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Alkashef NM, Seleem MN. Novel combinatorial approach: Harnessing HIV protease inhibitors to enhance amphotericin B's antifungal efficacy in cryptococcosis. PLoS One 2024; 19:e0308216. [PMID: 39088434 PMCID: PMC11293717 DOI: 10.1371/journal.pone.0308216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 07/18/2024] [Indexed: 08/03/2024] Open
Abstract
Cryptococcosis is a fungal infection that is becoming increasingly prevalent worldwide, particularly among individuals with compromised immune systems, such as HIV patients. Amphotericin B (AmB) is the first-line treatment mainly combined with flucytosine. The scarcity and the prohibitive cost of this regimen urge the use of fluconazole as an alternative, leading to increased rates of treatment failure and relapses. Therefore, there is a critical need for efficient and cost-effective therapy to enhance the efficacy of AmB. In this study, we evaluated the efficacy of the HIV protease inhibitors (PIs) to synergize the activity of AmB in the treatment of cryptococcosis. Five PIs (ritonavir, atazanavir, saquinavir, lopinavir, and nelfinavir) were found to synergistically potentiate the killing activity of AmB against Cryptococcus strains with ƩFICI ranging between 0.09 and 0.5 against 20 clinical isolates. This synergistic activity was further confirmed in a time-kill assay, where different AmB/PIs combinations exhibited fungicidal activity within 24 hrs. Additionally, PIs in combination with AmB exhibited an extended post-antifungal effect on treated cryptococcal cells for approximately 10 hrs compared to 4 hours with AmB alone. This promising activity against cryptococcal cells did not exhibit increased cytotoxicity towards treated kidney cells, ruling out the risk of drug combination-induced nephrotoxicity. Finally, we evaluated the efficacy of AmB/PIs combinations in the Caenorhabditis elegans model of cryptococcosis, where these combinations significantly reduced the fungal burden of the treated nematodes by approximately 2.44 Log10 CFU (92.4%) compared to the untreated worms and 1.40 Log10 ((39.4%) compared to AmB alone. The cost-effectiveness and accessibility of PIs in resource-limited geographical areas compared to other antifungal agents, such as flucytosine, make them an appealing choice for combination therapy.
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Affiliation(s)
- Nour M. Alkashef
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, United States of America
- Center for One Health Research, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, United States of America
- Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Zagazig, Alsharkia, Egypt
| | - Mohamed N. Seleem
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, United States of America
- Center for One Health Research, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, United States of America
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Mehdinezhad H, Ghadir S, Maleh PA, Akhondzadeh A, Baziboroun M. Cryptococcal meningoencephalitis and pneumonia in a HIV positive patient: A case report. Clin Case Rep 2024; 12:e9196. [PMID: 39055090 PMCID: PMC11266633 DOI: 10.1002/ccr3.9196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/23/2024] [Accepted: 06/22/2024] [Indexed: 07/27/2024] Open
Abstract
Key Clinical Messages Early diagnosis of cryptococcal infection is the key to improving outcomes, any newly diagnosed HIV patient presenting with subacute or chronic headache, particularly those who are CD4-deplete, should be investigated for cryptococcal meningitis. We had some delay in our patient management, including delay in HIV diagnosis, delay in doing LP and delay in initiation of anti-cryptococcal treatment and also early start of ART before specific cryptococcal treatment exacerbated IRIS in the patient. So, paying attention to these points can improve the prognosis of such patients. Abstract Cryptocccus is a fungal pathogen and the causative agent of Cryptococcosis among human immunodeficiency virus (HIV) positive people. Meningoencephalitis is the most common manifestation of cryptococcal infection, while pulmonary cryptococcosis is often neglected due to nonspecific clinical and radiological presentation leading to a delay in diagnosis and disseminated disease. Here, we reported a 67-year-old man with newly diagnosed HIV who presented with concurrent cryptococcal meningoencephalitis and pulmonary cryptococcosis that admitted with the complaint of dyspnea and productive cough for 1.5 months, worsening shortness of breath, fever and weight loss since 15 days prior to admission. He also had severe oral candidiasis. Lung computed tomography (CT) revealed ill-defined subpleural cavitary lesion in left lower zone with bilateral diffuse ground glass opacity and air bronchogram. His HIV PCR test was positive with absolute CD4 count less than 50 cells/mm3. After starting antiretroviral therapy (ART), he gradually developed a headache and decreased level of consciousness. Cerebrospinal fluid (CSF) analysis revealed 450 cells, predominantly lymphocytes, with protein of 343 mg/dL and glucose of 98 mg/dL (corresponding blood glucose 284 mg/dL). CSF India ink staining was positive for crypococcus spp. Liposomal amphotericin B in combination with fluconazole (due to the unavailability of flucytosin) was stated. He was intubated because of hypoxia and his bronchoalveolar lavage was positive for Cryptococcus spp. too. He died 2 weeks after starting antifungal therapy based on this study it should be mentioned that neurologic and respiratory symptoms may be the first presentation of acquired immunodeficiency syndrome.
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Affiliation(s)
- Hamed Mehdinezhad
- Clinical Research Development Unit of Rouhani HospitalBabol University of Medical SciencesBabolIran
| | - Sara Ghadir
- student research committeeBabol University of Medical SciencesBabolIran
| | - Parviz Amri Maleh
- Clinical Research Development Unit of Rouhani HospitalBabol University of Medical SciencesBabolIran
| | - Ailin Akhondzadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, clinical research of development unit of Rouhani HospitalBabol University of Medical SciencesBabolIran
| | - Mana Baziboroun
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, clinical research of development unit of Rouhani HospitalBabol University of Medical SciencesBabolIran
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Omer I, Khalil I, Abdalmumin A, Molefe PF, Sabeel S, Farh IZA, Mohamed HA, Elsharif HA, Mohamed ALAH, Awad-Elkareem MAE, Salih M. Design of an epitope-based peptide vaccine against Cryptococcus neoformans. FEBS Open Bio 2024. [PMID: 39020466 DOI: 10.1002/2211-5463.13858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/11/2024] [Accepted: 06/21/2024] [Indexed: 07/19/2024] Open
Abstract
Cryptococcus neoformans is the highest-ranked fungal pathogen in the Fungal Priority Pathogens List (FPPL) released by the World Health Organization (WHO). In this study, through in silico simulations, a multi-epitope vaccine against Cryptococcus neoformans was developed using the mannoprotein antigen (MP88) as a vaccine candidate. Following the retrieval of the MP88 protein sequences, these were used to predict antigenic B-cell and T-cell epitopes via the bepipred tool and the artificial neural network, respectively. Conserved B-cell epitopes AYSTPA, AYSTPAS, PASSNCK, and DSAYPP were identified as the most promising B-cell epitopes. While YMAADQFCL, VSYEEWMNY, and FQQRYTGTF were identified as the best candidates for CD8+ T-cell epitopes; and YARLLSLNA, ISYGTAMAV, and INQTSYARL were identified as the most promising CD4+ T-cell epitopes. The vaccine construct was modeled along with adjuvant and peptide linkers and the expasy protparam tool was used to predict the physiochemical properties. According to this, the construct vaccine was predicted to be antigenic, nontoxic, nonallergenic, soluble, stable, hydrophilic, and thermostable. Furthermore, the three-dimensional structure was also used in docking analyses with Toll-like receptor (TLR4). Finally, the cDNA of vaccine was successfully cloned into the E. coli pET-28a (+) expression vector. The results presented here could contribute towards the design of an effective vaccine against Cryptococcus neoformans.
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Affiliation(s)
- Ibtihal Omer
- Department of Therapeutic Drug Monitoring Laboratory, National Center for Kidney Diseases and Surgery, Khartoum, Sudan
| | - Isra Khalil
- Department of Microbiology, Faculty of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
| | - Ahmed Abdalmumin
- Biomedical Research Institute, Sudan National University, Khartoum, Sudan
| | - Philisiwe Fortunate Molefe
- Hair and Skin Research Laboratory, Department of Medicine, Division Dermatology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Solima Sabeel
- Department of Pathology, Faculty of Health Sciences, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, South Africa
| | | | - Hanaa Abdalla Mohamed
- Department of Microbiology, Faculty of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
| | - Hajr Abdallha Elsharif
- General Administration of Quarantine and Animal Health, Regional Training Institute, Khartoum, Sudan
| | | | | | - Mohamed Salih
- Department of Biotechnology, Africa City of Technology, Khartoum, Sudan
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Gómez-Gaviria M, Contreras-López LM, Aguilera-Domínguez JI, Mora-Montes HM. Strategies of Pharmacological Repositioning for the Treatment of Medically Relevant Mycoses. Infect Drug Resist 2024; 17:2641-2658. [PMID: 38947372 PMCID: PMC11214559 DOI: 10.2147/idr.s466336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/14/2024] [Indexed: 07/02/2024] Open
Abstract
Fungal infections represent a worldwide concern for public health, due to their prevalence and significant increase in cases each year. Among the most frequent mycoses are those caused by members of the genera Candida, Cryptococcus, Aspergillus, Histoplasma, Pneumocystis, Mucor, and Sporothrix, which have been treated for years with conventional antifungal drugs, such as flucytosine, azoles, polyenes, and echinocandins. However, these microorganisms have acquired the ability to evade the mechanisms of action of these drugs, thus hindering their treatment. Among the most common evasion mechanisms are alterations in sterol biosynthesis, modifications of drug transport through the cell wall and membrane, alterations of drug targets, phenotypic plasticity, horizontal gene transfer, and chromosomal aneuploidies. Taking into account these problems, some research groups have sought new therapeutic alternatives based on drug repositioning. Through repositioning, it is possible to use existing pharmacological compounds for which their mechanism of action is already established for other diseases, and thus exploit their potential antifungal activity. The advantage offered by these drugs is that they may be less prone to resistance. In this article, a comprehensive review was carried out to highlight the most relevant repositioning drugs to treat fungal infections. These include antibiotics, antivirals, anthelmintics, statins, and anti-inflammatory drugs.
