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Wang LA, Chuang YC, Yeh TK, Lin KP, Lin CJ, Liu PY. Talaromyces amestolkiae Infection in an AIDS Patient with Cryptococcal Meningitis. J Fungi (Basel) 2023; 9:932. [PMID: 37755040 PMCID: PMC10532648 DOI: 10.3390/jof9090932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Concurrent infections caused by multiple fungal pathogens in immunocompromised patients can pose diagnostic and treatment challenges. Here, we presented the first reported case in Taiwan of an AIDS patient who had concurrent infection with Cryptococcus neoformans meningitis and Talaromyces amestolkiae lymphadenopathy. The patient presented with an enlarged inguinal lymph node and was diagnosed with T. amestolkiae lymphadenitis. The species T. amestolkiae was identified using DNA sequencing, which had the capability of differentiating it from other Talaromyces species. The patient was discharged from the hospital following treatment with amphotericin B and subsequent administration of voriconazole. This case highlights the importance of maintaining a suspicion of co-infections and utilizing appropriate diagnostic tools, such as DNA sequencing, to identify possible pathogens. Further studies are needed to determine the optimal treatment for T. amestolkiae and other co-infecting fungal pathogens.
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Affiliation(s)
- Li-An Wang
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yu-Chuan Chuang
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Ting-Kuang Yeh
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Genomic Center for Infectious Diseases, Taichung Veterans General Hospital, Taichung 40706, Taiwan
| | - Kuan-Pei Lin
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chi-Jan Lin
- Institute of Molecular Biology, National Chung Hsing University, Taichung 40227, Taiwan
| | - Po-Yu Liu
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
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2
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Peres Emidio EC, Singulani JDL, Freitas GJC, Costa MC, Gouveia-Eufrasio L, Carmo PHF, Pedroso SHSP, Brito CB, Bastos RW, Ribeiro NQ, Oliveira LVN, Silva MF, Paixão TA, Souza DDG, Santos DA. Staphylococcus aureus triggers a protective inflammatory response against secondary Cryptococcus gattii infection in a murine model. Microbes Infect 2023; 25:105122. [PMID: 36842669 DOI: 10.1016/j.micinf.2023.105122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/05/2023] [Accepted: 02/17/2023] [Indexed: 02/28/2023]
Abstract
Prior infections can provide protection or enhance susceptibility to a subsequent infection through microorganism's interaction or host immunomodulation. Staphylococcus aureus (SA) and Cryptococcus gattii (CG) cause lungs infection, but it is unclear how they interact in vivo. This study aimed to study the effects of the primary SA lung infection on secondary cryptococcosis caused by CG in a murine model. The mice's survival, fungal burden, behavior, immune cells, cytokines, and chemokines were quantified to evaluate murine cryptococcosis under the influence of a previous SA infection. Further, fungal-bacterial in vitro interaction was studied in a culture medium and a phagocytosis assay. The primary infection with SA protects animals from the subsequent CG infection by reducing lethality, improving behavior, and impairing the fungal proliferation within the host. This phenotype was associated with the proinflammatory antifungal host response elicited by the bacteria in the early stage of cryptococcosis. There was no direct inhibition of CG by SA, although the phagocytic activity of macrophages was reduced. Identifying mechanisms involved in this protection may lead to new approaches for preventing and treating cryptococcosis.
