and molecular tests, the parasite burden was detected. RESULTS This study showed that a 10-day treatment with 20 mg/kg of fluconazole combined with sulfadiazine and pyrimethamine 1.40 mg/kg per day affected acute toxoplasmosis and reduced the parasitic load significantly in brain tissues and also increased the survival rate of all mice in this group until the last day of the study, in contrast to other treatment groups. These results also indicate the positive effects of combined therapy on Toxoplasma gondii and the prevention of relapse. CONCLUSIONS Reducing the parasitic burden and increasing the survival rate were more effective against acute toxoplasmosis in the combined treatment of different doses of fluconazole with current treatments than current treatments without fluconazole. In other words, combination therapy with fluconazole plus pyrimethamine reduced the parasitic burden in the brain significantly, so it could be a replacement therapy in patients with intolerance sulfadiazine.
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Affiliation(s)
- Sekandarpour Sina
- Infectious Disease and Tropical Medicine Research Center, Resistance Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Medical Parasitology and Mycology, Faculty of Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Jafari Modrek Mohammad
- Infectious Disease and Tropical Medicine Research Center, Resistance Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Medical Parasitology and Mycology, Faculty of Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Shafiei Reza
- Vector-Borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mohammadiha Anita
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Etemadi Soudabeh
- Infectious Disease and Tropical Medicine Research Center, Resistance Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Medical Parasitology and Mycology, Faculty of Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mirahmadi Hadi
- Infectious Disease and Tropical Medicine Research Center, Resistance Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Medical Parasitology and Mycology, Faculty of Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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Temfack E, Rim JJB, Spijker R, Loyse A, Chiller T, Pappas PG, Perfect J, Sorell TC, Harrison TS, Cohen JF, Lortholary O. Cryptococcal Antigen in Serum and Cerebrospinal Fluid for Detecting Cryptococcal Meningitis in Adults Living With Human Immunodeficiency Virus: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies. Clin Infect Dis 2021; 72:1268-1278. [PMID: 32829406 PMCID: PMC8522332 DOI: 10.1093/cid/ciaa1243] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Indexed: 02/01/2023] Open
Abstract
Cryptococcal antigen (CrAg) detection could direct the timely initiation of antifungal therapy. We searched MEDLINE and Embase for studies where CrAg detection in serum/cerebrospinal fluid (CSF) and CSF fungal culture were done on adults living with human immunodeficiency virus (HIV) who had suspected cryptococcal meningitis (CM). With Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), we evaluated the risk of bias in 11 included studies with 3600 participants, and used a random-effects meta-analysis to obtain summary sensitivity and specificity of serum and CSF CrAg, as well as agreement between CSF CrAg and CSF culture. Summary sensitivity and specificity of serum CrAg were 99.7% (97.4-100) and 94.1% (88.3-98.1), respectively, and summary sensitivity and specificity of CSF CrAg were 98.8% (96.2-99.6) and 99.3% (96.7-99.9), respectively. Agreement between CSF CrAg and CSF culture was 98% (97-99). In adults living with HIV who have CM symptoms, serum CrAg negativity may rule out CM, while positivity should prompt induction antifungal therapy if lumbar puncture is not feasible. In a first episode of CM, CSF CrAg positivity is diagnostic.