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Affiliation(s)
- Manuela Gómez-Gaviria
- Departamento de Biología, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, Gto, México
| | - Luisa M Contreras-López
- Departamento de Biología, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, Gto, México
| | - Julieta I Aguilera-Domínguez
- Departamento de Biología, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, Gto, México
| | - Héctor M Mora-Montes
- Departamento de Biología, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, Gto, México
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Colović N, Ljubičić J, Kostić D, Barać A, Jurišić V. Disseminated cerebral cryptococcosis after silent West Nile virus infection in a patient with polycythemia vera: A case report and review of the literature. SAGE Open Med Case Rep 2024; 12:2050313X241262145. [PMID: 38895656 PMCID: PMC11185029 DOI: 10.1177/2050313x241262145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Although disseminated cryptococcosis can occur occasionally, it is most commonly seen in immunodeficient patients. In 2005, a 43-year-old man was diagnosed with polycythemia vera. Following in 2018, he experienced an unknown-cause fever and headache. To establish the source of the symptoms, a magnetic resonance imaging scan of the brain was performed, which indicated meningeal and gyral-leptomeningeal thickening and several localized T2 hyperintense lesions measuring up to 10 × 14 mm in diameter. Cryptococcus neoformans was then cultivated from cerebrospinal fluid. Serum IgM antibodies against West Nile Virus were positive. After 8 weeks of treatment with amphotericin B and fluconazole, the overall condition improved, and the cerebrospinal fluid control culture became negative. The symptoms returned shortly after discontinuing antifungal therapy, necessitating the reintroduction of fluconazole. Currently, the patient is stable and responding positively to ruxolitinib. Here, it is demonstrated how a patient with polycythemia vera due to immunological weakness might develop disseminated cryptococcosis of the brain after West Nile virus infection.
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Affiliation(s)
- Nataša Colović
- Faculty of Medicine, University of Belgrade, Beograd, Serbia
- Clinic for Hematology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Ljubičić
- General Hospital Kraljevo, Service of Hematology, Kraljevo, Serbia
| | - Dejan Kostić
- Institute of Radiology, Military Medical Academy, Belgrade, Serbia
- Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Aleksandra Barać
- Faculty of Medicine, University of Belgrade, Beograd, Serbia
- Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Belgrade, Serbia
| | - Vladimir Jurišić
- University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
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Musubire A, Kagimu E, Mugabi T, Meya DB, Boulware DR, Bahr NC. Complex Decisions in HIV-Related Cryptococcosis: Addressing Second Episodes of Cryptococcal Meningitis. Curr HIV/AIDS Rep 2024; 21:75-85. [PMID: 38400871 PMCID: PMC11016006 DOI: 10.1007/s11904-024-00691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE OF REVIEW This review highlights the difficulties in diagnosing and treating persons with a prior history of cryptococcal meningitis who improve but suffer from a recurrence of symptoms. This scenario is well known to those who frequently care for patients with cryptococcal meningitis but is not well understood. We highlight major gaps in knowledge. RECENT FINDINGS We recently summarized our experience with 28 persons with paradoxical immune reconstitution inflammatory syndrome (IRIS) and 81 persons with microbiological relapse. CD4 count and cerebrospinal fluid white blood cell count were higher in IRIS than relapse but neither was reliable enough to routinely differentiate these conditions. Second-episode cryptococcal meningitis remains a difficult clinical scenario as cryptococcal antigen, while excellent for initial diagnosis has no value in differentiating relapse of infection from other causes of recurrent symptoms. Updated research definitions are proposed and rapid, accurate diagnostic tests are urgently needed.
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Affiliation(s)
- Abdu Musubire
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Enock Kagimu
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Timothy Mugabi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - David B Meya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, 66160 KS, USA.
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Hughto JM, Varma H, Yee K, Babbs G, Hughes LD, Pletta DR, Meyers DJ, Shireman TI. Characterizing Disparities in the HIV Care Continuum among Transgender and Cisgender Medicare Beneficiaries. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.19.24304525. [PMID: 38562705 PMCID: PMC10984057 DOI: 10.1101/2024.03.19.24304525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background In the US, transgender and gender-diverse (TGD) individuals, particularly trans feminine individuals, experience a disproportionately high burden of HIV relative to their cisgender counterparts. While engagement in the HIV Care Continuum (e.g., HIV care visits, antiretroviral (ART) prescribed, ART adherence) is essential to reduce viral load, HIV transmission, and related morbidity, the extent to which TGD people engage in one or more steps of the HIV Care Continuum at similar levels as cisgender people is understudied on a national level and by gendered subgroups. Methods and Findings We used Medicare Fee-for-Service claims data from 2009 to 2017 to identify TGD (trans feminine and non-binary (TFN), trans masculine and non-binary (TMN), unclassified gender) and cisgender (male, female) beneficiaries with HIV. Using a retrospective cross-sectional design, we explored within- and between-gender group differences in the predicted probability (PP) of engaging in one or more steps of the HIV Care Continuum. TGD individuals had a higher predicted probability of every HIV Care Continuum outcome compared to cisgender individuals [HIV Care Visits: TGD PP=0.22, 95% Confidence Intervals (CI)=0.22-0.24; cisgender PP=0.21, 95% CI=0.21-0.22); Sexually Transmitted Infection (STI) Screening (TGD PP=0.12, 95% CI=0.11-0.12; cisgender PP=0.09, 95% CI=0.09-0.10); ART Prescribed (TGD PP=0.61, 95% CI=0.59-0.63; cisgender PP=0.52, 95% CI=0.52-0.54); and ART Persistence or adherence (90% persistence: TGD PP=0.27, 95% CI=0.25-0.28; 95% persistence: TGD PP=0.13, 95% CI=0.12-0.14; 90% persistence: cisgender PP=0.23, 95% CI=0.22-0.23; 95% persistence: cisgender PP=0.11, 95% CI=0.11-0.12)]. Notably, TFN individuals had the highest probability of every outcome (HIV Care Visits PP =0.25, 95% CI=0.24-0.27; STI Screening PP =0.22, 95% CI=0.21-0.24; ART Prescribed PP=0.71, 95% CI=0.69-0.74; 90% ART Persistence PP=0.30, 95% CI=0.28-0.32; 95% ART Persistence PP=0.15, 95% CI=0.14-0.16) and TMN people or cisgender females had the lowest probability of every outcome (HIV Care Visits: TMN PP =0.18, 95% CI=0.14-0.22; STI Screening: Cisgender Female PP =0.11, 95% CI=0.11-0.12; ART Receipt: Cisgender Female PP=0.40, 95% CI=0.39-0.42; 90% ART Persistence: TMN PP=0.15, 95% CI=0.11-0.20; 95% ART Persistence: TMN PP=0.07, 95% CI=0.04-0.10). The main limitation of this research is that TGD and cisgender beneficiaries were included based on their observed care, whereas individuals who did not access relevant care through Fee-for-Service Medicare at any point during the study period were not included. Thus, our findings may not be generalizable to all TGD and cisgender individuals with HIV, including those with Medicare Advantage or other types of insurance. Conclusions Although TGD beneficiaries living with HIV had superior engagement in the HIV Care Continuum than cisgender individuals, findings highlight notable disparities in engagement for TMN individuals and cisgender females, and engagement was still low for all Medicare beneficiaries, independent of gender. Interventions are needed to reduce barriers to HIV care engagement for all Medicare beneficiaries to improve treatment outcomes and reduce HIV-related morbidity and mortality in the US.
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Affiliation(s)
- Jaclyn M.W. Hughto
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, United States
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, United States
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Hiren Varma
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
| | - Kim Yee
- OHSU-PSU School of Public Health, Portland, OR, United States
| | - Gray Babbs
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
| | - Landon D. Hughes
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - David R. Pletta
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, United States
| | - David J. Meyers
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
| | - Theresa I. Shireman
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, United States
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Qu J, Lv X. Cryptococcal meningitis in apparently immunocompetent patients. Crit Rev Microbiol 2024; 50:76-86. [PMID: 36562731 DOI: 10.1080/1040841x.2022.2159786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Cryptococcal meningitis (CM) is an invasive fungal disease that currently poses a threat to human health worldwide, with high morbidity and mortality, particularly in immunocompromised patients. Although CM mainly occurs in HIV-positive patients and other immunocompromised patients, it is also increasingly seen in seemingly immunocompetent hosts. The clinical characteristics of CM between immunocompromised and immunocompetent populations are different. However, few studies have focussed on CM in immunocompetent individuals. This review summarizes the clinical characteristics of apparently immunocompetent CM patients in terms of aetiology, immune pathogenesis, clinical presentation, laboratory data, imaging findings, treatment strategies and prognosis. It is of great significance to further understand the disease characteristics of CM, explore new treatment strategies and improve the prognosis of CM in immunocompetent individuals.