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Affiliation(s)
- Elúzia Castro Peres Emidio
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Junya de Lacorte Singulani
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gustavo José Cota Freitas
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marliete Carvalho Costa
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ludmila Gouveia-Eufrasio
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paulo Henrique Fonseca Carmo
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Camila Bernardo Brito
- Departamento de Microbiologia/Laboratório de Interação Microorganismo-Hospedeiro, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rafael Wesley Bastos
- Centro de Biociências, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Noelly Queiroz Ribeiro
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lorena Vívien Neves Oliveira
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Monique Ferreira Silva
- Departamento de Patologia/Laboratório de Patologia Celular e Molecular, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Tatiane Alves Paixão
- Departamento de Patologia/Laboratório de Patologia Celular e Molecular, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Daniele da Glória Souza
- Departamento de Microbiologia/Laboratório de Interação Microorganismo-Hospedeiro, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Daniel Assis Santos
- Departamento de Microbiologia/Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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3
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Ogai A, Yagi K, Ito F, Domoto H, Shiomi T, Chin K. Fatal Disseminated Tuberculosis and Concurrent Disseminated Cryptococcosis in a Ruxolitinib-treated Patient with Primary Myelofibrosis: A Case Report and Literature Review. Intern Med 2022; 61:1271-1278. [PMID: 34565769 PMCID: PMC9107979 DOI: 10.2169/internalmedicine.6436-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ruxolitinib, a Janus kinase inhibitor, improves symptoms in patients with myelofibrosis. However, its association with the development of opportunistic infections has been a concern. We herein report a 71-year-old man with primary myelofibrosis who developed disseminated tuberculosis and concurrent disseminated cryptococcosis during ruxolitinib treatment. We also reviewed the literature on disseminated tuberculosis and/or cryptococcosis associated with ruxolitinib treatment. This is the first case of disseminated tuberculosis and concurrent disseminated cryptococcosis during treatment with ruxolitinib. We therefore suggest considering not only disseminated tuberculosis but also cryptococcosis in the differential diagnosis of patients with abnormal pulmonary shadows during ruxolitinib treatment.
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Affiliation(s)
- Asuka Ogai
- Department of Hematology, Department of Medicine, Keiyu Hospital, Japan
| | - Kazuma Yagi
- Department of Pulmonary Medicine, Department of Medicine, Keiyu Hospital, Japan
| | - Fumimaro Ito
- Department of Pulmonary Medicine, Department of Medicine, Keiyu Hospital, Japan
| | | | - Tetsuya Shiomi
- Department of Pulmonary Medicine, Department of Medicine, Keiyu Hospital, Japan
| | - Kenko Chin
- Department of Hematology, Department of Medicine, Keiyu Hospital, Japan
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4
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Xue X, Deng H, Zhao L, Zang X, Asuquo IP, Meng M, Ma X, Qin C, Meng Y, Wu C, Gao J, Pan L. Cryptococcosis caused by cryptococcus gattii: 2 case reports and literature review. Medicine (Baltimore) 2020; 99:e23213. [PMID: 33327239 PMCID: PMC7738107 DOI: 10.1097/md.0000000000023213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/30/2020] [Accepted: 10/17/2020] [Indexed: 12/05/2022] Open
Abstract
Cryptococcosis caused by Cryptococcus gattii, is a life threatening fungal infection with recently increasing prevalence. C. gattii is a species complex comprising multiple independent species. However, many biological characteristics and clinical features of cryptococcosis due to C. gattii are relatively less well defined. In this paper, we identify two cases of C. gattii infection, and laboratory findings of genotype VGI and VGII in two groups of apparently immunocompetent Chinese individuals respectively. Upon detailed review of all 35 cases of C. gattii infections, it was observed that C. gattii can cause debilitating illness in both immunocompetent and immunocompromised individuals. Cryptococcosis due to C. gattii is a serious systemic fungal infection, with pulmonary central nervous system tropism. Epidemiologically, C. gattii infection is not only restricted in tropical and subtropical regions, but also in other geographical settings.
