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Shi J, Chen J, Hu L, Song Q, Qian G. Clinical, radiological, and laboratory features of HIV-negative pulmonary cryptococcosis with regard to serum lateral flow assay. Front Med (Lausanne) 2024; 11:1234474. [PMID: 38818403 PMCID: PMC11138259 DOI: 10.3389/fmed.2024.1234474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Cryptococcosis is the second most common invasive yeast infection in China. Pulmonary cryptococcosis (PC) is difficult to diagnose due to the lack of specific clinical features and the limitation of diagnostic techniques. Although lateral flow assay was very useful in diagnosing cryptococcal infection, quite a few patients with PC presented negative serum lateral flow assay (sLFA). Methods We conducted a retrospective study of HIV-negative patients who were diagnosed with PC in our hospital over the past decade to explore the potential relationship between the clinical profiles and sLFA in PC. Results In total, 112 patients with sLFA tested were enrolled in this study, of which 58.93% were male. The positivity rate of sLFA for PC was 91.07%. The extent of pulmonary lesions was positively correlated with sLFA grade (Spearman r = 0.268, p < 0.01). Solitary nodule (SN) and pneumonia were the most common imaging findings in PC with negative and positive sLFA respectively. Among 65 symptomatic PC patients, 14 presented with fever and had higher hypersensitive C-reactive protein (hsCRP) level and more extensive pulmonary involvement (Mann-Whitney U test, p < 0.05) than those without fever. Symptomatic PC patients were more likely to have positive results of sLFA (Mann-Whitney U test, p = 0.05) compared against asymptomatic ones. Discussion In conclusion, negative sLFA cannot exclude PC in patients with a solitary nodule in lung. Positive sLFA is more reliable in diagnosing PC in symptomatic patients with diffused lesions in lung who generally experience a more severe systemic inflammatory reaction.
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Affiliation(s)
- Jiejun Shi
- Department of Infectious Diseases, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Jianhua Chen
- Department of Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Liqing Hu
- Department of Clinical Laboratory, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Qifa Song
- Medical Data Research Center, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Guoqing Qian
- Department of Infectious Diseases, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
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Allena N, Kolli M, Tale S, Soibam P, Layek A. Pulmonary Cryptococcosis Mimicking Lung Cancer: A Diagnostic Challenge. Cureus 2023; 15:e47597. [PMID: 38022362 PMCID: PMC10665769 DOI: 10.7759/cureus.47597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Pulmonary cryptococcosis, although rare, maybe seen in both immunocompromised and immunocompetent patients. Cryptococcosis presenting as a lung mass mimicking lung cancer is very rare. Here, we report our experience with pulmonary cryptococcosis presenting as a lung mass mimicking malignancy in an immunocompetent patient. In this case, the patient presented to us with left-sided pleural effusion and lung mass on computed tomography (CT) of the chest. Bronchoscopy and endobronchial ultrasound (EBUS)-guided fine needle aspiration cytology (FNAC) was performed, which showed cryptococcal organisms. He responded well to oral anti-fungal therapy without any need for surgical interventions.