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Affiliation(s)
- Junyan Qu
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoju Lv
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
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Wang Y, Gu Y, Shen K, Cui X, Min R, Sun S, Feng C, Chen Y, Wang L, Ma G, Chen B, Ni Y, Zhong H, Shi Y, Su X. The management and outcome of cryptococcosis in patients with different immune statuses and treatment protocols: A multicenter real-world study in Jiangsu Province - China. J Mycol Med 2023; 33:101389. [PMID: 37099991 DOI: 10.1016/j.mycmed.2023.101389] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/27/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE The incidence of cryptococcosis is increasing in non-immunocompromised patients. However, the evidence on proper management is inadequate in this population. We conducted this multi-center real-world study in pulmonary cryptococcosis patients with different immune statuses, so as to provide practical evidence for optimized clinical management of cryptococcosis, especially for mild-to-moderate immunodeficient diseases patients. METHODS This is a prospective observational study. The clinical data of patients with proven cryptococcosis were collected and analyzed from 7 tertiary teaching hospitals in Jiangsu Province, China from January, 2013 to December, 2018. Proven cases include pulmonary cryptococcosis, cryptococcal meningitis, cryptococcemia and cutaneous cryptococcosis. Patients were followed up over 24 months. According to their immune status, patients with cryptococcosis were divided into three groups, namely immunocompetent group (IC), mild-to-moderate immunodeficient diseases group (MID), severe immunodeficient diseases group (SID). Meanwhile, pulmonary crypotococcosis (PC) and extrapulmonary crypotococcosis (EPC) were also classified and analyzed. RESULTS 255 proven cases of cryptococcosis were enrolled. Finally, 220 cases completed the follow-up. 143 proven cases (65.0%) were immunocompetent (IC), 41 cases (18.6%) were MID, and 36 cases (16.4%) were SID. 174 cases (79.1%) were PC and 46 cases (20.9%) were EPC. The mortality was significantly higher in SID and MID patients [47.2% (SID) vs. 12.2% (MID) vs. 0.0% (IC), p<0.001]. The mortality was also significantly higher in EPC patients [45.7% vs. 0.6% (PC), p<0.001]. Patients with alternative initial antifungal treatment had higher mortality than patients with guideline recommended initial treatment [23.1% vs. 9.5%, p=0.041]. In MID group, the mortality of receiving alternative initial antifungal treatment was significantly higher than recommended initial treatment [2/3 vs. 3/34(8.8%), p=0.043]. In pulmonary cryptococcosis patients with MID, the mortality was very similar to IC group [0.0% vs. 0.0% (IC)], lower than SID group [0.0% vs. 11.1% (SID), p=0.555]. However, in extrapulmonary cryptococcosis patients with MID, the mortality was significantly higher than that in IC [62.5% vs. 0.0% (IC)], and similar to SID patients [62.5% vs. 59.3% (SID)]. CONCLUSION The immune status exert a significant influence on the management and prognosis of cryptococcosis patients. The mortality of cryptococcosis patients with MID is higher than that of immunocompetent patients. For MID patients with pure pulmonary cryptococcosis, it is acceptable to take the treatment recommended as IC patients. For the MID patients with extrapulmonary cryptococcosis, the mortality is high and the initial treatment should follow the regimen for SID patients. Following the recommended treatment regimen in the IDSA guideline can reduce mortality in patients with cryptococcosis. Starting on alternative initial antifungal treatment may bring worse outcomes.
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Affiliation(s)
- Yu Wang
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Yu Gu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China, 210008
| | - Kunlu Shen
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southern Medical University, Guangzhou, China, 510000
| | - Xuefan Cui
- Department of Respiratory Medicine, Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China, 210002
| | - Rui Min
- Department of Respiratory Medicine, Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China, 210002
| | - Siqing Sun
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Nanjing, Nanjing, China, 210002
| | - Chunlai Feng
- Department of Respiratory Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China, 213000
| | - Yanbin Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China, 215000
| | - Li Wang
- Department of Respiratory and Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China, 210002
| | - Guoer Ma
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, China, 212000
| | - Bilin Chen
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China, 210008
| | - Yueyan Ni
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008
| | - Huanhuan Zhong
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China, 210008
| | - Yi Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China, 210008
| | - Xin Su
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China, 210008; Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China, 210008; Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southern Medical University, Guangzhou, China, 510000.
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10
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A Possible New Diagnostic Method for Early Diagnosis of Cryptococcus Infection in Lymphoma Patient Co-Infected with SARS-CoV-2. REPORTS 2023. [DOI: 10.3390/reports6010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
A Cryptococcus subspecies, neoformans, represents the most pathogenic infection for humans, particularly in immunocompromised hosts (e.g., cancer patients, drug users). In the present study, we described a 67-year old woman with non-Hodgkin lymphoma who developed an infectious disease sustained by Cryptococcus neoformans. Biochemical data documented a decrease in lymphocytes count while clinical evaluation was suggestive on meningeal infection. The microbiological analysis of the serum, using a dilution pattern through the CrAg lateral flow assay (Immy, Norman, OK 73069, USA) detected the antigen of Cryptococcus (dilution 1/1280), and a treatment with liposomal amphotericin B (3 mg/kg id) plus flucytosine (100 mg/kg per day orally in four divided doses) were started, showing an improvement of symptoms. This case report suggests that an antigen dilution can be used to perform a rapid diagnosis and to quickly start the pharmacological treatment.
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11
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Xu XL, Zhao T, Huang YQ, Lu YQ, He XJ, Wu YS, Zhang W, Yu JH, Yang TT, Xu LJ, Lan K, Zhang DF, Harypursat V, Chen YK. Therapeutic lumbar puncture and lumbar drainage: which is more effective for the management of intracranial hypertension in HIV patients with cryptococcal meningitis? Results of a prospective non-randomized interventional study in China. Curr Med Res Opin 2022; 38:803-810. [PMID: 35225112 DOI: 10.1080/03007995.2022.2047539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of therapeutic lumbar drainage (LD) compared to therapeutic lumbar puncture (LP) for the management of intracranial hypertension (ICH) among HIV-positive patients with cryptococcal meningitis (CM). METHODS The study was a multicenter prospective non-randomized interventional clinical trial. One hundred and sixteen HIV-associated CM patients were identified who presented with ICH (≥250 mmH2O). The LP group comprised 76 cases, while the LD group consisted of 40 cases. We compared mortality, intracranial pressure (ICP) normalization rate, and clinical symptom remission at 10 weeks, between the two groups. RESULTS The cumulative mortality at week 10 was 22.4% in the LP group and 20% in the LD group (p = .927), without any significant difference in mortality between the two groups. Improvement after treatment at 2-weeks, ICP normalization, and headache reversal event occurrence in the two groups showed no significant difference (p > .05). The incidence of CSF Cryptococcus clearance at two weeks in the LD group was significantly higher than in the LP group (p < .05). The frequency of invasive lumbar therapeutic procedures in the LP group during the first week was higher than that of the LD group (p < .05). Localized infection at the puncture site occurred more frequently in the LD group than in the LP group (p < .05). CONCLUSION For HIV-positive CM patients with an elevated ICP, LD and LP are comparably effective and safe options to normalize ICP. LP increases the frequency of invasive lumbar therapeutic procedures but does not incur more risk of infection events at the puncture site, while LD may accelerate CSF Cryptococcus clearance but may induce more frequent localized infection. TRIAL REGISTRATION This study was registered as one of 12 trials under a general project at the Chinese Clinical Trial Registry (ChiCTR1900021195).
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Affiliation(s)
- Xiao-Lei Xu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Ting Zhao
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Yan-Qun Huang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Yan-Qiu Lu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Xue-Jiao He
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Yu-Shan Wu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Wei Zhang
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Jian-Hua Yu
- Department of Infectious Diseases, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Tong-Tong Yang
- Department of Infectious Disease, Public Health Clinical Center of Chengdu, Sichuan, China
| | - Li-Jun Xu
- National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ke Lan
- Division of Infectious Disease, Longtan Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - De-Fa Zhang
- Infectious Disease Department, Tianjin Second People's Hospital, Tianjin, China
| | - Vijay Harypursat
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Yao-Kai Chen
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
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12
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Synthesis and Evaluation of the Antifungal and Toxicological Activity of Nitrofuran Derivatives. Pharmaceutics 2022; 14:pharmaceutics14030593. [PMID: 35335969 PMCID: PMC8950151 DOI: 10.3390/pharmaceutics14030593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
Fungal diseases affect more than 1 billion people worldwide. The constant global changes, the advent of new pandemics, and chronic diseases favor the diffusion of fungal pathogens such as Candida, Cryptococcus, Aspergillus, Trichophyton, Histoplasma capsulatum, and Paracoccidioides brasiliensis. In this work, a series of nitrofuran derivatives were synthesized and tested against different fungal species; most of them showed inhibitory activity, fungicide, and fungistatic profile. The minimal inhibitory concentration (MIC90) values for the most potent compounds range from 0.48 µg/mL against H. capsulatum (compound 11) and P. brasiliensis (compounds 3 and 9) to 0.98 µg/mL against Trichophyton rubrum and T. mentagrophytes (compounds 8, 9, 12, 13 and 8, 12, 13, respectively), and 3.9 µg/mL against Candida and Cryptococcus neoformans strains (compounds 1 and 5, respectively). In addition, all compounds showed low toxicity when tested in vitro on lung cell lines (A549 and MRC-5) and in vivo in Caenorhabditis elegans larvae. Many of them showed high selectivity index values. Thus, these studied nitrofuran derivatives proved to be potent against different fungal species, characterized by low toxicity and high selectivity; for these reasons, they may become promising compounds for the treatment of mycoses.
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13
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Enock K, Julius K, Griffith BC, Abila DB, Rutakingirwa MK, Kasibante J, Kandole KT, Kwizera R, Semeere A, Meya DB. Evaluation of the initial 12 months of a routine cryptococcal antigen screening program in reduction of HIV-associated cryptococcal meningitis in Uganda. BMC Health Serv Res 2022; 22:301. [PMID: 35246128 PMCID: PMC8897917 DOI: 10.1186/s12913-022-07624-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asymptomatic Cryptococcal Antigenemia (CrAg) patients develop meningitis within a month of testing positive. Pre-emptive antifungal therapy can prevent progression to Cryptococcal meningitis (CM). In April 2016, a national CrAg screening program was initiated in 206 high-volume health facilities that provide antiretroviral therapy in Uganda. We report the evaluation of the CrAg screening cascade focusing on linkage to care, fluconazole therapy for 10 weeks and 6 months follow up, and ART initiation in a subset of facilities. METHODS We conducted a retrospective, cross-sectional survey of patients with CD4 < 100 at seven urban and seven rural facilities after 1 year of program implementation. We quantified the number of patients who transitioned through the steps of the CrAg screening cascade over six-months follow-up. We defined cascade completion as a pre-emptive fluconazole prescription for the first 10 weeks. We conducted semi-structured interviews with lab personnel and clinic staff to assess functionality of the CrAg screening program. Data was collected using REDCap. RESULTS We evaluated 359 patient records between April 2016 to March 2017; the majority (358/359, 99.7%) were from government owned health facilities and just over half (193/359, 53.8%) had a median baseline CD4 cell count of < 50 cell/μL. Overall, CrAg screening had been performed in 255/359 (71.0, 95% CI, 66.0-75.7) of patients' records reviewed, with a higher proportion among urban facilities (170/209 (81.3, 95% CI, 75.4-86.4)) than rural facilities (85/150 (56.7, 95% CI, 48.3-64.7)). Among those who were CrAg screened, 56/255 (22.0, 95% CI, 17.0-27.5%) had cryptococcal antigenemia, of whom 47/56 (83.9, 95% CI, 71.7-92.4%) were initiated on pre-emptive therapy with fluconazole and 8/47 (17.0, 95% CI, 7.6-30.8%) of these were still receiving antifungal therapy at 6 months follow up. At least one CNS symptom was present in 70% (39/56) of those with antigenemia. In patients who had started ART, almost 40% initiated ART prior to CrAg screening. Inadequacy of equipment/supplies was reported by 15/26 (58%) of personnel as a program barrier, while 13/26 (50%) reported a need for training about CM and CrAg screening. CONCLUSION There was a critical gap in the follow-up of patients after initiation on fluconazole therapy. ART had been initiated in almost 40% of patients prior to CrAg screening.. Higher antigenemia patients presenting with CNS symptoms could be related to late presentation. There is need to address these gaps after a more thorough evaluation.