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Affiliation(s)
- Elvis Temfack
- Institut Pasteur, Centre National de la Recherche Scientifique,
Molecular Mycology Unit Unite Mixte de Recherche 2000,
Paris, France
- Internal Medicine Unit, Douala General Hospital,
Douala, Cameroon
| | | | - Rene Spijker
- Cochrane Netherlands, Julius Centre for Health Sciences and Primary
Care, University Medical Centre Utrecht,
Utrecht, The
Netherlands
| | - Angela Loyse
- Institute of Infection and Immunity, St. George’s University of
London, London, United Kingdom
- Department of Infection, St George’s University Hospitals
National Health Service Trust, London,
United Kingdom
- Institute of Infectious Disease and Molecular Medicine, University of
Cape Town, Cape Town, South Africa
| | - Tom Chiller
- Tulane School of Public Health and Tropical Medicine,
Atlanta, Georgia, USA
| | - Peter G Pappas
- Division of Infectious Diseases, University of Alabama at
Birmingham, Birmingham, Alabama, USA
| | - John Perfect
- Division of Infectious Diseases, Department of Medicine, Duke
University Medical Centre, Durham, North
Carolina, USA
| | - Tania C Sorell
- University of Sydney Faculty of Medicine and Health, Westmead Clinical
School and Centre for Infectious Diseases and Microbiology, The Westmead
Institute of Medical Research, Westmead,
Australia
| | - Thomas S Harrison
- Institute of Infection and Immunity, St. George’s University of
London, London, United Kingdom
- Department of Infection, St George’s University Hospitals
National Health Service Trust, London,
United Kingdom
- Institute of Infectious Disease and Molecular Medicine, University of
Cape Town, Cape Town, South Africa
| | - Jérémie F Cohen
- Institut National de la Sante et de la Recherche Medicale UMR 1153
Hospital, Assistance Publique-Hopitaux de Paris, Paris Descartes
University, Paris, France
- Department of General Pediatrics and Pediatric Infectious Diseases,
Necker Hospital, Assistance Publique-Hopitaux de Paris. Paris Descartes
University, Paris, France
| | - Olivier Lortholary
- Institut Pasteur, Centre National de la Recherche Scientifique,
Molecular Mycology Unit Unite Mixte de Recherche 2000,
Paris, France
- University Paris Descartes, Necker Pasteur Center for Infectious
Diseases and Tropical Medicine, Hôpital Necker - Enfants malades,
Assistance Publique-Hopitaux de Paris, Institut Hospitalo-Universitaire
Imagine, Paris, France
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Xu XL, Zhao T, Harypursat V, Lu YQ, Li Y, Chen YK. Asymptomatic cryptococcal antigenemia in HIV-infected patients: a review of recent studies. Chin Med J (Engl) 2020; 133:2859-2866. [PMID: 33273336 PMCID: PMC10631590 DOI: 10.1097/cm9.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Indexed: 11/26/2022] Open
Abstract
The prevalence of asymptomatic cryptococcal antigenemia (ACA) in human immunodeficiency virus (HIV) infected individuals has been observed to be elevated. The prevalence of ACA ranges from 1.3% to 13%, with different rates of prevalence in various regions of the world. We reviewed studies conducted internationally, and also referred to two established expert consensus guideline documents published in China, and we have concluded that Chinese HIV-infected patients should undergo cryptococcal antigen screening when CD4 T-cell counts fall below 200 cells/μL and that the recommended treatment regimen for these patients follow current World Health Organization guidelines, although it is likely that this recommendation may change in the future. Early screening and optimized preemptive treatment for ACA is likely to help decrease the incidence of cryptococcosis, and is lifesaving. Further studies are warranted to explore issues related to the optimal management of ACA.
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Affiliation(s)
- Xiao-Lei Xu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Ting Zhao
- Division of Science and Education, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Vijay Harypursat
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Yan-Qiu Lu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Yan Li
- Public Health College, Zunyi Medical University, Zunyi, Guizhou 563000, China
| | - Yao-Kai Chen
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing 400036, China
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9
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A novel method for identifying and distinguishing Cryptococcus neoformans and Cryptococcus gattii by surface-enhanced Raman scattering using positively charged silver nanoparticles. Sci Rep 2020; 10:12480. [PMID: 32719360 PMCID: PMC7385644 DOI: 10.1038/s41598-020-68978-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/30/2020] [Indexed: 11/08/2022] Open
Abstract
There are approximately 1 million cryptococcal infections per year among HIV+ individuals, resulting in nearly 625,000 deaths. Cryptococcus neoformans and Cryptococcus gattii are the two most common species that cause human cryptococcosis. These two species of Cryptococcus have differences in pathogenicity, diagnosis, and treatment. Cryptococcal infections are usually difficult to identify because of their slow growth in vitro. In addition, the long detection cycle of Cryptococcus in clinical specimens makes the diagnosis of Cryptococcal infections difficult. Here, we used positively charged silver nanoparticles (AgNPs+) as a substrate to distinguish between C. neoformans and C. gattii in clinical specimens directly via surface-enhanced Raman scattering (SERS) and spectral analysis. The AgNPs+ self-assembled on the surface of the fungal cell wall via electrostatic aggregation, leading to enhanced SERS signals that were better than the standard substrate negatively charged silver nanoparticles (AgNPs). The SERS spectra could also be used as a sample database in the multivariate analysis via orthogonal partial least-squares discriminant analysis. This novel SERS detection method can clearly distinguish between the two Cryptococcus species using principal component analysis. The accuracy of the training data and test data was 100% after a tenfold crossover validation.