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Affiliation(s)
- Nishant Allena
- Department of Internal Medicine, BronxCare Health System, New York, USA
| | - Mrudula Kolli
- Department of Internal Medicine, Gayatri Vidya Parishad Medical College, Visakhapatnam, IND
| | - Sudheer Tale
- Department of Internal Medicine, Maharajah's Institute of Medical Sciences, Visakhapatnam, IND
- Department of Pulmonary and Critical Care Medicine, Medicover Hospitals, Visakhapatnam, IND
| | - Pahel Soibam
- Department of Pulmonary and Critical Care Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, IND
| | - Avishek Layek
- Department of Chest Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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Correlation Between CD4 Cell Count, HIV Viral Load, and Chest CT Findings of AIDS-associated Pulmonary Cryptococcosis. IRANIAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.5812/iranjradiol-127182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: The computed tomography (CT) features of acquired immune deficiency syndrome (AIDS)-associated pulmonary cryptococcosis (PC) are correlated with the viral load of human immunodeficiency virus (HIV). An increase in CD4-positive T lymphocyte (CD4) cell count in peripheral blood after a highly active antiretroviral therapy (HAART) can reflect the morphological changes of lung lesions. Objectives: This study aimed to evaluate the correlation between CT features and HIV viral load and to determine a cut-off value for CD4 cell count increment to investigate the prognosis of PC. It also aimed to examine the morphology of PC lesions and their prognosis following HAART. Methods: Sixty-two patients with AIDS-associated PC, confirmed by pathology or follow-up, were enrolled in this study. The CT findings were recorded and classified as nodular, cavitary, and consolidation groups and their subtypes. Forty HIV patients who had undergone HAART were screened in this study, and the outcomes of lung lesions were recorded in a follow-up of 3 - 6 months. The participants were divided into improvement and progression groups. The correlation analysis and the receiver operator characteristic (ROC) curve analysis were used to examine the correlation between CT morphology and HIV viral load and to determine the cut-off value for CD4 cell count increment. The intraclass correlation coefficient (ICC) for inter-observer agreement was also calculated. Results: In the nodular group, patients with miliary nodules had the highest HIV viral load in peripheral blood (miliary nodules vs. solitary nodules, P = 0.009; miliary nodules vs. multiple nodules; P = 0.024). In the cavitary group, thick-walled cavity lesions had a higher HIV viral load than thin-walled cavity lesions (thin-walled vs. thick-walled cavity lesions, P = 0.036). Changes in the morphology of lesions, indicating the progression or improvement of PC, had a positive correlation with the CD4 cell count increment (F = 4.260, P = 0.045). The cut-off value for CD4 cell count increment to differentiate the two outcomes (progression and improvement) was 44/µL. The area under the curve (AUC) was 0.851, and sensitivity, specificity, and accuracy were estimated at 0.815, 0.714, and 0.764, respectively. Conclusion: In AIDS-associated PC, different types of lesions were related to the HIV viral load, and CD4 cell count increment following HAART was associated with the morphological changes of lesions. This finding can be helpful for clinicians and radiologists to make an accurate diagnosis and evaluate the treatment outcomes, as well as disease progression.
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Li Z, Wang M, Zeng P, Chen Z, Zhan Y, Li S, Lin Y, Cheng J, Ye F. Examination of a Chinese-made cryptococcal glucuronoxylomannan antigen test in serum and bronchoalveolar lavage fluid for diagnosing pulmonary cryptococcosis in HIV-negative patients. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:307-313. [PMID: 34052144 DOI: 10.1016/j.jmii.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/21/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We presented the performance of a Chinese-made cryptococcal glucuronoxylomannan (GXM) antigen test using serum and bronchoalveolar lavage fluid (BALF) samples in the HIV-negative Chinese population. METHODS Between February 2017 and January 2019, HIV-negative patients with pulmonary cryptococcosis were recruited and followed-up every three months, including completion of a chest CT examination and collection of serum and BALF samples. RESULTS Here, thirty-seven confirmed and ten clinically diagnosed patients were recruited. Furthermore, samples from 174 noncryptococcosis patients that may cause false positives were also collected. The sensitivity of a lateral flow assay (LFA) for detecting cryptococcal GXM antigen in serum and BALF samples from confirmed cases was 97% and 95%, respectively, and the specificity was 98.2% and 93%, respectively, and the differences in these values between the BALF and serum samples were not significant. The serum cryptococcal GXM antigen value showed a positive correlation (r: 0.581, p < 0.001) with pulmonary lesion size, while the BALF value showed no correlation (r: 0.253, p: 0.13). The positivity rate of BALF was higher than that of serum when the diameter of the pulmonary lesion was small (diameter less than 20 mm). Moreover, the serum cryptococcal GXM antigen levels showed an overall decreasing trend with the decrease in pulmonary lesion size after antifungal therapy in patient follow-up. CONCLUSIONS The Chinese-made cryptococcal GXM antigen test has better sensitivity and specificity for diagnosing pulmonary cryptococcosis in the HIV-negative Chinese population, and it could be used to diagnose and to monitor this disease.