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Affiliation(s)
- Kagimu Enock
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda. .,Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, P.O Box 7072, Uganda.
| | - Kiwanuka Julius
- Makerere University School of Public Health, Kampala, Uganda
| | - Bridget C Griffith
- University of Minnesota, School of Public Health, Minneapolis, MN, USA.,McGill University, Montreal, Canada
| | - Derrick Bary Abila
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Morris K Rutakingirwa
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, P.O Box 7072, Uganda
| | - John Kasibante
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, P.O Box 7072, Uganda
| | - Kiiza Tadeo Kandole
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, P.O Box 7072, Uganda
| | - Richard Kwizera
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, P.O Box 7072, Uganda
| | - Aggrey Semeere
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.,Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, P.O Box 7072, Uganda
| | - David B Meya
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.,Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, P.O Box 7072, Uganda
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14
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Del Risco Zevallos J, Torres Quilis C, Issus Olive G, García F. Pleural effusion as a manifestation of a Cryptococcal infection in an HIV patient. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2021; 39:524-526. [PMID: 34865713 DOI: 10.1016/j.eimce.2020.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/23/2020] [Indexed: 06/13/2023]
Affiliation(s)
| | | | | | - Felipe García
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain; AIDS Research Group, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
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15
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Rapper SLD, Tankeu SY, Kamatou G, Viljoen A, van Vuuren S. The use of chemometric modelling to determine chemical composition-antimicrobial activity relationships of essential oils used in respiratory tract infections. Fitoterapia 2021; 154:105024. [PMID: 34455037 DOI: 10.1016/j.fitote.2021.105024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 12/19/2022]
Abstract
The antimicrobial effects of essential oils are commonly cited within aromatherapeutic texts for use in respiratory tract infections. These essential oils are inhaled or applied to the skin to treat infections and manage symptoms associated with these conditions. A limited number of these essential oils have been scientifically studied to support these claims, specifically, against respiratory pathogens. This study reports on the minimum inhibitory concentration (MIC) of 49 commercial essential oils recommended for respiratory tract infections, and identifies putative biomarkers responsible for the determined antimicrobial effect following a biochemometric workflow. Essential oils were investigated against nine pathogens. Three essential oils, Amyris balsamifera (amyris), Coriandrum sativum (coriander) and Santalum austrocaledonicum (sandalwood) were identified as having greater activity (MIC value = 0.03-0.13 mg/ml) compared to the other essential oils investigated. The essential oil composition of all 49 oils were determined using Gas Chromatography coupled to Mass Spectroscopy (GC-MS) analysis and the GC-MS data analysed together with the antimicrobial data using chemometric tools. Eugenol was identified as the main biomarker responsible for antimicrobial activity in the majority of the essential oils. The ability of a chemometric model to accurately predict the active and inactive biomarkers of the investigated essential oils against pathogens of the respiratory tract was 80.33%.
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Affiliation(s)
- Stephanie Leigh-de Rapper
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, South Africa
| | - Sidonie Yankam Tankeu
- Department of Pharmaceutical Sciences, Faculty of Sciences, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa
| | - Guy Kamatou
- Department of Pharmaceutical Sciences, SAMRC Herbal Drugs Research Unit, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa
| | - Alvaro Viljoen
- Department of Pharmaceutical Sciences, Faculty of Sciences, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa; Department of Pharmaceutical Sciences, SAMRC Herbal Drugs Research Unit, Tshwane University of Technology, Private Bag X680, Pretoria 0001, South Africa
| | - Sandy van Vuuren
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, South Africa.
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16
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Zhao T, Xu XL, Nie JM, Chen XH, Jiang ZS, Liu SQ, Yang TT, Yang X, Sun F, Lu YQ, Harypursat V, Chen YK. Establishment of a novel scoring model for mortality risk prediction in HIV-infected patients with cryptococcal meningitis. BMC Infect Dis 2021; 21:786. [PMID: 34376147 PMCID: PMC8353436 DOI: 10.1186/s12879-021-06417-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/07/2021] [Indexed: 12/04/2022] Open
Abstract
Background Cryptococcal meningitis (CM) remains a leading cause of death in HIV-infected patients, despite advances in CM diagnostic and therapeutic strategies. This study was performed with the aim to develop and validate a novel scoring model to predict mortality risk in HIV-infected patients with CM (HIV/CM). Methods Data on HIV/CM inpatients were obtained from a Multicenter Cohort study in China. Independent risk factors associated with mortality were identified based on data from 2013 to 2017, and a novel scoring model for mortality risk prediction was established. The bootstrapping statistical method was used for internal validation. External validation was performed using data from 2018 to 2020. Results We found that six predictors, including age, stiff neck, impaired consciousness, intracranial pressure, CD4+ T-cell count, and urea levels, were associated with poor prognosis in HIV/CM patients. The novel scoring model could effectively identify HIV/CM patients at high risk of death on admission (area under curve 0.876; p<0.001). When the cut-off value of 5.5 points or more was applied, the sensitivity and specificity was 74.1 and 83.8%, respectively. Our scoring model showed a good discriminatory ability, with an area under the curve of 0.879 for internal validation via bootstrapping, and an area under the curve of 0.886 for external validation. Conclusions Our developed scoring model of six variables is simple, convenient, and accurate for screening high-risk patients with HIV/CM, which may be a useful tool for physicians to assess prognosis in HIV/CM inpatients.
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Affiliation(s)
- Ting Zhao
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China
| | - Xiao-Lei Xu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China
| | - Jing-Min Nie
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China
| | - Xiao-Hong Chen
- Department of Infectious Diseases, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang province, China
| | - Zhong-Sheng Jiang
- Division of Infectious Diseases, Liuzhou People's Hospital, Liuzhou, Guangxi province, China
| | - Shui-Qing Liu
- Department of Infectious Diseases, Guiyang Public Health Clinical Center, Guiyang, Guizhou province, China
| | - Tong-Tong Yang
- Department of Infectious Disease, Public Health Clinical Center of Chengdu, Chengdu, Sichuan province, China
| | - Xuan Yang
- Department of Infectious Diseases, Sixth People's Hospital of Zhengzhou, Zhengzhou, Henan province, China
| | - Feng Sun
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China
| | - Yan-Qiu Lu
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China
| | - Vijay Harypursat
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China
| | - Yao-Kai Chen
- Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba, Chongqing, 400036, China.
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17
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Del Risco Zevallos J, Torres Quilis C, Issus Olive G, García F. Pleural effusion as a manifestation of a Cryptococcal infection in an HIV patient. Enferm Infecc Microbiol Clin 2021; 39:S0213-005X(20)30415-8. [PMID: 33446399 DOI: 10.1016/j.eimc.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Affiliation(s)
| | | | | | - Felipe García
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain; AIDS Research Group, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
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18
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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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19
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Zhao J, Zhao X, Yang S, Miao S, Liu Y. Surgical treatment and operation time in human immunodeficiency virus-negative cryptococcal meningitis. Medicine (Baltimore) 2020; 99:e22546. [PMID: 33080688 PMCID: PMC7571884 DOI: 10.1097/md.0000000000022546] [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] [Indexed: 02/07/2023] Open
Abstract
There are still no unified guidelines of surgical treatment and timing for human immunodeficiency virus (HIV)-negative patients with cryptococcal meningitis (CM).The clinical data and follow-up data were collected from HIV-negative CM patients in Xiangya Hospital of Central South University from January 2009 to November 2018, and 42 patients who were treated with surgical intervention were enrolled in the present study. These 42 patients were divided into ventriculoatrial (VA) group, ventriculoperitoneal group, external ventricle drainage (EVD) group, hydrocephalus (HYC) group, non-HYC group, EVD group, and non-EVD group (VA/ ventriculoperitoneal) according to different surgical procedures. Statistical analyses were conducted using SPSS (version 19.0, Chicago, IL).Signs of headache, fever, and loss of consciousness in the VA group were significantly improved compared with the EVD group at 1 week after operation (P < .05). The mortality rate of the VA group was significantly lower than that of the EVD group (P < .05). Moreover, male patients were more prone to have HYC (P < .05). Younger patients tended to develop HYC (P < .05). Cerebrospinal fluid sugar in the non-HYC group was significantly lower compared with the HYC group (P < .05). Time of CM-to-operation in the non-HYC group was markedly shorter compared with the HYC group (P < .01).VA procedure could be one of the first choices for the treatment of uncontrollable intracranial hypertension caused by CM. Severe uncontrollable headache, loss of consciousness, and cerebral hernia were indications of emergency surgery. Repeated headache, hearing impairment, and especially progressive loss of vision were indications of early surgery to avoid permanent damage to nerve functions of HIV-negative CM patients.
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Affiliation(s)
- Jie Zhao
- Department of Neurosurgery, Xiangya Hospital
| | - Xiang Zhao
- Department of Neurosurgery, Xiangya Hospital
| | - Shaobo Yang
- Department of Neurosurgery, Xiangya Hospital
| | - Shuying Miao
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ying Liu
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha
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20
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Bramantono B, Danial A, Hadi U. A case of an AIDS patient with Cryptococcus neoformans infection. Pan Afr Med J 2020; 36:88. [PMID: 32774647 PMCID: PMC7392875 DOI: 10.11604/pamj.2020.36.88.20406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022] Open
Abstract
Cryptococcosis is the most common fungal disease in HIV-infected persons. It is known as the AIDS-defining illness for 60-70% of HIV-infected patients. Before antiretroviral therapy (ARV) was discovered, fungal and other opportunistic infections were a major problem for people with advanced HIV/AIDS. Presented here is a case of a 43-year-old man who was newly diagnosed HIV, in which he was admitted due to shortness of breath and decreased consciousness. His clinical symptoms, physical examination, laboratory and radiologic findings indicated a Cryptococcus neoformans infection. The patient had received treatment using anti-fungal and ARV that showed a clinical improvement during observation.