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Affiliation(s)
- Xinying Xue
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University
| | - Hui Deng
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University
| | - Longting Zhao
- Department of Infectious diseases, Rizhao Central Hospital, Rizhao, China
| | - Xuelei Zang
- Department of Microbiology, Chinese PLA General Hospital, Beijing
| | | | - Mingming Meng
- Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xidong Ma
- Department of Respiratory Disease, School of Clinical Medicine, Weifang Medical University, Weifang, Shandong
| | - Chong Qin
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University
| | - Yao Meng
- Department of Chest surgery, Beijing Shijitan Hospital, Capital Medical University
| | | | - Jie Gao
- Department of Pathology, General Hospital of PLA, Beijing
| | - Lei Pan
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University
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Pinheiro SB, Sousa ES, Cortez ACA, da Silva Rocha DF, Menescal LSF, Chagas VS, Gómez ASP, Cruz KS, Santos LO, Alves MJ, Matsuura ABJ, Wanke B, Trilles L, Frickmann H, de Souza JVB. Cryptococcal meningitis in non-HIV patients in the State of Amazonas, Northern Brazil. Braz J Microbiol 2020; 52:279-288. [PMID: 33025379 DOI: 10.1007/s42770-020-00383-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022] Open
Abstract
Cryptococcosis is a life-threatening fungal infection caused by the Cryptococcus neoformans/Cryptococcus gattii species complex. Most cases are recorded in patients suffering from HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome). However, this infection also occurs in non-HIV patients with a proportion of 10-30% of all cases. The study aimed at the clinical and molecular characterization of non-HIV patients diagnosed with cryptococcosis at the Tropical Medicine Foundation (FMT-HVD) from July 2016 to June 2019. Medical records of respective patients were analyzed to describe the course of cryptococcosis in non-HIV patients. In addition, multi-locus sequence typing (MLST) was applied to identify the sequence types of the isolated Cryptococcus strains, to perform phylogenetic analysis, and to evaluate the isolates' genetic relationship to global reference strains. Antifungal susceptibility profiles to amphotericin B, fluconazole, and itraconazole were assessed by broth microdilution. From a total of 7 patients, 4 were female, the age range varied between 10 and 53 years (median of 36.3 years). Cryptococcal meningitis was the common clinical manifestation (100%). The period between onset of symptoms and confirmed diagnosis ranged from 15 to 730 days (mean value of 172.9 days), and the observed mortality was 57.1%. Of note, comorbidities of the assessed cryptococcosis patients comprised hypertension, diabetes mellitus, and intestinal tuberculosis. Genotyping applying PCR-RFLP of the URA5 gene identified all clinical isolates as C. gattii genotype VGII. Using MLST, it was possible to discriminate the sequence types ST20 (n = 4), ST5 (n = 3), and the newly identified sequence type ST560 (n = 1). The antifungals amphotericin B, fluconazole, and itraconazole showed satisfactory inhibitory activity (microdilution test) against all C. gattii VGII strains.
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Affiliation(s)
- Silviane Bezerra Pinheiro
- Pós Graduação em Ciências Farmacêuticas, Universidade Federal do Amazonas, Manaus, Brazil.,Laboratório de Micologia, Instituto Nacional de Pesquisas da Amazônia, Manaus, Brazil
| | - Ednaira Sullany Sousa
- Pós Graduação em Ciências Farmacêuticas, Universidade Federal do Amazonas, Manaus, Brazil.,Laboratório de Micologia, Instituto Nacional de Pesquisas da Amazônia, Manaus, Brazil
| | | | | | | | | | | | - Kátia Santana Cruz
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado - AM, Manaus, Brazil
| | | | | | | | - Bodo Wanke
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz - RJ, Rio de Janeiro, Brazil
| | - Luciana Trilles
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz - RJ, Rio de Janeiro, Brazil
| | - Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, External site at the Bernhard Nocht Institute, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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6
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Opportunistic Cryptococcal Antigenemia in the HAART Era at HIV Epidemic Settings of Northwest Ethiopia. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2020; 2020:5017120. [PMID: 32963654 PMCID: PMC7492940 DOI: 10.1155/2020/5017120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/23/2020] [Accepted: 08/28/2020] [Indexed: 11/20/2022]