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Affiliation(s)
- Zhengtu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Mingdie Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Peiying Zeng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Zhaoming Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Yangqing Zhan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Shaoqiang Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Ye Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Jing Cheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
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Tashiro H, Haraguchi T, Takahashi K, Sadamatsu H, Tajiri R, Takamori A, Kimura S, Sueoka-Aragane N. Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis. BMC Pulm Med 2020; 20:116. [PMID: 32349734 PMCID: PMC7191728 DOI: 10.1186/s12890-020-1149-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/14/2020] [Indexed: 02/08/2023] Open
Abstract
Background Pulmonary cryptococcosis is an uncommon infectious disease that can develop in both immunocompromised and immunocompetent patients. The severity of chronic kidney disease (CKD) was reported to be one of the risk factors for pulmonary cryptococcosis, but its clinical characteristics have not been fully assessed. The purpose of this study was to clarify the clinical characteristics of advanced CKD in patients with pulmonary cryptococcosis. Methods The present study retrospectively investigated 56 patients who had non-human immunodeficiency virus (HIV) pulmonary cryptococcosis and were treated at Saga University Hospital between 2005 and 2018. The clinical characteristics were evaluated and compared between patients with estimated glomerular filtration rate (eGFR) > 45 mL/min/1.73 m2 (n = 42, early CKD) and those with eGFR < 45 mL/min/1.73 m2 (n = 14, advanced CKD. Results Compared with patients with early CKD, those with advanced CKD had significantly higher rate of disseminated cryptococcosis (21.4% vs. 2.4%, p = 0.03); lower percentage of patients who recovered after treatment (63.6% vs. 92.5%, p = 0.02); and more frequent clinical features of fever (57.1% vs. 19.0%, p < 0.01), pleural effusion (21.4% vs. 2.4%, p = 0.03), high white blood cell count (8550/mL vs. 6150/mL, p = 0.01) and C-reactive protein (CRP) (2.1 mg/dL vs. 0.2 mg/dL, p = 0.02), and low level of serum albumin (3.0 g/dL vs. 3.8 g/dL, p < 0.01). Multivariate analysis adjusted by immunosuppressive drug use indicated the significant factors of fever (odds ratio or β value [95% confidence interval] 6.4 [1.65–20.09], p < 0.01), high white blood cell count (1293.2 [110.2–2476.2], p = 0.03), C-reactive protein (0.89 [0.18–1.59], p = 0.01) and low level of serum albumin (− 0.34 [− 0.54 – − 0.14], p < 0.01) in patients with eGFR < 45 mL/min/1.73m2. Conclusion Advanced CKD was associated with poor clinical characteristics and outcomes in patients with non-HIV pulmonary cryptococcosis. Trial registration The patients in this study were registered retrospectively.
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Affiliation(s)
- Hiroki Tashiro
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan.
| | - Tetsuro Haraguchi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
| | - Hironori Sadamatsu
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
| | - Ryo Tajiri
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Ayako Takamori
- Clinical Research Center, Saga University Hospital, Saga, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture, 849-8501, Japan
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6
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An Unusual Cause of Recurrent Pleural Effusion. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Zhu T, Luo WT, Chen GH, Tu YS, Tang S, Deng HJ, Xu W, Zhang W, Qi D, Wang DX, Li CY, Li H, Wu YQ, Li SJ. Extent of Lung Involvement and Serum Cryptococcal Antigen Test in Non-Human Immunodeficiency Virus Adult Patients with Pulmonary Cryptococcosis. Chin Med J (Engl) 2018; 131:2210-2215. [PMID: 30203796 PMCID: PMC6144838 DOI: 10.4103/0366-6999.240815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Serum cryptococcal antigen (CrAg) test is the most used noninvasive method to detect cryptococcal infection. However, false-negative CrAg test is not uncommon in clinical practice. Then, the aim of this study was to investigate the factors associated with false-negative CrAg test among non-human immunodeficiency virus (HIV) adult patients with pulmonary cryptococcosis and its clinical features. Methods: One hundred and fourteen non-HIV adult patients with pulmonary cryptococcosis, proven by biopsy, were retrospectively reviewed. Finally, 85 patients were enrolled; 56 were CrAg positive (CrAg+ group) and 29 were negative (CrAg− group). It was a cross-sectional study. Then, baseline characteristics, underlying diseases, clinical symptoms, laboratory findings, and chest radiological findings were reviewed and analyzed. Chi-square test was used to analyze categorical variable. Odds ratio (OR) was used to measure correlation. Student's t-test was obtained to analyze continuous variable. Results: No difference in baseline characteristics, underlying diseases, clinical symptoms, and laboratory findings were found between two groups (P > 0.05 in all). Nevertheless, diffuse extent lesion was 82.1% in CrAg+ group and 10.3% in CrAg− group (χ2= 40.34, P < 0.001; OR = 39.87). Conclusions: Among patients with limited pulmonary involvement, a negative serum CrAg does not preclude the diagnosis of pulmonary cryptococcosis. However, among patients with extensive pulmonary involvement, serum CrAg is a useful diagnostic tool for pulmonary cryptococcosis. Furthermore, we also noticed that the untypical and mild presentations with extensive pulmonary lesion might be the features of pulmonary cryptococcosis, which needs further investigation.