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Affiliation(s)
- Bramantono Bramantono
- Tropical and Infectious Disease Division, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Teaching Hospital, Surabaya, East Java, Indonesia
| | - Ahmad Danial
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Teaching Hospital, Surabaya, East Java, Indonesia
| | - Usman Hadi
- Tropical and Infectious Disease Division, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Teaching Hospital, Surabaya, East Java, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Teaching Hospital, Surabaya, East Java, Indonesia
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21
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Bermas A, Geddes‐McAlister J. Combatting the evolution of antifungal resistance in
Cryptococcus neoformans. Mol Microbiol 2020; 114:721-734. [DOI: 10.1111/mmi.14565] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/09/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Arianne Bermas
- Department of Molecular and Cellular Biology University of Guelph Guelph ON Canada
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22
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Brilhante RSN, Silva JAT, Araújo GDS, Pereira VS, Gotay WJP, Oliveira JSD, Guedes GMDM, Pereira-Neto WA, Castelo-Branco DDSCM, Cordeiro RDA, Sidrim JJC, Rocha MFG. Darunavir inhibits Cryptococcus neoformans/ Cryptococcus gattii species complex growth and increases the susceptibility of biofilms to antifungal drugs. J Med Microbiol 2020; 69:830-837. [PMID: 32459616 DOI: 10.1099/jmm.0.001194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Cryptococcus species are pathogens commonly associated with cases of meningoencephalitis in individuals who are immunosuppressed due to AIDS.Aim. The aim was to evaluate the effects of the antiretroviral darunavir alone or associated with fluconazole, 5-flucytosine and amphotericin B against planktonic cells and biofilms of Cryptococcus species.Methodology. Susceptibility testing of darunavir and the common antifungals against 12 members of the Cryptococcus neoformans/Cryptococcus gattii species complex was evaluated by broth microdilution. The interaction between darunavir and antifungals against planktonic cells was tested by a checkerboard assay. The effects of darunavir against biofilm metabolic activity and biomass were evaluated by the XTT reduction assay and crystal violet staining, respectively.Results. Darunavir combined with amphotericin B showed a synergistic interaction against planktonic cells. No antagonistic interaction was observed between darunavir and the antifungals used. All Cryptococcus species strains were strong biofilm producers. Darunavir alone reduced biofilm metabolic activity and biomass when added during and after biofilm formation (P<0.05). The combination of darunavir with antifungals caused a significant reduction in biofilm metabolic activity and biomass when compared to darunavir alone (P<0.05).Conclusion. Darunavir presents antifungal activity against planktonic cells of Cryptococcus species and synergism with amphotericin B. In addition, darunavir led to reduced biofilm formation and showed activity against mature biofilms of Cryptococcus species. Activity of the antifungals against mature biofilms was enhanced in the presence of darunavir.
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Affiliation(s)
- Raimunda Sâmia Nogueira Brilhante
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Department of Pathology and Legal Medicine, Federal University of Ceará. Rua Cel. Nunes de Melo, 1315 - Rodolfo Teófilo - CEP: 60430-275, Fortaleza, Ceará, Brazil
| | - José Alexandre Telmos Silva
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Department of Pathology and Legal Medicine, Federal University of Ceará. Rua Cel. Nunes de Melo, 1315 - Rodolfo Teófilo - CEP: 60430-275, Fortaleza, Ceará, Brazil
| | - Géssica Dos Santos Araújo
- Postgraduate Program in Veterinary Sciences, College of Veterinary, State University of Ceará. Av. Dr. Silas Munguba, 1700, Campus do Itaperi, CEP: 60714-903, Fortaleza, Ceará, Brazil
| | - Vandbergue Santos Pereira
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Department of Pathology and Legal Medicine, Federal University of Ceará. Rua Cel. Nunes de Melo, 1315 - Rodolfo Teófilo - CEP: 60430-275, Fortaleza, Ceará, Brazil
| | - Wilker Jose Perez Gotay
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Department of Pathology and Legal Medicine, Federal University of Ceará. Rua Cel. Nunes de Melo, 1315 - Rodolfo Teófilo - CEP: 60430-275, Fortaleza, Ceará, Brazil
| | - Jonathas Sales de Oliveira
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Department of Pathology and Legal Medicine, Federal University of Ceará. Rua Cel. Nunes de Melo, 1315 - Rodolfo Teófilo - CEP: 60430-275, Fortaleza, Ceará, Brazil
| | - Glaucia Morgana de Melo Guedes
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Department of Pathology and Legal Medicine, Federal University of Ceará. Rua Cel. Nunes de Melo, 1315 - Rodolfo Teófilo - CEP: 60430-275, Fortaleza, Ceará, Brazil
| | - Waldemiro Aquino Pereira-Neto
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Department of Pathology and Legal Medicine, Federal University of Ceará. Rua Cel. Nunes de Melo, 1315 - Rodolfo Teófilo - CEP: 60430-275, Fortaleza, Ceará, Brazil
| | - Débora de Souza Collares Maia Castelo-Branco
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Department of Pathology and Legal Medicine, Federal University of Ceará. Rua Cel. Nunes de Melo, 1315 - Rodolfo Teófilo - CEP: 60430-275, Fortaleza, Ceará, Brazil
| | - Rossana de Aguiar Cordeiro
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Department of Pathology and Legal Medicine, Federal University of Ceará. Rua Cel. Nunes de Melo, 1315 - Rodolfo Teófilo - CEP: 60430-275, Fortaleza, Ceará, Brazil
| | - José Júlio Costa Sidrim
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Department of Pathology and Legal Medicine, Federal University of Ceará. Rua Cel. Nunes de Melo, 1315 - Rodolfo Teófilo - CEP: 60430-275, Fortaleza, Ceará, Brazil
| | - Marcos Fábio Gadelha Rocha
- Specialized Medical Mycology Center, Postgraduate Program in Medical Microbiology, Department of Pathology and Legal Medicine, Federal University of Ceará. Rua Cel. Nunes de Melo, 1315 - Rodolfo Teófilo - CEP: 60430-275, Fortaleza, Ceará, Brazil
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Naicker SD, Mpembe RS, Maphanga TG, Zulu TG, Desanto D, Wadula J, Mvelase N, Maluleka C, Reddy K, Dawood H, Maloba M, Govender NP. Decreasing fluconazole susceptibility of clinical South African Cryptococcus neoformans isolates over a decade. PLoS Negl Trop Dis 2020; 14:e0008137. [PMID: 32231354 PMCID: PMC7108701 DOI: 10.1371/journal.pntd.0008137] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background Fluconazole is used in combination with amphotericin B for induction treatment of cryptococcal meningitis and as monotherapy for consolidation and maintenance treatment. More than 90% of isolates from first episodes of cryptococcal disease had a fluconazole minimum inhibitory concentration (MIC) ≤4 μg/ml in a Gauteng population-based surveillance study of Cryptococcus neoformans in 2007–2008. We assessed whether fluconazole resistance had emerged in clinical cryptococcal isolates over a decade. Methodology and principal findings We prospectively collected C. neoformans isolates from 1 January through 31 March 2017 from persons with a first episode of culture-confirmed cryptococcal disease at 37 South African hospitals. Isolates were phenotypically confirmed to C. neoformans species-complex level. We determined fluconazole MICs (range: 0.125 μg/ml to 64 μg/ml) of 229 C. neoformans isolates using custom-made broth microdilution panels prepared, inoculated and read according to Clinical and Laboratory Standards Institute M27-A3 and M60 recommendations. These MIC values were compared to MICs of 249 isolates from earlier surveillance (2007–2008). Clinical data were collected from patients during both surveillance periods. There were more males (61% vs 39%) and more participants on combination induction antifungal treatment (92% vs 32%) in 2017 compared to 2007–2008. The fluconazole MIC50, MIC90 and geometric mean MIC was 4 μg/ml, 8 μg/ml and 4.11 μg/ml in 2017 (n = 229) compared to 1 μg/ml, 2 μg/ml and 2.08 μg/ml in 2007–2008 (n = 249) respectively. Voriconazole, itraconazole and posaconazole Etests were performed on 16 of 229 (7%) C. neoformans isolates with a fluconazole MIC value of ≥16 μg/ml; only one had MIC values of >32 μg/ml for these three antifungal agents. Conclusions and significance Fluconazole MIC50 and MIC90 values were two-fold higher in 2017 compared to 2007–2008. Although there are no breakpoints, higher fluconazole doses may be required to maintain efficacy of standard treatment regimens for cryptococcal meningitis. Cryptococcus neoformans, a pathogenic fungal species-complex with an environmental niche, is the most common cause of meningitis among HIV-seropositive adults in sub-Saharan Africa. Fluconazole is recommended in combination with amphotericin B for induction treatment of cryptococcal meningitis and as monotherapy for consolidation and maintenance treatment. Fluconazole is also commonly prescribed to HIV-seropositive individuals for other indications; fluconazole exposure may result in secondary resistance if patients have concurrent active cryptococcal disease. Azole fungicides used in agriculture may potentially drive primary cryptococcal resistance when the fungus is exposed to these fungicides in the environment. We aimed to determine fluconazole MICs in 2017 and compare these values to those obtained in a 2007–2008 South African survey to assess whether fluconazole resistance had emerged in C. neoformans over a decade. We found that the proportion of isolates with an MIC of ≥16 μg/ml increased from 0% in 2007–2008 to 7% in 2017. MIC50 and MIC90 values were also two-fold higher in 2017 compared to 2007–2008. These study findings provided evidence for higher fluconazole dose recommendations (in combination with amphotericin B for the induction phase and as monotherapy for consolidation and maintenance phases) in the 2019 Southern African guideline for HIV-associated cryptococcosis.