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10
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Amona FM, Denning DW, Moukassa D, Hennequin C. Current burden of serious fungal infections in Republic of Congo. Mycoses 2020; 63:543-552. [PMID: 32181941 DOI: 10.1111/myc.13075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Republic of Congo (RoC) is characterised by a high prevalence of tuberculosis and HIV/AIDS, which largely drive the epidemiology of serious fungal infections. OBJECTIVE We aimed to estimate the current burden of serious fungal infections in RoC. MATERIAL AND METHODS Using local, regional or global data and estimates of population and at-risk population groups, deterministic modelling was employed to estimate national incidence or prevalence of the most serious fungal infections. RESULTS Our study revealed that about 5.4% of the Congolese population (283 450) suffer from serious fungal infections yearly. The incidence of cryptococcal meningitis, Pneumocystis jirovecii pneumonia and disseminated histoplasmosis in AIDS patients was estimated at 560, 830 and 120 cases per year. Oral and oesophageal candidiasis collectively affects 12 320 HIV-infected patients. Chronic pulmonary aspergillosis, 67% post-tuberculosis, probably has a prevalence of 3420. Fungal asthma (allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitisation) probably has a prevalence of 3640 and 4800, although some overlap due to disease definition is likely. The estimated prevalence of recurrent vulvovaginal candidiasis and tinea capitis is 85 440 and 178 400 respectively. Mostly related to agricultural activity, fungal keratitis affects an estimated 700 Congolese yearly. CONCLUSION These data underline the urgent need for an intensified awareness towards Congolese physicians to fungal infections and for increased efforts to improve diagnosis and management of fungal infections in the RoC.
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Affiliation(s)
- Fructueux M Amona
- Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo.,Laboratory of Parasitology-Mycology, Edith Lucie Bongo Ondimba General Hospital, Oyo, Congo.,Research Center and Study of Infectious and Tropical Pathologies, Oyo, Congo
| | - David W Denning
- National Aspergillosis Centre, Wythenshawe Hospital, The University of Manchester, Manchester, UK.,Leading International Fungal Education (LIFE), Cheshire, UK
| | - Donatien Moukassa
- Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo.,Research Center and Study of Infectious and Tropical Pathologies, Oyo, Congo
| | - Christophe Hennequin
- Inserm, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Sorbonne Université, Paris, France
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11
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Clinical and microbiological characteristics of cryptococcosis at an university hospital in China from 2013 to 2017. Braz J Infect Dis 2019; 24:7-12. [PMID: 31870760 PMCID: PMC9392018 DOI: 10.1016/j.bjid.2019.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 11/02/2019] [Accepted: 11/10/2019] [Indexed: 12/14/2022] Open
Abstract
Background This study aims to explore the epidemiology, clinical profile and strain characteristics of cryptococcosis from 2013 to 2017 in a major teaching hospital in China. Methods Trends in antifungal drug susceptibility of 217 consecutive non-repetitive cryptococcal isolates collected from patients of an university hospital in China were analyzed between 2013 and 2017. Of those, 98 isolates were conserved for identification by internal transcribed spacer (ITS) sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system. Multilocus sequence typing (MLST) was used to designate molecular types. Clinical characteristics of the 98 patients with cryptococcosis during the period of 2013–2017 were retrospectively evaluated. Results There was a trend for gradual increase in the MIC range of fluconazole was from 2013 to 2017. The conserved 98 clinical cryptococcal isolates included 97 C. neoformans and one C. gattii, and 90 (91.8%) isolates belonged to ST5 genotype VNI. Out of the 98 patients with cryptococcosis, 28 (28.6%) were HIV-infected and 32 (32.7%) had no underlying diseases. HIV-infected patients had higher mortality than HIV-uninfected patients (28.6% vs 14.3%, p = 0.147). Conclusions Most of the patients with cryptococcosis were not HIV-infected in this study, while patients with HIV had a higher mortality. Reduced susceptibility to fluconazole was observed among C. neoformans isolates, most of them belonged to ST5 genotype VNI having an impact on the effective dose of fluconazole.
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12
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Hailu K, Niguse S, Hagos K, Abdulkader M. Cryptococcal antigenemia and associated risk factors among ART-naïve and ART-experienced HIV-infected peoples at selected health institutions of Mekelle, Northern Ethiopia. Microbiologyopen 2018; 8:e00746. [PMID: 30277315 PMCID: PMC6562113 DOI: 10.1002/mbo3.746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 01/14/2023] Open
Abstract
Cryptococcal infection is a major cause of opportunistic infection in HIV/AID‐infected peoples. We determined cryptococcal antigenemia and cryptococcal meningitis among antiretroviral therapy (ART) initiated and ART‐naive HIV‐infected peoples. A cross‐sectional study was conducted at selected health facilities in Mekelle, Ethiopia. Blood was collected to determine CD4 and plasma cryptococcal antigen (CrAg). CSF CrAg and CSF culture and urease tests were also done. Socio‐demographic and clinical data were collected using a structured questionnaire and clinical chart review. From the enrolled study participants, 267 study participants had complete data, of which, 137 (51%) were females. From the study participants, 140 (52%) and 127 (48%) were ART experienced and ART naïve, respectively. The prevalence of cryptococcal antigenemia was 9 (3.4%). All the study participants, except one (CD4 = 120 cells/mm3), had CD4 count less than 100 cells/mm3. From CrAg‐positive peoples, 6 (4.7%) were ART naïve. Five CrAg‐positive peoples had cryptococcal meningitis. Being male, rural residence, and being hospitalized were associated with cryptococcal antigenemia. Cryptococcal infection poses a substantial risk of HIV‐positive peoples. This study provides relevant data for CrAg screening interventions in patients with low CD4 cell counts.