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Affiliation(s)
- Tao Zhu
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Wan-Ting Luo
- Southern Medical University, Guangzhou, Guangdong 510280, China
| | - Gui-Hua Chen
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Yue-Sheng Tu
- Southern Medical University, Guangzhou, Guangdong 510280, China
| | - Shuo Tang
- Department of Orthopedic Medicine, Shenzhen Nanshan Hospital, Shenzhen, Guangdong 518052, China
| | - Huo-Jin Deng
- Department of Respiratory Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510280, China
| | - Wei Xu
- Southern Medical University, Guangzhou, Guangdong 510280, China
| | - Wei Zhang
- Department of Respiratory Medicine, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610500, China
| | - Di Qi
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Dao-Xin Wang
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Chang-Yi Li
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - He Li
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Yan-Qiao Wu
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Shen-Jin Li
- Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
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Kashef Hamadani BH, Franco-Paredes C, McCollister B, Shapiro L, Beckham JD, Henao-Martínez AF. Cryptococcosis and cryptococcal meningitis: New predictors and clinical outcomes at a United States academic medical centre. Mycoses 2018; 61:314-320. [PMID: 29284182 DOI: 10.1111/myc.12742] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 12/19/2022]
Abstract
As the diagnosis of cryptococcosis is challenging in low-prevalence settings, uncovering predictive factors can improve early diagnosis and timely treatment. The aim of the study was to relate clinical outcomes to predictive variables for the presence of cryptococcosis. A retrospective case-control study matched by collection date, age and gender at a 1:2 ratio (55 cases and 112 controls) was performed in case patients diagnosed with Cryptococcus infection at the University of Colorado Hospital between 2000 and 2017 (n = 167). A bivariate and a forward, stepwise multivariable logistic regression model were performed to identify predictors of cryptococcosis infection. In an adjusted multivariable model, cryptococcal infection was significantly associated with the presence of respiratory symptoms, hyponatremia, lung disease or corticosteroids. Additionally, cryptococcal meningitis was associated with headaches, corticosteroids or increased CSF protein. Conversely, a reduced risk of cryptococcosis was associated with hypertension or peripheral monocytosis. Cryptococcal meningitis leads to subsequent hearing impairment (16% vs 4% (control), P = .013), muscle weakness (40% vs 20%, P = .021), cognitive deficits (33% vs 6%, P = .0001) or any adverse outcome (84% vs 29%, P = .0001). We uncovered novel clinical predictors for the presence of cryptococcal infection or cryptococcal meningitis. This study in patients at a low-prevalence US medical centre underscores the importance of early diagnosis in this population.