Abstract
Background Cryptococcus neoformans is a frequent opportunistic infection in patients with the acquired immunodeficiency syndrome. While the advent of ART reduces the occurrence of cryptococcal meningitis in HIV patients, cryptococcal disease remains a leading cause of morbidity and mortality in the developing world especially in sub-Saharan Africa which is the epicenter of HIV. This study aimed to assess the cryptococcal antigenemia, CD4+ Th cell counts, HIV RNA viral load, and clinical presentations among HIV-positive patients in Northwest Ethiopia. Method A total of two hundred (200) HIV-positive patients were recruited for this study. Cryptococcus antigenemia prevalence in plasma samples of HIV‐positive patients was determined by using Antigen lateral flow assay (CrAg‐LFA) also, and CD4+ Th cell counts and HIV‐RNA levels were quantified from blood specimen. Patients' demographic data, clinical manifestation, and concurrent opportunistic infection were recorded. Result The sex distributions of study participants were 105(52.5%) male and 94(47.5%) female with an age range of 15–65 (mean 39.42 ± 9) years. All patients had a CD4+ T-cell count <100 cells/µl with the median 54 cells/μl and median HIV-RNA viral load 2.16 × 105 RNA copies/ml (50–3.66 × 105 RNA copies/ml); the prevalence of cryptococcal antigenemia was found to be 4% in HIV-positive patients. More than half and two third of CrAg‐positive patients had a CD4 count <25 cells/μl and HIV viral load >10,000 copies/ml, respectively, as well; Tuberculosis, Candidiasis, and herpes zoster are the most often observed concurrent infections while cryptococcal antigenemia is significantly associated with oral candidiasis (p < 0.001). Conclusion Although the advent of ART, early diagnosis of cryptococcosis, and application of antifungal interventions, HIV-induced cryptococcal antigenemia positivity in HIV infected individuals is still the countries' big challenge. Thus, stringent follow-up and case management should be considered.
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Sawai T, Nakao T, Koga S, Ide S, Yoshioka S, Matsuo N, Mukae H. Miliary tuberculosis with co-existing pulmonary cryptococcosis in non-HIV patient without underlying diseases: a case report. BMC Pulm Med 2018; 18:6. [PMID: 29338706 PMCID: PMC5771133 DOI: 10.1186/s12890-018-0578-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 01/08/2018] [Indexed: 11/17/2022] Open
Abstract
Background Tuberculosis and cryptococcosis co-infection usually occurs in immunosuppressed patients with impaired cell-mediated immunity. However, there are few reports about such co-infection in non-HIV patients without underlying diseases. Here, we report a case of miliary tuberculosis with co-existing pulmonary cryptococcosis in non-HIV patient without underlying diseases. Case presentation An 84-year-old Asian female presented to our hospital with complaints of a 1-week history of abdominal pain and appetite loss. Chest computed tomography (CT) showed diffuse micronodules in random patterns in both lung fields. Liver, skin and bone marrow biopsies showed epithelioid cell granuloma. Polymerase chain reaction of gastric aspirate was positive for Mycobacterium tuberculosis. According to these findings, miliary tuberculosis was suspected and antimycobacterial therapy was initiated. After a 6-month treatment course, chest radiograph showed new multiple nodules in the right middle lung field. Chest CT showed that a right S6 small nodule was increased and new multiple nodules appeared in the right lower lobe. Flexible fiberoptic bronchoscopy was subsequently perfomed. Cytology of the bronchial lavage showed a small number of Periodic acid-Schiff-positive bodies, suggesting Cryptococcus species. Moreover, serum cryptococcal antigen testing was positive. According to these findings, pulmonary cryptococcosis was diagnosed, although the culture was negative. Oral fluconazole therapy was subsequently initiated. After a 6-month treatment course, chest radiograph showed gradual improvement. Conclusion Although tuberculosis and cryptococcosis co-infection is relatively rare in immunocompromised hosts, such as those with acquired immunodeficiency syndrome, clinicians should be aware that these infections can co-exist even in non-HIV patients without underlying diseases.