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Affiliation(s)
- Kibra Hailu
- Laboratory Department, Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia
| | - Selam Niguse
- Medical Microbiology and Immunology Unit, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Kiflom Hagos
- Medical Microbiology and Immunology Unit, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Mahmud Abdulkader
- Medical Microbiology and Immunology Unit, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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13
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HIV-associated opportunistic CNS infections: pathophysiology, diagnosis and treatment. Nat Rev Neurol 2018; 12:662-674. [PMID: 27786246 DOI: 10.1038/nrneurol.2016.149] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Nearly 30 years after the advent of antiretroviral therapy (ART), CNS opportunistic infections remain a major cause of morbidity and mortality in HIV-positive individuals. Unknown HIV-positive disease status, antiretroviral drug resistance, poor drug compliance, and recreational drug abuse are factors that continue to influence the morbidity and mortality of infections. The clinical and radiographic pattern of CNS opportunistic infections is unique in the setting of HIV infection: opportunistic infections in HIV-positive patients often have characteristic clinical and radiological presentations that can differ from the presentation of opportunistic infections in immunocompetent patients and are often sufficient to establish the diagnosis. ART in the setting of these opportunistic infections can lead to a paradoxical worsening caused by an immune reconstitution inflammatory syndrome (IRIS). In this Review, we discuss several of the most common CNS opportunistic infections: cerebral toxoplasmosis, progressive multifocal leukoencephalopathy (PML), tuberculous meningitis, cryptococcal meningitis and cytomegalovirus infection, with an emphasis on clinical pearls, pathological findings, MRI findings and treatment. Moreover, we discuss the risk factors, pathophysiology and management of IRIS. We also summarize the challenges that remain in management of CNS opportunistic infections, which includes the lack of phase II and III clinical trials, absence of antimicrobials for infections such as PML, and controversy regarding the use of corticosteroids for treatment of IRIS.
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14
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Mandengue CE, Denning DW. The Burden of Serious Fungal Infections in Cameroon. J Fungi (Basel) 2018; 4:E44. [PMID: 29601494 PMCID: PMC6023387 DOI: 10.3390/jof4020044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 12/24/2022] Open
Abstract
Fungal infections are frequent in Cameroon, and invasive fungal infections are sometimes detected, usually in HIV-infected patients. For these reasons, we have estimated the burden of fungal infections. Using published literature and population estimates for the at-risk group, we used deterministic modelling to derive national incidence and prevalence estimates for the most serious fungal diseases. HIV infection is common and an estimated 120,000 have CD4 counts <200 × 10⁶/mL and commonly present with opportunistic infection. Oesophageal candidiasis in HIV is common, and in poorly controlled diabetics. We estimate 6720 cases of cryptococcal meningitis, 9000 of Pneumocystis pneumonia, 1800 of disseminated histoplasmosis annually complicating AIDS, and 1200 deaths from invasive aspergillosis in AIDS, but there are no data. We found that 2.4% of adults have chronic obstructive pulmonary disease (COPD) and 2.65% have asthma, with "fungal asthma" affecting 20,000. Chronic pulmonary aspergillosis probably affects about 5000 people, predominantly after tuberculosis but also with COPD and other lung diseases. Also, tinea capitis in schoolchildren is frequent. Overall, an estimated 1,235,775 people are affected by a serious fungal infection. There is an urgent need for government and clinician attention, improved laboratory facilities, fungal diagnostic tests, and competent laboratory technicians, as well as all World Health Organization (WHO)-endorsed essential antifungal drugs to be made available, as only fluconazole is registered and available in the country.
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Affiliation(s)
- Christine E Mandengue
- Department of Internal Medicine (Dermatology), Université des Montagnes, Bangangté P.O. Box 208, Cameroon (Central Africa).
| | - David W Denning
- National Aspergillosis Centre, Wythenshawe Hospital and The University of Manchester, Manchester M13 9PL, UK.