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Affiliation(s)
| | - Carlos Franco-Paredes
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA.,Hospital Infantil de México, Federico Gómez, México City, México
| | - Bruce McCollister
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA
| | - Leland Shapiro
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA.,Division of Infectious Diseases, Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - J David Beckham
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA.,Division of Infectious Diseases, Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - Andrés F Henao-Martínez
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA
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Lu J, Palavecino EL, Salih ZT. Pulmonary cryptococcosis diagnosed on a lung fine-needle aspiration. Diagn Cytopathol 2017; 46:160-161. [PMID: 29063707 DOI: 10.1002/dc.23842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/28/2017] [Accepted: 10/04/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Jing Lu
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Elizabeth L Palavecino
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Ziyan T Salih
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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10
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Isolated Cryptococcal neoformans Pleuritis in a Lung Cancer Patient: Case Report and Review of the Literature. CURRENT TROPICAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40475-016-0093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Liu X, Jia W, Huang S, Sun G. A case of pulmonary cryptococcosis with large pericardial effusion diagnosed using cervical lymph node biopsy. CLINICAL RESPIRATORY JOURNAL 2016; 12:820-823. [PMID: 27873481 DOI: 10.1111/crj.12581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/21/2016] [Accepted: 11/01/2016] [Indexed: 12/21/2022]
Abstract
Pulmonary cryptococcosis (PC) is a relatively rare infectious disease. It mainly involves the lungs; however, in some patients, the infection could spread to other parts of the body. PC mostly occurs in patients with immune deficiencies. However, PC infections have been reported in non-immunocompromised patients. The diagnosis of PC is challenging in patients without immune deficiencies. Here, the case of a 27-year-old immunocompetent woman who was diagnosed with PC was report. She had unexplained fever and a history of close contact with poultry feathers. Lesions were observed in the lungs, pleural cavity, pericardium, and cervical lymph nodes. Biopsy of the cervical lymph nodes helped in the pathological diagnosis of PC. She was treated with fluconazole, and the lesions disappeared. They present this case to encourage detailed inquiry of medical history in such patients, improve the diagnostic awareness of clinicians, and help reduce the likelihood of misdiagnosis.
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Affiliation(s)
- Xuchun Liu
- Department of Respiratory Medicine, Chizhou Clinical College of Anhui Medical University, Chizhou People's Hospital, Chizhou, Anhui, 247100, China
| | - Wei Jia
- Department of Respiratory Medicine, Shanghai Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, 200082, China
| | - Shubin Huang
- Department of Pathology, Chizhou Clinical College of Anhui Medical University, Chizhou People's Hospital, Chizhou, Anhui, 247100, China
| | - Gengyun Sun
- Department of Respiratory Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China
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12
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Equine Pulmonary Cryptococcosis: A Comparative Literature Review and Evaluation of Fluconazole Monotherapy. Mycopathologia 2016; 182:413-423. [PMID: 27655152 DOI: 10.1007/s11046-016-0065-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/05/2016] [Indexed: 12/18/2022]
Abstract
Cryptococcus is the most common fungal respiratory pathogen in Australian horses, manifesting primarily as pulmonary granulomas. Disease severity at presentation is dependent on the athletic use of the horse. The diagnosis and estimation of disease severity are centred around clinical findings, cytological evaluation of respiratory tract secretions, diagnostic imaging, and antigen titre testing. Both the lateral flow assay and the latex cryptococcal antigen titre are used, and important similarities and differences between species are discussed. Cryptococcus gattii occurs with greater frequency than Cryptococcus neoformans in equine pulmonic cryptococcosis and can be successfully treated with enteral fluconazole monotherapy, with disease severity determining treatment length.
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13
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Henao-Martínez AF, Gross L, Mcnair B, McCollister B, DeSanto K, Montoya JG, Shapiro L, Beckham JD. Risk Factors for Cryptococcal Meningitis: A Single United States Center Experience. Mycopathologia 2016; 181:807-814. [PMID: 27502502 DOI: 10.1007/s11046-016-0048-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/01/2016] [Indexed: 02/04/2023]
Abstract
Cryptococcal meningitis carries a high mortality. Further understanding of immune suppression factors associated with neuroinvasive infection will improve risk stratification and enhance early diagnosis and treatment with antifungal therapy. The aim of the study was to corroborate established or find novel clinical predictors for cryptococcal meningitis. We performed a matched case-control study of Cryptococcus infection in immunocompromised patients with or without cryptococcal meningitis. Data of all patients with a diagnosis of cryptococcal disease were collected at University of Colorado Hospital between 2000 and 2015 (n = 51). Thirty patients were diagnosed with cryptococcal meningitis. We built a logistic regression model for risk factors associated with cryptococcal meningitis. The single-predictor univariate model found that a positive blood culture, positive serum cryptococcal antigen, current malignancy, and headaches were significantly associated with cryptococcal meningitis (p = 0.02). In the adjusted multivariate model, central nervous system disease was significantly associated with a diagnosis of HIV infection (OR 24.45, 95 % CI 1.62-350.37; p = 0.022) and a positive serum cryptococcal antigen test (OR 42.92, 95 % CI 3.26-555.55; p = 0.0055). In patients with HIV infection or a positive serum cryptococcal antigen, the pretest probability of neuroinvasive Cryptococcus infection is increased and an aggressive diagnostic evaluation should be conducted to exclude infection and consider empiric therapy.