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Affiliation(s)
- Serisha D. Naicker
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Ruth S. Mpembe
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Tsidiso G. Maphanga
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Medical Microbiology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Thokozile G. Zulu
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Daniel Desanto
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeannette Wadula
- National Health Laboratory Service, Microbiology Laboratory, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Nomonde Mvelase
- National Health Laboratory Service, Department of Medical Microbiology, RK Khan Hospital, Durban, South Africa
| | - Caroline Maluleka
- National Health Laboratory Service, Microbiology Laboratory, Dr George Mukhari Academic Hospital, Pretoria, South Africa
| | - Kessendri Reddy
- National Health Laboratory Service, Microbiology Laboratory, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Halima Dawood
- National Health Laboratory Service, Microbiology Laboratory, Edendale Hospital, Pietermaritzburg, South Africa
| | - Motlatji Maloba
- National Health Laboratory Service, Department of Medical Microbiology, Universitas Academic Laboratory Complex, Bloemfontein, South Africa
| | - Nelesh P. Govender
- National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Echieh C, Nwagboso C, Ogbudu S, Eze J, Ochang E, Jibrin P, Etiuma A, Bassey O. Invasive Pulmonary Cryptococcal Infection Masquerading as Lung Cancer with Brain Metastases: A Case Report. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:30-34. [PMID: 35531582 PMCID: PMC9067635 DOI: 10.4103/jwas.jwas_47_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/04/2022] [Indexed: 11/05/2022]
Abstract
Cryptococcosis, a global disease problem, seen frequently in the immuno-suppressed, also affects patients without apparent immuno-suppression. Pulmonary cryptococcosis patients often present as cryptococcal pneumonia, whereas intracranial cryptococcosis presents with meningitis. We present a 33-year-old immunocompetent man, diagnosed with invasive pulmonary cryptococcal disease with spread to the brain. This case is unique because the patient was previously treated for tuberculosis and presented with typical bronchopulmonary thoracic, extra-thoracic as well as computed tomography (CT) scan features suggestive of lung cancer. Cryptococcosis was diagnosed by identification of oval thick-walled yeast on histology of lung biopsy specimen. The patient was treated with flucytosine and fluconazole initially and subsequently with Amphotericin B and fluconazole. He made clinical improvement with the resolution of symptoms but had residual radiological features. Invasive cryptococcosis affecting the lung and brain may present with a clinical picture similar to metastatic lung cancer. We recommend routine fungal stains and fungal culture in suspected cases.
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Affiliation(s)
- Chidiebere Echieh
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria,Address for correspondence: Dr. Chidiebere Peter Echieh, Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria. E-mail:
| | - Chimaobi Nwagboso
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Stephen Ogbudu
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - John Eze
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Ernest Ochang
- Department of Microbiology, University of Calabar, Calabar, Cross River State, Nigeria
| | - Paul Jibrin
- Department of Pathology, National Hospital, Abuja, Nigeria
| | - Anietimfon Etiuma
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Okon Bassey
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
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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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Maybruck BT, Lam WC, Specht CA, Ilagan MXG, Donlin MJ, Lodge JK. The Aminoalkylindole BML-190 Negatively Regulates Chitosan Synthesis via the Cyclic AMP/Protein Kinase A1 Pathway in Cryptococcus neoformans. mBio 2019; 10:e02264-19. [PMID: 31848271 PMCID: PMC6918072 DOI: 10.1128/mbio.02264-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023] Open
Abstract
Cryptococcus neoformans can cause fatal meningoencephalitis in patients with AIDS or other immunocompromising conditions. Current antifungals are suboptimal to treat this disease; therefore, novel targets and new therapies are needed. Previously, we have shown that chitosan is a critical component of the cryptococcal cell wall and is required for survival in the mammalian host and that chitosan deficiency results in rapid clearance from the mammalian host. We had also identified several specific proteins that were required for chitosan biosynthesis, and we hypothesize that screening for compounds that inhibit chitosan biosynthesis would identify additional genes/proteins that influence chitosan biosynthesis. To identify these compounds, we developed a robust and novel cell-based flow cytometry screening method to identify small-molecule inhibitors of chitosan production. We screened the ICCB Known Bioactives library and identified 8 compounds that reduced chitosan in C. neoformans We used flow cytometry-based counterscreens and confirmatory screens, followed by a biochemical secondary screen to refine our primary screening hits to 2 confirmed hits. One of the confirmed hits that reduced chitosan content was the aminoalkylindole BML-190, a known inverse agonist of mammalian cannabinoid receptors. We demonstrated that BML-190 likely targets the C. neoformans G-protein-coupled receptor Gpr4 and, via the cyclic AMP (cAMP)/protein kinase A (PKA) signaling pathway, contributes to an intracellular accumulation of cAMP that results in decreased chitosan. Our discovery suggests that this approach could be used to identify additional compounds and pathways that reduce chitosan biosynthesis and could lead to potential novel therapeutics against C. neoformansIMPORTANCECryptococcus neoformans is a fungal pathogen that kills ∼200,000 people every year. The cell wall is an essential organelle that protects fungi from the environment. Chitosan, the deacetylated form of chitin, has been shown to be an essential component of the cryptococcal cell wall during infection of a mammalian host. In this study, we screened a set of 480 compounds, which are known to have defined biological activities, for activity that reduced chitosan production in C. neoformans Two of these compounds were confirmed using an alternative method of measuring chitosan, and one of these was demonstrated to impact the cAMP signal transduction pathway. This work demonstrates that the cAMP pathway regulates chitosan biosynthesis in C. neoformans and validates that this screening approach could be used to find potential antifungal agents.
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Affiliation(s)
- Brian T Maybruck
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Woei C Lam
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Charles A Specht
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ma Xenia G Ilagan
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Maureen J Donlin
- Department of Biochemistry and Molecular Biology, Saint Louis University, St. Louis, Missouri, USA
| | - Jennifer K Lodge
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Zhang Y, Cooper B, Gui X, Sherer R, Cao Q. Clinical diversity of invasive cryptococcosis in AIDS patients from central China: report of two cases with review of literature. BMC Infect Dis 2019; 19:1003. [PMID: 31775716 PMCID: PMC6882200 DOI: 10.1186/s12879-019-4634-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/13/2019] [Indexed: 01/09/2023] Open
Abstract
Background Although antiretroviral therapy (ART) has greatly improved the prognosis of acquired immunodeficiency syndrome (AIDS) patients globally, opportunistic infections (OIs) are still common in Chinese AIDS patients, especially cryptococcosis. Case presentation We described here two Chinese AIDS patients with cryptococcal infections. Case one was a fifty-year-old male. At admission, he was conscious and oriented, with papulonodular and umbilicated skin lesions, some with ulceration and central necrosis resembling molluscum contagiosum. The overall impression reminded us of talaromycosis: we therefore initiated empirical treatment with amphotericin B, even though the case history of this patient did not support such a diagnosis. On the second day of infusion, the patient complained of intermittent headache, but the brain CT revealed no abnormalities. On the third day, a lumbar puncture was performed. The cerebral spinal fluid (CSF) was turbid, with slightly increased pressure. India ink staining was positive, but the cryptococcus antigen latex agglutination test (CrAgLAT: IMMY, USA) was negative. Two days later, the blood culture showed a growth of Cryptococcus neoformans, and the same result came from the skin culture. We added fluconazole to the patient’s treatment, but unfortunately, he died three days later. Case two was a sixty-four-year-old female patient with mild fever, productive cough, dyspnea upon movement, and swelling in both lower limbs. The patient was empirically put on cotrimoxazole per os and moxifloxacin by infusion. A bronchofibroscopy was conducted with a fungal culture, showing growth of Cryptococcus laurentii colonies. Amphotericin B was started thereafter but discontinued three days later in favor of fluconazole 400 mg/d due to worsening renal function. The patient became afebrile after 72 h of treatment with considerable improvement of other comorbidities and was finally discharged with continuing oral antifungal therapy. Conclusions Our cases illustrate that cryptococcal disease is an important consideration when treating immunocompromised individuals such as AIDS patients. Life threatening meningitis or meningoencephalitis caused by C. neoformansmay still common in these populations and can vary greatly in clinical presentations, especially with regard to skin lesions. Pulmonary cryptococcosis caused by C. laurentii is rare, but should also be considered in certain contexts. Guidelines for its earlier diagnosis, treatment and prophylaxis are needed.
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Affiliation(s)
- Yongxi Zhang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Brian Cooper
- Section of Infectious Diseases and Global Health, University of Chicago, 5841 S. Maryland Avenue, MC5065, Chicago, IL, 60637, USA
| | - Xi'en Gui
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Renslow Sherer
- Section of Infectious Diseases and Global Health, University of Chicago, 5841 S. Maryland Avenue, MC5065, Chicago, IL, 60637, USA
| | - Qian Cao
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
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Sood R, Tyagi R, Selhi P, Kaur H, Sood N. Cerebrospinal fluid pleocytosis in immunocompromised patients: Can it be Cryptococcus. Diagn Cytopathol 2019; 48:164-168. [PMID: 31714023 DOI: 10.1002/dc.24340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/31/2019] [Accepted: 10/28/2019] [Indexed: 11/07/2022]
Abstract
Cryptococcal meningitis commonly affects immunocompromised cases and can have varied presentation. In some instances, the presence of a plethora of inflammatory cells on cerebrospinal fluid (CSF) in an immunosuppressed patient can lead to further investigations, which unravel the presence of cryptococcal meningitis. The aim of this retrospective study was to analyze the spectrum of CSF findings of immunosuppressed patients who were diagnosed to have cryptococcal meningitis. Retrospective analysis of CSF cytospin slides exhibiting pleocytosis and belonging to immunocompromised patients was performed, and these cases were found to have cryptococcal meningitis. Out of 932 cases of CSF (January 2016-July 2017), 10 had pleocytosis and 5 of these 10 cases demonstrated spores of Cryptococcus. Male-to-female ratio was 1:1.5. All the patients were immunocompromised and had CSF leukocytosis. Lymphocytes and monocytes were present in all samples while only one case showed plasma cells. Spores of Cryptococcus were also noted in all the cases and highlighted on India Ink Preparation and Gomori Methenamine Silver stain. All the cases were positive for agglutination-based cryptococcal antigen assay, except one where the test was not done. All immunosuppressed patients having pleocytosis in CSF were found to have cryptococcal infection. Therefore, pleocytosis in CSF in any immunosuppressed patient should raise the suspicion of cryptococcal meningitis. The pathologist and the clinician need to be vigilant in such scenarios to rule out any opportunistic infection and investigate the patient thoroughly for any underlying immunosuppression.