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15
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Bongomin F, Oladele RO, Gago S, Moore CB, Richardson MD. A systematic review of fluconazole resistance in clinical isolates of Cryptococcus species. Mycoses 2018; 61:290-297. [PMID: 29377368 DOI: 10.1111/myc.12747] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 12/30/2022]
Abstract
Fluconazole is the most commonly used antifungal agent for both the treatment of cryptococcal meningitis, and for prophylaxis against the disease. However, its prolonged use has the potential to exert selection pressure in favour of fluconazole-resistant strains. We evaluated the prevalence of fluconazole resistance in Cryptococcus spp. clinical isolates in 29 studies from 1988 to May 2017 included in EMBASE and MEDLINE databases. A total of 4995 Cryptococcus isolates from 3210 patients constituted this study; 248 (5.0%) of the isolates from relapsed episodes of cryptococcosis were included in this analysis. Eleven (38%) of the studies used minimum inhibitory concentrations (MICs) breakpoints of ≥64 μg/mL to define fluconazole resistance, 6 (21%) used ≥32 μg/mL, 11 (38%) used ≥16 μg/mL and 1 (3%) used ≤20 μg/mL. Overall, mean prevalence of fluconazole resistance was 12.1% (95% confidence interval [CI]: 6.7-17.6) for all isolates (n = 4995). Mean fluconazole resistance was 10.6% (95% CI: 5.5-15.6) for the incident isolates (n = 4747) and 24.1% (95% CI: -3.1-51.2) for the relapse isolates (n = 248). Of the 4995 isolates, 936 (18.7%) had MICs above the ecological cut-off value. Fluconazole resistance appears to be an issue in Cryptococcus isolates from patients with relapses. It remains unclear whether relapses occur due to resistance or other factors. There is an urgent need to establish antifungal breakpoints for Cryptococcus spp.
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Affiliation(s)
- Felix Bongomin
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,The National Aspergillosis Centre & NHS Mycology Reference Centre-Manchester, ECMM Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rita O Oladele
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Sara Gago
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Manchester Fungal Infection Group, Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Caroline B Moore
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,The National Aspergillosis Centre & NHS Mycology Reference Centre-Manchester, ECMM Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Malcolm D Richardson
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,The National Aspergillosis Centre & NHS Mycology Reference Centre-Manchester, ECMM Center of Excellence in Clinical and Laboratory Mycology and Clinical Studies, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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16
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Kassi FK, Bellet V, Drakulovski P, Krasteva D, Roger F, Valérie BTA, Aboubakar T, Doumbia A, Kouakou GA, Delaporte E, Reynes J, Yavo W, Menan HIE, Bertout S. Comparative typing analyses of clinical and environmental strains of the Cryptococcus neoformans/Cryptococcus gattii species complex from Ivory Coast. J Med Microbiol 2017; 67:87-96. [PMID: 29214970 DOI: 10.1099/jmm.0.000654] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The aim of this study was to assess the biotope of the Cryptococcus neoformans/Cryptococcus gattii species complex from Ivory Coast, and clarify the possible epidemiological relationship between environmental and clinical strains. METHODOLOGY Samples from Eucalyptus camaldulensis (n=136), Mangifera indica (n=13) and pigeon droppings (n=518) were collected from different sites close to the living environment of Ivorian HIV patients with cryptococcosis (n=10, 50 clinical strains). Clinical and environmental strains were characterized by molecular serotyping and genotyping [RFLP analysis of the URA5 gene, (GACA)4, (GTG)5 and M13 PCR fingerprinting] and compared.Results/Key findings. Environmental strains were recovered only from the pigeon droppings. In vitro susceptibility profiles showed that all strains were susceptible to fluconazole, flucytosine and amphotericin B. All environmental strains consisted of C. neoformans (A, AFLP1/VNI), whereas clinical strains included C. neoformans (A, AFLP1/VNI), C. neoformans x Cryptococcus deneoformans hybrids (AD, AFLP3/VNIII) and Cryptococcus deuterogattii (B, AFLP6/VGII). Two patients were co-infected with both C. neoformans and C. neoformans x C. deneoformans hybrids. We noticed a low genetic diversity among the environmental samples compared to the high diversity of the clinical samples. Some clinical strains were genetically more similar to environmental strains than to other clinical strains, including those from the same patient. CONCLUSION These results provide new information on the ecology and epidemiology of the C. neoformans/C. gattii species complex in Ivory Coast.