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Affiliation(s)
- Toyomitsu Sawai
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan.
| | - Takumi Nakao
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Satoru Koga
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Shotaro Ide
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Sumako Yoshioka
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Nobuko Matsuo
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555, Japan
| | - Hiroshi Mukae
- Second Department of Internal Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto-machi, Nagasaki, Japan
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Abstract
The review touches upon a problem of coinfection caused by several important fungal infections (aspergillus, candida, pneumocystis, cryptococcus) and infectious or parasitic diseases. The authors also investigate epidemiologic determinants of such clinical forms of pathologic process. There are a lot of scientific gaps in the studying coinfections concerning mycosis and other infections. Physicians and infection control practitioners sometimes reveal such cases therefore complex characteristics of the coinfections is required.
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Hatthakaroon C, Pharkjaksu S, Chongtrakool P, Suwannakarn K, Kiratisin P, Ngamskulrungroj P. Molecular epidemiology of cryptococcal genotype VNIc/ST5 in Siriraj Hospital, Thailand. PLoS One 2017; 12:e0173744. [PMID: 28323835 PMCID: PMC5360237 DOI: 10.1371/journal.pone.0173744] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/24/2017] [Indexed: 12/23/2022] Open
Abstract
Despite the strong association between Cryptococcus neoformans infection and the Human immunodeficiency virus (HIV) status of patients globally, most cryptococcosis cases in Far East Asia occur in non-HIV individuals. Molecular epidemiological studies, using multilocus sequence typing (MLST), have shown that more than 95% of cryptococcal strains belong to a specific subtype of VNI. However, this association has never been specifically examined in other parts of Asia. Therefore, in this study, we investigated the VNIc/ST5 genotype distribution among cryptococcosis patients in Thailand. Fifty-one C. neoformans isolates were collected from clinical samples in Siriraj Hospital, Bangkok, Thailand. The strains were predominantly isolated from HIV-positive patients (88.57%) and all were molecular type VNI MATα. An MLST analysis identified five sequence types (ST) in Siriraj Hospital, of which ST4 (45.10%) and ST6 (35.29%) were most common, and ST5 (15.69%), ST32 (1.96%), and ST93 (1.96) were less common. Contrary to reports from Far East Asia, ST5 was predominantly (83.33%) found in HIV patients (P = 0.657), and there was no significant change in the prevalence of ST5 over the past 10 years (P = 0.548). A further analysis of comorbidities showed higher morbidity and delays in the cryptococcal diagnosis in patients with tuberculosis coinfection or without HIV. Our study suggests that although the Thai population is genetically closely related to the Far East Asian population, ST5 is not associated with non-HIV status in Thailand. Therefore, this association may not be related to the host’s genetic background. However, its mechanism remains unclear.
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Affiliation(s)
- Chanin Hatthakaroon
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand
| | - Sujiraphong Pharkjaksu
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand
| | - Piriyaporn Chongtrakool
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand
| | - Kamol Suwannakarn
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand
| | - Pattarachai Kiratisin
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand
| | - Popchai Ngamskulrungroj
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand
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10
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Cryptococcosis and tuberculosis co-infection in mainland China. Emerg Microbes Infect 2016; 5:e98. [PMID: 27599473 PMCID: PMC5113057 DOI: 10.1038/emi.2016.95] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/02/2016] [Accepted: 07/05/2016] [Indexed: 11/17/2022]
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11
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Musabende M, Mukabatsinda C, Riviello ED, Ogbuagu O. Concurrent cryptococcal meningitis and disseminated tuberculosis occurring in an immunocompetent male. BMJ Case Rep 2016; 2016:bcr-2015-213380. [PMID: 26917794 DOI: 10.1136/bcr-2015-213380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 61-year-old man living in rural Rwanda presented with a 2-month history of fevers, headaches, dry cough, weight loss and confusion. A cerebrospinal fluid analysis revealed neutrophilic pleocytosis, yeast and a positive cryptococcal antigen (CrAg). An HIV antibody test was negative. The patient's cough worsened while on antifungal induction therapy with intravenous conventional amphotericin B and high-dose oral fluconazole. Computerised tomography (CT) scan of the chest showed extensive miliary infiltrates. Bronchoalveolar lavage revealed acid-fast bacilli on smear and a positive GeneXpert test without rifampicin resistance. The patient improved with the addition of antitubercular therapy. In this case report, we describe an unusual presentation of two opportunistic infections occurring together in an HIV-negative man with no other known immunocompromising conditions. The case highlights the fact that, in disease endemic areas, multiple disseminated infections can occur in individuals without obvious immunocompromise.