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Affiliation(s)
- Ridhi Sood
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana
| | - Ruchita Tyagi
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Pavneet Selhi
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Harpreet Kaur
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Neena Sood
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh
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Setianingrum F, Rautemaa-Richardson R, Denning DW. Pulmonary cryptococcosis: A review of pathobiology and clinical aspects. Med Mycol 2019; 57:133-150. [PMID: 30329097 DOI: 10.1093/mmy/myy086] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/05/2018] [Indexed: 01/13/2023] Open
Abstract
Pulmonary cryptococcosis is an important opportunistic invasive mycosis in immunocompromised patients, but it is also increasingly seen in immunocompetent patients. The main human pathogens are Cryptococcus neoformans and C. gattii, which have a worldwide distribution. In contrast to cryptococcal meningitis, pulmonary cryptococcosis is still underdiagnosed because of limitations in diagnostic tools. It can mimic lung cancer, pulmonary tuberculosis, bacterial pneumonia, and other pulmonary mycoses both clinically and radiologically. Pulmonary nodules are the most common radiological feature, but these are not specific to pulmonary cryptococcosis. The sensitivity of culture of respiratory samples for Cryptococcus is poor and a positive result may also reflect colonisation. Cryptococcal antigen (CrAg) with lateral flow device is a fast and sensitive test and widely used on serum and cerebrospinal fluid, but sera from patients with pulmonary cryptococcosis are rarely positive in the absence of disseminated disease. Detection of CrAg from respiratory specimens might assist the diagnosis of pulmonary cryptococcosis but there are very few data. Molecular detection techniques such as multiplex reverse transcription polymerase chain reaction (RT-PCR) could also provide better sensitivity but these still require validation for respiratory specimens. The first line of treatment for pulmonary cryptococcosis is fluconazole, or amphotericin B and flucytosine for those with central nervous system involvement. Pulmonary cryptococcosis worsens the prognosis of cryptococcal meningitis. In this review, we summarize the biological aspects of Cryptococcus and provide an update on the diagnosis and management of pulmonary cryptococcosis.
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Affiliation(s)
- Findra Setianingrum
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, UK
- Parasitology Department, Universitas Indonesia, Jakarta, Indonesia
| | - Riina Rautemaa-Richardson
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, UK
- Mycology Reference Centre Manchester, ECMM Centre of Excellence in Clinical and Laboratory Mycology and Clinical Studies, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Infectious Diseases, Wythenshawe Hospital Manchester University NHS Foundation Trust, Manchester, UK
| | - David W Denning
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, UK
- Department of Infectious Diseases, Wythenshawe Hospital Manchester University NHS Foundation Trust, Manchester, UK
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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de Sá NP, de Barros PP, Junqueira JC, Vaz JA, de Oliveira RB, Rosa CA, Santos DA, Johann S. Thiazole derivatives act on virulence factors of Cryptococcus spp. Med Mycol 2019; 57:84-91. [PMID: 29471408 DOI: 10.1093/mmy/myx158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 12/06/2017] [Indexed: 01/16/2023] Open
Abstract
Cryptococcosis is an opportunistic or primary fungal infection considered to be the most prevalent fatal fungal disease worldwide. Owing to the limited number of available drugs, it is necessary to search for novel antifungal compounds. In the present work, we assessed the antifungal efficacy of three thiazole derivatives (1, 2, and 3). We conducted in vitro and in vivo assays to investigate their effects on important virulence factors, such as capsule and biofilm formation. In addition, the phagocytosis index of murine macrophages exposed to compounds 1, 2, and 3 and the in vivo efficacy of 1, 2, and 3 in Galleria mellonella infected with Cryptococcus spp. were evaluated. All compounds exhibited antifungal activity against biofilms and demonstrated a reduction in biofilm metabolic activity by 43-50% for C. gattii and 26-42% for C. neoformans. Thiazole compounds promoted significant changes in the capsule thickness of C. gattii compared to that of C. neoformans. Further examination of these compounds suggests that they can improve the phagocytosis process of peritoneal murine macrophages in vitro, causing an increase in the phagocytosis rate. Survival percentage was examined in the invertebrate model Galleria mellonella larvae, and only compound 3 could increase the survival at doses of 5 mg/kg after infection with C. gattii (P = .0001) and C. neoformans (P = .0007), similar to fluconazole at 10 mg/kg. The results demonstrated that thiazole compounds, mainly compound 3, have potential to be used for future studies in the search for new therapeutics for cryptococcosis.
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Affiliation(s)
- Nívea Pereira de Sá
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Patrícia Pimentel de Barros
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, Univ Estadual de São Paulo, São José dos Campos, São Paulo, Brazil
| | - Juliana Campos Junqueira
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, Univ Estadual de São Paulo, São José dos Campos, São Paulo, Brazil
| | - Jéssica Aparecida Vaz
- Department of Pharmaceutical Products, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Renata Barbosa de Oliveira
- Department of Pharmaceutical Products, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carlos Augusto Rosa
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Daniel Assis Santos
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Susana Johann
- Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Concurrent Persistent Cryptococcosis and Mycobacterium avium Complex Infections in a Patient With Human Immunodeficiency Virus. Ochsner J 2019; 19:169-173. [PMID: 31258430 DOI: 10.31486/toj.17.0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Fungal infections are known for their chronicity and latency and are difficult to eradicate. The pathophysiology of these invading pathogens and the resulting alteration of the immune system are not fully understood. Fungal meningitis is associated with significant rates of morbidity and mortality, especially among immunocompromised patients. Cryptococcosis, an infection secondary to the fungus Cryptococcus, is one of the most important opportunistic infections among patients with human immunodeficiency virus (HIV), and expediting treatment is crucial. Case Report: We report the case of a 28-year-old male with HIV who had a simultaneous co-infection with cryptococcal meningitis and Mycobacterium avium complex (MAC). The patient required a 2-week induction phase of antifungal medication with amphotericin B and flucytosine. Despite aggressive initial therapy and the patient's significant clinical improvement, his radiologic findings and lumbar puncture showed persistent cryptococcal infection. Conclusion: Concurrent infection with cryptococcosis and MAC is extremely rare even in immunosuppressed patients. In our case, the concurrent infection was associated with a prolonged course of therapy during the induction phase for cryptococcosis.
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Al-Abbasi FA, Sadath S, Mushtaq G, Anwar F. Vitamin B combination reduces fluconazole toxicity in Wistar rats. Daru 2019; 27:525-531. [DOI: 10.1007/s40199-019-00252-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022] Open
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Vukićević T, Hinze C, Baltzer S, Himmerkus N, Quintanova C, Zühlke K, Compton F, Ahlborn R, Dema A, Eichhorst J, Wiesner B, Bleich M, Schmidt-Ott KM, Klussmann E. Fluconazole Increases Osmotic Water Transport in Renal Collecting Duct through Effects on Aquaporin-2 Trafficking. J Am Soc Nephrol 2019; 30:795-810. [PMID: 30988011 DOI: 10.1681/asn.2018060668] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/13/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Arginine-vasopressin (AVP) binding to vasopressin V2 receptors promotes redistribution of the water channel aquaporin-2 (AQP2) from intracellular vesicles into the plasma membrane of renal collecting duct principal cells. This pathway fine-tunes renal water reabsorption and urinary concentration, and its perturbation is associated with diabetes insipidus. Previously, we identified the antimycotic drug fluconazole as a potential modulator of AQP2 localization. METHODS We assessed the influence of fluconazole on AQP2 localization in vitro and in vivo as well as the drug's effects on AQP2 phosphorylation and RhoA (a small GTPase, which under resting conditions, maintains F-actin to block AQP2-bearing vesicles from reaching the plasma membrane). We also tested fluconazole's effects on water flow across epithelia of isolated mouse collecting ducts and on urine output in mice treated with tolvaptan, a VR2 blocker that causes a nephrogenic diabetes insipidus-like excessive loss of hypotonic urine. RESULTS Fluconazole increased plasma membrane localization of AQP2 in principal cells independent of AVP. It also led to an increased AQP2 abundance associated with alterations in phosphorylation status and ubiquitination as well as inhibition of RhoA. In isolated mouse collecting ducts, fluconazole increased transepithelial water reabsorption. In mice, fluconazole increased collecting duct AQP2 plasma membrane localization and reduced urinary output. Fluconazole also reduced urinary output in tolvaptan-treated mice. CONCLUSIONS Fluconazole promotes collecting duct AQP2 plasma membrane localization in the absence of AVP. Therefore, it might have utility in treating forms of diabetes insipidus (e.g., X-linked nephrogenic diabetes insipidus) in which the kidney responds inappropriately to AVP.