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Affiliation(s)
- Fulgence K Kassi
- Laboratoire de Parasitologie et de Mycologie - CeDReS (Centre de Diagnostic et de Recherche sur le SIDA et les Autres Maladies Infectieuses), UFR Pharmacie, CHU de Treichville, Université Félix Houphouët Boigny, Abidjan, Ivory Coast
| | - Virginie Bellet
- UMI 233 IRD-UM INSERM U1175 TransVIHMI, Groupe Infections Fongique et Parasitaire Laboratoire de Parasitologie et de Mycologie Médicale, UFR Pharmacie, Montpellier Cedex 5, France
| | - Pascal Drakulovski
- UMI 233 IRD-UM INSERM U1175 TransVIHMI, Groupe Infections Fongique et Parasitaire Laboratoire de Parasitologie et de Mycologie Médicale, UFR Pharmacie, Montpellier Cedex 5, France
| | - Donika Krasteva
- UMI 233 IRD-UM INSERM U1175 TransVIHMI, Groupe Infections Fongique et Parasitaire Laboratoire de Parasitologie et de Mycologie Médicale, UFR Pharmacie, Montpellier Cedex 5, France
| | - Frédéric Roger
- UMI 233 IRD-UM INSERM U1175 TransVIHMI, Groupe Infections Fongique et Parasitaire Laboratoire de Parasitologie et de Mycologie Médicale, UFR Pharmacie, Montpellier Cedex 5, France
| | - Bedia-Tanoh A Valérie
- Laboratoire de Parasitologie et de Mycologie - CeDReS (Centre de Diagnostic et de Recherche sur le SIDA et les Autres Maladies Infectieuses), UFR Pharmacie, CHU de Treichville, Université Félix Houphouët Boigny, Abidjan, Ivory Coast
| | - Touré Aboubakar
- Laboratoire de Parasitologie et de Mycologie - CeDReS (Centre de Diagnostic et de Recherche sur le SIDA et les Autres Maladies Infectieuses), UFR Pharmacie, CHU de Treichville, Université Félix Houphouët Boigny, Abidjan, Ivory Coast
| | - Adama Doumbia
- Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Ivory Coast
| | - Gisèle A Kouakou
- Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Ivory Coast
| | - Eric Delaporte
- UMI 233 Service des Maladies Infectieuses et Tropicales, CHU Gui de Chauliac, Montpellier, France
| | - Jacques Reynes
- UMI 233 Service des Maladies Infectieuses et Tropicales, CHU Gui de Chauliac, Montpellier, France
| | - William Yavo
- Laboratoire de Parasitologie et de Mycologie - CeDReS (Centre de Diagnostic et de Recherche sur le SIDA et les Autres Maladies Infectieuses), UFR Pharmacie, CHU de Treichville, Université Félix Houphouët Boigny, Abidjan, Ivory Coast
| | - Hervé I E Menan
- Laboratoire de Parasitologie et de Mycologie - CeDReS (Centre de Diagnostic et de Recherche sur le SIDA et les Autres Maladies Infectieuses), UFR Pharmacie, CHU de Treichville, Université Félix Houphouët Boigny, Abidjan, Ivory Coast
| | - Sebastien Bertout
- UMI 233 IRD-UM INSERM U1175 TransVIHMI, Groupe Infections Fongique et Parasitaire Laboratoire de Parasitologie et de Mycologie Médicale, UFR Pharmacie, Montpellier Cedex 5, France
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17
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Chadli S, Aghrouch M, Taqarort N, Malmoussi M, Ouagari Z, Moustaoui F, Bourouache M, Oulkheir S. [Neuromeningeal cryptococcosis in patients infected with HIV at Agadir regional hospital, (Souss-Massa, Morocco)]. J Mycol Med 2017; 28:161-166. [PMID: 29132792 DOI: 10.1016/j.mycmed.2017.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 10/18/2017] [Accepted: 10/22/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Neuromeningeal cryptococcosis (NMC) is a severe and fatal opportunistic infection. Lethality is frequent in the absence of treatment, especially in the presence of HIV co-infection. OBJECTIVE To determine the prevalence, epidemiological, clinical, biological and therapeutic aspects as well as the evolution of NMC for patients infected with HIV. PATIENTS AND METHODS This is a retrospective study of 40 cases of neuromeningeal cryptococcosis diagnosed in HIV-infected patients. Data are collected for 7 years (from January 2010 to December 2016) in the registers of the parasitology laboratory and the infectious diseases department at the regional hospital center in Agadir. RESULTS A reduction in the prevalence of neuromeningeal cryptococcosis in HIV-infected patients was noted from 2010 to 2016 (3.66% to 0.83%). The overall prevalence of NMC was 1.53%. The mean age was 37±10 years old, with 90% of patients aged less than 45 years. The main clinical symptomatology was headache (75%). The main cytochemical abnormalities of cerebrospinal fluid analysis were hyperproteinorachy (60%), hypoglycorachy (63%) and lymphocytosis (50%). The mean CD4 cell count was 47/mm3. Patients were initially treated with amphotericin B, relayed with fluconazole. The overall lethality was 35%. CONCLUSION Neuromeningeal cryptococcosis is a serious opportunistic infection in patients HIV-infected, and the lethality rate remains unacceptable. Fighting NMC in HIV+ patients requires early diagnosis, increased access to antiretrovirals, rapid introduction of appropriate treatment and the prescription of effective systemic antifungals.