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Affiliation(s)
- Marcellin Musabende
- Department of Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | | | - Elisabeth D Riviello
- Department of Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Onyema Ogbuagu
- Department of Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
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12
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Chen XH, Gao YC, Zhang Y, Tang ZH, Yu YS, Zang GQ. TUBERCULOSIS INFECTION MIGHT INCREASE THE RISK OF INVASIVE CANDIDIASIS IN AN IMMUNOCOMPETENT PATIENT. Rev Inst Med Trop Sao Paulo 2016. [PMID: 26200971 PMCID: PMC4544255 DOI: 10.1590/s0036-46652015000300016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Deep Candida infections commonly occur in immunosuppressed patients.
A rare case of a multiple deep organ infection with Candida
albicansand spinal tuberculosis was reported in a healthy young man. The
19-year-old man complained of month-long fever and lower back pain. He also had a
history of scalded mouth syndrome. Coinfection with Mycobacterium
tuberculosis and Candida albicans was diagnosed using
the culture of aspirates from different regions. Symptoms improved considerably after
antifungal and antituberculous therapy. This case illustrates that infection with
tuberculosis might impair the host's immune system and increase the risk of invasive
candidiasis in an immunocompetent patient.
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Affiliation(s)
- Xiao-Hua Chen
- Department of Infectious Diseases, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yun-Chao Gao
- Department of Nuclear Medicine, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Zhang
- Department of Infectious Diseases, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng-Hao Tang
- Department of Infectious Diseases, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yong-Sheng Yu
- Department of Infectious Diseases, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Guo-Qing Zang
- Department of Infectious Diseases, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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13
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Nabaei G, Afhami S. Disseminated cryptococcosis and active pulmonary tuberculosis co-infection in an otherwise healthy adult. IRANIAN JOURNAL OF NEUROLOGY 2015; 14:174-6. [PMID: 26622985 PMCID: PMC4662693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Ghaemeh Nabaei
- Iranian Center of Neurological Research AND Department of Neurology, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran
| | - Shirin Afhami
- Department of Infectious Disease, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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14
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A Case of Disseminated Cryptococcal Infection and Concurrent Lung Tuberculosis in a Patient under Steroid Therapy for Interstitial Pneumonia. Case Rep Pulmonol 2015; 2015:358926. [PMID: 26124974 PMCID: PMC4466355 DOI: 10.1155/2015/358926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/25/2015] [Indexed: 01/15/2023] Open
Abstract
Both disseminated cryptococcal infection and tuberculosis occur in hosts with impaired cell-mediated immunity, but there have been few reports about the concurrent infections in patients without human immunodeficiency virus infection. A 64-year-old man, who had been taking corticosteroids for interstitial pneumonia, was diagnosed with disseminated cryptococcal infection. While the patient was receiving anticryptococcal therapy, pulmonary tuberculosis also emerged. The patient developed acute exacerbation of interstitial pneumonia and passed away. Based on the patient's clinical course, serial computed tomography images, and autopsy results, we believe that the preceding several months of corticosteroid treatment might have contributed to these coinfections in the lungs already vulnerable due to underlying fibrosis.