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Affiliation(s)
- Tanja Vukićević
- Max Delbrück Center for Molecular Medicine Berlin, (MDC), Research area Cardiovascular & Metabolic Disease, Berlin, Germany
| | - Christian Hinze
- Max Delbrück Center for Molecular Medicine Berlin, (MDC), Research area Cardiovascular & Metabolic Disease, Berlin, Germany.,Department of Nephrology and Medical Intensive Care and.,Berlin Institute of Health, Berlin, Germany
| | - Sandrine Baltzer
- Max Delbrück Center for Molecular Medicine Berlin, (MDC), Research area Cardiovascular & Metabolic Disease, Berlin, Germany
| | - Nina Himmerkus
- Institute of Physiology, Christian Albrechts University Kiel, Kiel, Germany
| | | | - Kerstin Zühlke
- Max Delbrück Center for Molecular Medicine Berlin, (MDC), Research area Cardiovascular & Metabolic Disease, Berlin, Germany
| | - Friederike Compton
- Department of Nephrology and Medical Intensive Care and.,Berlin Institute of Health, Berlin, Germany
| | - Robert Ahlborn
- Information Technology Department, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alessandro Dema
- Max Delbrück Center for Molecular Medicine Berlin, (MDC), Research area Cardiovascular & Metabolic Disease, Berlin, Germany
| | - Jenny Eichhorst
- Leibniz-Forschungsinstitut für Molekulare Pharmakologie (FMP), Cellular Imaging, Berlin, Germany
| | - Burkhard Wiesner
- Leibniz-Forschungsinstitut für Molekulare Pharmakologie (FMP), Cellular Imaging, Berlin, Germany
| | - Markus Bleich
- Institute of Physiology, Christian Albrechts University Kiel, Kiel, Germany
| | - Kai M Schmidt-Ott
- Max Delbrück Center for Molecular Medicine Berlin, (MDC), Research area Cardiovascular & Metabolic Disease, Berlin, Germany; .,Department of Nephrology and Medical Intensive Care and.,Berlin Institute of Health, Berlin, Germany
| | - Enno Klussmann
- Max Delbrück Center for Molecular Medicine Berlin, (MDC), Research area Cardiovascular & Metabolic Disease, Berlin, Germany; .,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany; and.,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Vegetative Physiology, Berlin, Germany
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Marino A, Caltabiano E, Zagami A, Onorante A, Zappalà C, Locatelli ME, Pampaloni A, Scuderi D, Bruno R, Cacopardo B. Rapid emergence of cryptococcal fungemia, Mycobacterium chelonae vertebral osteomyelitis and gastro intestinal stromal tumor in a young HIV late presenter: a case report. BMC Infect Dis 2018; 18:693. [PMID: 30587143 PMCID: PMC6307234 DOI: 10.1186/s12879-018-3573-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 11/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background Highly active antiretroviral therapy has significantly changed the natural history of HIV infection, leading to a dramatic reduction of HIV-related morbidity and mortality. Late Presenters, Very Late Presenters and AIDS presenters still represent, also in Europe, including Italy, a huge challenge in terms of diagnostic and therapeutic management. Case presentation A 35-year-old male with a history of fever and back pain. HIV test resulted positive with a high HIV Viral Load and a very low T-CD4 number of cells (5 cells/mm3). Imaging investigations revealed multiple vertebral and pulmonary lesions together with abdominal and thoracic lymphadenopathy. Blood cultures were positive for Cryptococcus neoformans and for Staphylococcus haemolyticus. Lymphnode biopsy resulted positive in PCR for Non-Tuberculosis Mycobacteria (Mycobacterium chelonae). A gastric biopsy also revealed a GIST. The patient also had CMV DNA positive. Although we performed antiretroviral therapy and specific-therapies for each disease, he was transferred to intensive care unit where he died due to an Acute Respiratory Distress Syndrome. Conclusion The reported case is unusual due to the relevant number of opportunistic diseases (both infectious and tumoral) emerging not long after the HIV infection had been diagnosed. Late presenters HIV patients and AIDS presenters still represent a challenge, which is often too complex for clinicians to deal with. In spite of proper management, the risk of suboptimal results cannot be excluded. Electronic supplementary material The online version of this article (10.1186/s12879-018-3573-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Marino
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy.
| | - Eleonora Caltabiano
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Aldo Zagami
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Anna Onorante
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Carmela Zappalà
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Maria Elena Locatelli
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Alessio Pampaloni
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Daniele Scuderi
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Roberto Bruno
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Bruno Cacopardo
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
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A phenylthiazole derivative demonstrates efficacy on treatment of the cryptococcosis & candidiasis in animal models. Future Sci OA 2018; 4:FSO305. [PMID: 30057783 PMCID: PMC6060395 DOI: 10.4155/fsoa-2018-0001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/08/2018] [Indexed: 12/16/2022] Open
Abstract
Aim: In this work we test 2-(2-(cyclohexylmethylene)hydrazinyl)-4-phenylthiazole (CHT) against Cryptococcus spp. and Candida albicans. Methods: The ability of CHT to act in biofilm and also to interfere with C. albicans adhesion was evaluated, as well as the efficiency of the CHT in cryptococcosis and candidiasis invertebrate and murine models. Results & conclusion: In the present work we verified that CHT is found to inhibit Cryptococcus and C. albicans affecting biofilm in both and inhibited adhesion of Candida to human buccal cells. When we evaluated in vivo, CHT prolonged survival of Galleria mellonella after infections with Cryptococcusgattii, Cryptococcusneoformans or C. albicans and promoted a reduction in the fungal burden to the organs in the murine models. These results demonstrate CHT therapeutic potential. Candida spp. and Cryptococcus spp. cause thousands of deaths each year. In general, antifungal drugs have several limitations to their use, and there are a limited number of these drugs available to be used in the treatments of fungal diseases. This work contributes to the search for new antifungal drugs for the treatment of candidiasis and cryptococcosis, aiming in the future, after all necessary tests, to serve as a basis for the production of drugs that could be used in the treatment of patients with these fungal diseases.
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Monapathi ME, Bezuidenhout CC, Rhode OHJ. Efflux pumps genes of clinical origin are related to those from fluconazole-resistant Candida albicans isolates from environmental water. WATER SCIENCE AND TECHNOLOGY : A JOURNAL OF THE INTERNATIONAL ASSOCIATION ON WATER POLLUTION RESEARCH 2018; 77:899-908. [PMID: 29488953 DOI: 10.2166/wst.2017.607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Efflux pumps coded for by CDR1, CDR2, FLU1 and MDR1 genes could be responsible for the observed resistant phenotypes in azole-resistant Candida albicans from environmental water. This was demonstrated for clinical isolates. The aim of this study was to determine the presence and genetic similarity between efflux pump genes from clinical and environmental C. albicans isolates. Yeasts were isolated and identified using 26S rRNA gene sequencing. Disk diffusion tests were conducted. PCR was used to detect the presence of efflux genes. The fragments were sequenced and subjected to BLAST and subsequent phylogenetic analysis. Thirty seven C. albicans were identified from five selected rivers; Mooi River (19 isolates), Harts River (9 isolates), Marico River (5 isolates), Crocodile River (3 isolates) and Schoonspruit River (1 isolate). All the isolates were completely resistant to azoles. Efflux pump genes were detected in most (≥60%) of the isolates. Phylogenetic analysis showed high sequence similarity between sequences from environmental isolates and clinical isolates. Resistance to the azoles and the detection of efflux pump genes renders these antifungal agents ineffective. This is a major problem, particularly for the immune-compromised sector of the community of the North West Province and warrants further investigation.
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Affiliation(s)
- M E Monapathi
- Unit for Environmental Science and Management - Microbiology, North-West University: Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, South Africa E-mail:
| | - C C Bezuidenhout
- Unit for Environmental Science and Management - Microbiology, North-West University: Potchefstroom Campus, Private Bag X6001, Potchefstroom 2520, South Africa E-mail:
| | - O H J Rhode
- Agricultural Research Council-Grain Crops, Potchefstroom, South Africa
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Villanueva-Lozano H, Treviño-Rangel RDJ, González GM, Hernández-Rodríguez PA, Camacho-Ortiz A, Castillo-Reyna L, Galindo-Alvarado SG, Martínez-Reséndez MF. Clinical evaluation of the antifungal effect of sertraline in the treatment of cryptococcal meningitis in HIV patients: a single Mexican center experience. Infection 2017; 46:25-30. [PMID: 28815430 DOI: 10.1007/s15010-017-1059-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/10/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Cryptococcal meningitis is a potentially fatal fungal infection associated with a significant attributable morbidity and mortality, especially among HIV/AIDS patients. The first-line therapy for the treatment of this clinical entity is the combinatory therapy of amphotericin B plus flucytosine. However, the high cost, toxic effects, and limited repertoire of effective antifungal drugs have led to the investigation of novel molecules. This is a prospective, double-blinded, and randomized study performed in a Mexican tertiary care center to evaluate the antifungal activity of sertraline in the treatment of cryptococcal meningitis in HIV patients. METHODS During June 2015-December 2016, patients were recruited and included in one of two study groups: group A was given standard antifungal treatment plus sertraline 200 mg/day, while group B was given standard antifungal plus placebo. Lumbar punctures were performed on days 0, 7, and 14 of the study, and cryptococcal antigenemia and quantitative fungal culture in cerebrospinal fluid at each time point were evaluated to measure the rate of fungal clearance. RESULTS The fungal loads and cryptococcal antigenemia titers showed a marked tendency to decrease by day 14 in both groups. Otherwise, group B exhibited a slightly higher nonstatistical rate of fungal clearance (-0.2868 ± 0.08275 log CFU/ml/day) than group A (-0.2496 ± 0.08340 log CFU/ml/day). CONCLUSIONS A statistical difference between study groups was not found. This is the first study in Latin America that reports the experience of using sertraline as an adjuvant in the antifungal management of cryptococcal meningitis in HIV patients.
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Affiliation(s)
- Hiram Villanueva-Lozano
- Department of Microbiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
- Infectious Diseases Service, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Av. Francisco I. Madero and Dr. José E. González s/n. Mitras Centro, Monterrey, 64460, Nuevo Leon, Mexico
| | - Rogelio de J Treviño-Rangel
- Department of Microbiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Gloria M González
- Department of Microbiology, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Pedro A Hernández-Rodríguez
- Infectious Diseases Service, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Av. Francisco I. Madero and Dr. José E. González s/n. Mitras Centro, Monterrey, 64460, Nuevo Leon, Mexico
| | - Adrián Camacho-Ortiz
- Infectious Diseases Service, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Av. Francisco I. Madero and Dr. José E. González s/n. Mitras Centro, Monterrey, 64460, Nuevo Leon, Mexico
| | - Luis Castillo-Reyna
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo Leon, Mexico
| | - Sandra G Galindo-Alvarado
- Infectious Diseases Service, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Av. Francisco I. Madero and Dr. José E. González s/n. Mitras Centro, Monterrey, 64460, Nuevo Leon, Mexico
| | - Michel F Martínez-Reséndez
- Infectious Diseases Service, Department of Internal Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Av. Francisco I. Madero and Dr. José E. González s/n. Mitras Centro, Monterrey, 64460, Nuevo Leon, Mexico.
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