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Affiliation(s)
- S Chadli
- Institut supérieur des professions infirmières et techniques de santé (ISPITS), Agadir, Maroc.
| | - M Aghrouch
- Laboratoire des analyses médicales, centre hospitalier régional Hassan II, Agadir, Maroc
| | - N Taqarort
- Faculté polydisciplinaire de Taroudant, université Ibn Zohr, Agadir, Maroc
| | - M Malmoussi
- Service des maladies infectieuses, centre hospitalier régional Hassan II, Agadir, Maroc
| | - Z Ouagari
- Service des maladies infectieuses, centre hospitalier régional Hassan II, Agadir, Maroc
| | - F Moustaoui
- Laboratoire des analyses médicales, centre hospitalier régional Hassan II, Agadir, Maroc
| | - M Bourouache
- Faculté des sciences, université Ibn Zohr, Agadir, Maroc
| | - S Oulkheir
- Institut supérieur des professions infirmières et techniques de santé (ISPITS), Agadir, Maroc
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18
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Burchard GD, Grobusch MP. Central Africa. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
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19
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Tchuente Tchuenmogne MA, Kammalac TN, Gohlke S, Kouipou RMT, Aslan A, Kuzu M, Comakli V, Demirdag R, Ngouela SA, Tsamo E, Sewald N, Lenta BN, Boyom FF. Compounds from Terminalia mantaly L. (Combretaceae) Stem Bark Exhibit Potent Inhibition against Some Pathogenic Yeasts and Enzymes of Metabolic Significance. MEDICINES (BASEL, SWITZERLAND) 2017; 4:E6. [PMID: 28930221 PMCID: PMC5597071 DOI: 10.3390/medicines4010006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/23/2016] [Accepted: 01/12/2017] [Indexed: 12/30/2022]
Abstract
Background: Pathogenic yeasts resistance to current drugs emphasizes the need for new, safe, and cost-effective drugs. Also, new inhibitors are needed to control the effects of enzymes that are implicated in metabolic dysfunctions such as cancer, obesity, and epilepsy. Methods: The anti-yeast extract from Terminalia mantaly (Combretaceae) was fractionated and the structures of the isolated compounds established by means of spectroscopic analysis and comparison with literature data. Activity was assessed against Candida albicans, C. parapsilosis and C. krusei using the microdilution method, and against four enzymes of metabolic significance: glucose-6-phosphate dehydrogenase, human erythrocyte carbonic anhydrase I and II, and glutathione S-transferase. Results: Seven compounds, 3,3'-di-O-methylellagic acid 4'-O-α-rhamnopyranoside; 3-O-methylellagic acid; arjungenin or 2,3,19,23-tetrahydroxyolean-12-en-28-oïc acid; arjunglucoside or 2,3,19,23-tetrahydroxyolean-12-en-28-oïc acid glucopyranoside; 2α,3α,24-trihydroxyolean-11,13(18)-dien-28-oïc acid; stigmasterol; and stigmasterol 3-O-β-d-glucopyranoside were isolated from the extract. Among those, 3,3'-di-O-methylellagic acid 4'-O-α-rhamnopyranoside, 3-O-methylellagic acid, and arjunglucoside showed anti-yeast activity comparable to that of reference fluconazole with minimal inhibitory concentrations (MIC) below 32 µg/mL. Besides, Arjunglucoside potently inhibited the tested enzymes with 50% inhibitory concentrations (IC50) below 4 µM and inhibitory constant (Ki) <3 µM. Conclusions: The results achieved indicate that further SAR studies will likely identify potent hit derivatives that should subsequently enter the drug development pipeline.