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Affiliation(s)
- Andrés F Henao-Martínez
- Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA.
| | - Lilyana Gross
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Bryan Mcnair
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Bruce McCollister
- Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
| | - Kristen DeSanto
- Health Sciences Library, University of Colorado Denver, Aurora, Colorado, USA
| | - Jose G Montoya
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical Center, Stanford, Palo Alto, CA, USA
| | - Leland Shapiro
- Division of Infectious Diseases, Department of Medicine, Denver Veterans Affairs Medical Center, 1055 Clermont Street, Box 111L, Denver, CO, 80220, USA
| | - J David Beckham
- Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
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15
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Sung JH, Kim DH, Oh MJ, Lee KJ, Bae YA, Kwon KW, Lee SM, Kang HJ, Choi J. A Case of Pulmonary Cryptococcosis in an Immunocompetent Male Patient Diagnosed by a Percutaneous Supraclavicular Lymph Node Biopsy. Tuberc Respir Dis (Seoul) 2015; 78:276-80. [PMID: 26175785 PMCID: PMC4499599 DOI: 10.4046/trd.2015.78.3.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 11/24/2022] Open
Abstract
Cryptococcal pneumonia usually occurs in immunocompromised patients with malignancy, acquired immune deficiency syndrome, organ transplantations, immunosuppressive chemotherapies, catheter insertion, or dialysis. It can be diagnosed by gaining tissues in lung parenchyma or detecting antigen in blood or bronchoalveolar lavage fluid. Here we report an immunocompetent 32-year-old male patient with diabetes mellitus diagnosed with cryptococcal pneumonia after a ultrasound-guided percutaneous supraclavicular lymph node core needle biopsy. We treated him with fluconazole at 400 mg/day for 9 months according to the guideline. This is the first case that cryptococcal pneumonia was diagnosed from a percutaneous lymph node biopsy in South Korea.
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Affiliation(s)
- Ji Hee Sung
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Do Hoon Kim
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Mi-Jung Oh
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Kyoung Ju Lee
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Young A Bae
- Department of Radiology, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Kye Won Kwon
- Department of Pathology, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Seung Min Lee
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Ho Joon Kang
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Jinyoung Choi
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
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Sun L, Chen H, Shao C, Song Y, Bai C. Pulmonary cryptococcosis with trachea wall invasion in an immunocompetent patient: a case report and literature review. ACTA ACUST UNITED AC 2014; 87:324-8. [PMID: 24525662 DOI: 10.1159/000357715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 11/28/2013] [Indexed: 11/19/2022]
Abstract
Cryptococcosis causes significant morbidity and mortality in the world. Pulmonary cryptococcosis is a kind of subacute or chronic pulmonary fungal disease. We present a case of pulmonary cryptococcosis with a trachea wall invasion-like malignant tumor in an immunocompetent patient and a literature review. The 44-year-old man, a nonsmoker, suffered from mild dyspnea and white sputum with intermittent blood streaks. A computed tomography (CT) scan of his chest showed two possibly malignant lesions in the right hilum and upper-right field of his lung, which have higher uptake values of fluorodeoxyglucose on positron emission tomography (PET)/CT. Lung biopsy pathology showed scattered fungal spores and positive periodic acid-Schiff (PAS) staining. The immune status and blood tumor markers were all normal in this patient. The titer of Cryptococcus antigen latex agglutination test was 1:1,280. Under fiberoptic bronchoscopy, a prominent new mass on the right wall of the trachea blocked most of the right main bronchus. To reduce the symptoms of airway obstruction, treatment by bronchoscopy, i.e. ablation and endotracheal stent, was used. As his symptoms were aggravated by the use of itraconazole, amphotericin B liposome was used as antifungal treatment. All these methods led to a better prognosis. We conclude that pulmonary cryptococcosis may mimic lung neoplasms radiologically and bronchoscopically, even in immunocompetent patients.