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Siroos B, Ahmadinejad Z, Tabaeizadeh M, Hedayat Yaghoobi M, Torabi A, Ghaffarpour M. Rare Association of Severe Cryptococcal and Tuberculosis in Central Nervous System in a case of Sarcoidosis. Med J Islam Repub Iran 2014; 28:22. [PMID: 25250282 PMCID: PMC4154284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 07/07/2013] [Indexed: 11/04/2022] Open
Abstract
Sarcoidosis is a multisystem noncaseating granulomatous disease with a propensity for lung, eye, and skin which recently have been proposed that mycobacterium tuberculosis may contribute in its pathogenesis, and rarely involves central nervous system (CNS). Despite CD4+ lymphocytopenia, sarcoidosis by itself does not increase risk of opportunistic infections other than cryptococcosis. Nonetheless, simultaneous association of CNS cryptococcosis and tuberculosis infection remains extremely rare event in immunocompetent states, and has not been reported in sarcoidosis yet. We here presented such a case in a 42 years old man, a known case of sarcoidosis with diagnostic and therapeutic difficulties were encountered in a fourteen-month-long hospitalization period.
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Affiliation(s)
- Bahaadin Siroos
- 1. Resident of Neurology, Imam Khomeini Hospital, Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Ahmadinejad
- 2. Associated Professor of Infectious Disease, Imam Khomeini Hospital, Department of Infectious Disease, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohamad Tabaeizadeh
- 3. Resident of Neurology, Imam Khomeini Hospital, Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mojtaba Hedayat Yaghoobi
- 4. Resident of Infectious Disease, Imam Khomeini Hospital, Department of Infectious Disease, Tehran University of Medical Sciences, Tehran, Iran.
| | - Alireza Torabi
- 5. Resident of Neurology, Imam Khomeini Hospital, Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - Majid Ghaffarpour
- 6. Professor of Neurology, Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran.
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Hasimoto e Souza LK, Costa CR, Fernandes ODFL, Abrão FY, Silva TC, Treméa CM, Silva MDRR. Clinical and microbiological features of cryptococcal meningitis. Rev Soc Bras Med Trop 2014; 46:343-7. [PMID: 23856876 DOI: 10.1590/0037-8682-0061-2012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 05/21/2013] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION In this study, the clinical features, underlying diseases and clinical outcomes of patients with cryptococcosis were investigated. In addition, a molecular analysis of the Cryptococcus neoformans species complex isolated from these patients was performed. METHODS A prospective study of 62 cases of patients with cryptococcal infection was conducted at the Hospital de Doenças Tropicais de Goiás Dr. Anuar Auad from 2009-2010. Cryptococcal meningitis cases were diagnosed by direct examination and cerebrospinal fluid (CSF) sample culture. The profiling of these patients was assessed. The CSF samples were submitted to India ink preparation and cultured on Sabouraud dextrose agar, and C. neoformans was identified by the production of urease, a positive phenoloxidase test and assimilation of carbohydrates. C. neoformans and C. gattii isolates were distinguished by growth on L-canavanine-glycine-bromothymol blue medium, and molecular analysis was conducted via PCR fingerprinting reactions using M13 and (GACA)4 primers. RESULTS From the 62 patients with cryptococcosis, 71 isolates of CSF were obtained; 67 (94.4%) isolates were identified as C. neoformans var. grubii/VNI, and 4 (5.6%) were identified as C. gattii/VGII. Of these patients, 53 had an HIV diagnosis. The incidence of cryptococcosis was higher among patients 20-40 years of age, with 74.2% of the cases reported in males. Cryptococcus-related mortality was noted in 48.4% of the patients, and the symptoms were altered sensorium, headache, fever and stiff neck. CONCLUSIONS The high morbidity and mortality observed among patients with cryptococcosis demonstrate the importance of obtaining information regarding the epidemiological profile and clinical course of the disease in the State of Goiás, Brazil.
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Affiliation(s)
- Lúcia Kioko Hasimoto e Souza
- Laboratório de Micologia, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goias, Goiânia, GO, Brazil.
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