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Affiliation(s)
- Marthe Aimée Tchuente Tchuenmogne
- Laboratory of Natural Products and Organic Synthesis, Department of Organic Chemistry, Faculty of Science, University of Yaoundé 1, P.O. Box 812, Yaoundé, Cameroon.
| | - Thierry Ngouana Kammalac
- Antimicrobial & Biocontrol Agents Unit, Laboratory for Phytobiochemistry and Medicinal Plants Studies, Department of Biochemistry, Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon.
| | - Sebastian Gohlke
- Chemistry Department, Organic and Bioorganic Chemistry, Bielefeld University, P.O. Box 100131, D-33501 Bielefeld, Germany.
| | - Rufin Marie Toghueo Kouipou
- Antimicrobial & Biocontrol Agents Unit, Laboratory for Phytobiochemistry and Medicinal Plants Studies, Department of Biochemistry, Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon.
| | - Abdulselam Aslan
- Faculty of Engineering, Department of Industrial Engineering, Giresun University, 28200 Giresun, Turkey.
| | - Muslum Kuzu
- Faculty of Pharmacy, Department of Basic Pharmaceutical Sciences, Agrı Ibrahim Cecen University, 04100 Agri, Turkey.
| | - Veysel Comakli
- School of Health, Department of Nutrition and Dietetics, Agrı Ibrahim Cecen University, 04100 Agri, Turkey.
| | - Ramazan Demirdag
- School of Health, Department of Nutrition and Dietetics, Agrı Ibrahim Cecen University, 04100 Agri, Turkey.
| | - Silvère Augustin Ngouela
- Laboratory of Natural Products and Organic Synthesis, Department of Organic Chemistry, Faculty of Science, University of Yaoundé 1, P.O. Box 812, Yaoundé, Cameroon.
| | - Etienne Tsamo
- Laboratory of Natural Products and Organic Synthesis, Department of Organic Chemistry, Faculty of Science, University of Yaoundé 1, P.O. Box 812, Yaoundé, Cameroon.
| | - Norbert Sewald
- Chemistry Department, Organic and Bioorganic Chemistry, Bielefeld University, P.O. Box 100131, D-33501 Bielefeld, Germany.
| | - Bruno Ndjakou Lenta
- Department of Chemistry, Higher Teacher Training College, University of Yaoundé 1, Yaoundé, Cameroon.
| | - Fabrice Fekam Boyom
- Antimicrobial & Biocontrol Agents Unit, Laboratory for Phytobiochemistry and Medicinal Plants Studies, Department of Biochemistry, Faculty of Science, University of Yaoundé I, P.O. Box 812, Yaoundé, Cameroon.
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20
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Kassi FK, Drakulovski P, Bellet V, Krasteva D, Gatchitch F, Doumbia A, Kouakou GA, Delaporte E, Reynes J, Mallié M, Menan HIE, Bertout S. Molecular epidemiology reveals genetic diversity among 363 isolates of theCryptococcus neoformansandCryptococcus gattiispecies complex in 61 Ivorian HIV-positive patients. Mycoses 2016; 59:811-817. [DOI: 10.1111/myc.12539] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/21/2016] [Accepted: 07/03/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Fulgence K. Kassi
- Laboratoire de Parasitologie et de Mycologie - CeDReS (Centre de Diagnostic et de Recherche sur le SIDA et les autres maladies infectieuses); UFR Pharmacie; CHU de Treichville; Université Félix Houphouët Boigny; Abidjan Côte d'Ivoire
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
| | - Pascal Drakulovski
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
| | - Virginie Bellet
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
| | - Donika Krasteva
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
| | - François Gatchitch
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
| | - Adama Doumbia
- Service des Maladies Infectieuses et Tropicales; CHU de Treichville; Abidjan Côte d'Ivoire
| | - Gisèle A. Kouakou
- Service des Maladies Infectieuses et Tropicales; CHU de Treichville; Abidjan Côte d'Ivoire
| | - Eric Delaporte
- UMI 233 Service des Maladies Infectieuses et Tropicales; CHU Gui de Chauliac; Montpellier France
| | - Jacques Reynes
- UMI 233 Service des Maladies Infectieuses et Tropicales; CHU Gui de Chauliac; Montpellier France
| | - Michèle Mallié
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
| | - Hervé I. E. Menan
- Laboratoire de Parasitologie et de Mycologie - CeDReS (Centre de Diagnostic et de Recherche sur le SIDA et les autres maladies infectieuses); UFR Pharmacie; CHU de Treichville; Université Félix Houphouët Boigny; Abidjan Côte d'Ivoire
| | - Sebastien Bertout
- UMI 233 IRD-UM INSERM U1175 Laboratoire de Parasitologie et de Mycologie, UFR Pharmacie; Montpellier Cedex 5 France
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