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Affiliation(s)
- Li Sun
- Department of Pulmonary Medicine, Shanghai Institute of Respiratory Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
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Cavitary Lung Lesion in a Patient With AIDS. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e318276909d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pulmonary cryptococcosis in non-AIDS patients. Braz J Infect Dis 2012; 16:531-9. [PMID: 23154046 DOI: 10.1016/j.bjid.2012.07.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 07/19/2012] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the clinical features, management, and prognosis of pulmonary cryptococcosis in non-acquired immunodeficiency syndrome (AIDS) patients. METHOD 24 cases of pulmonary cryptococcosis with accurate pathological diagnosis were retrospectively studied. RESULTS 15 male patients and nine female patients were diagnosed at the first affiliated hospital of Sun Yat-sen University from November 1999 to November 2011. The mean age at the time of diagnosis was 44.2±11.3 years (range: 24 to 65 years). Among these patients, 13 had other comorbidities. 15 were symptomatic and the other nine were asymptomatic. The most common presenting symptoms were cough, chest tightness, expectoration, and fever. None had concurrent cryptococcal meningitis. The most frequent radiologic abnormalities on chest computed tomography (CT) scans were solitary or multiple pulmonary nodules, and masses or consolidations, and most lesions were located in the lower lobes. All patients had biopsies for the accurate diagnosis. Among the 24 patients, nine patients underwent surgical resections (eight had pneumonectomy via thoracotomy and one had a pneumonectomy via thoracoscopy). Five of the patients who underwent surgery also received antifungal drug therapy (fluconazole) for one to three months after the surgery. The other 15 only received antifungal drug therapy (fluconazole or voriconazole) for three to six months (five patients are still on therapy). The follow-up observation of 19 patients who had already finished their treatments lasted from two to 11 years, and there was no relapse, dissemination, or death in any of these patients. CONCLUSION Non-AIDS patients with pulmonary cryptococcosis have a good prognosis with appropriate management.
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Kim YS, Lee IH, Kim HS, Jin SS, Lee JH, Kim SK, Song SH, Yoo J, Kim CH, Kwon SS. Pulmonary cryptococcosis mimicking primary lung cancer with multiple lung metastases. Tuberc Respir Dis (Seoul) 2012; 73:182-6. [PMID: 23166553 PMCID: PMC3492405 DOI: 10.4046/trd.2012.73.3.182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 08/06/2012] [Accepted: 08/30/2012] [Indexed: 12/11/2022] Open
Abstract
Cryptococcosis is an invasive fungal infection, which is more common in immunocompromised patients. However, pulmonary cryptococcosis can occur in immunocompetent patients and should be considered on a differential diagnosis for nodular or mass-like lesions in chest radiograph. Recently, we experienced a patient with pulmonary cryptococcosis, successfully treated with oral fluconazole therapy. A 74-year-old female patient was referred for an evaluation of abnormal images, a large consolidative mass with multiple nodular consolidations and small nodules that mimics primary lung cancer with multiple lung to lung metastases. Computed tomography-guided lung biopsy confirmed the diagnosis of pulmonary cryptococcosis. The follow-up image taken after 4 months with oral fluconazole treatment showed marked improvement.
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Affiliation(s)
- Yu Seung Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Ruffin R, Bardin PG. Respirology year-in-review 2008: clinical science. Respirology 2009; 14:159-66. [PMID: 19192225 DOI: 10.1111/j.1440-1843.2008.01471.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Richard Ruffin
- Discipline of Medicine, University of Adelaide, Queen Elizabeth Hospital Campus, Adelaide, South Australia, Australia
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