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Roosen L, Maes D, Musetta L, Himmelreich U. Preclinical Models for Cryptococcosis of the CNS and Their Characterization Using In Vivo Imaging Techniques. J Fungi (Basel) 2024; 10:146. [PMID: 38392818 PMCID: PMC10890286 DOI: 10.3390/jof10020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Infections caused by Cryptococcus neoformans and Cryptococcus gattii remain a challenge to our healthcare systems as they are still difficult to treat. In order to improve treatment success, in particular for infections that have disseminated to the central nervous system, a better understanding of the disease is needed, addressing questions like how it evolves from a pulmonary to a brain disease and how novel treatment approaches can be developed and validated. This requires not only clinical research and research on the microorganisms in a laboratory environment but also preclinical models in order to study cryptococci in the host. We provide an overview of available preclinical models, with particular emphasis on models of cryptococcosis in rodents. In order to further improve the characterization of rodent models, in particular the dynamic aspects of disease manifestation, development, and ultimate treatment, preclinical in vivo imaging methods are increasingly used, mainly in research for oncological, neurological, and cardiac diseases. In vivo imaging applications for fungal infections are rather sparse. A second aspect of this review is how research on models of cryptococcosis can benefit from in vivo imaging methods that not only provide information on morphology and tissue structure but also on function, metabolism, and cellular properties in a non-invasive way.
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Affiliation(s)
- Lara Roosen
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
| | - Dries Maes
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
| | - Luigi Musetta
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
| | - Uwe Himmelreich
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
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2
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Acharya S, Allam RR, Karanjkar VK, Rathod D, Mahajan R, Deshpande P, Palkar A, Todmal S, Koli S, Dhande S, Dale J, Yeldandi VV, Harshana A, Agarwal R, Upadhyaya S, Nyendak M. Implementation of point-of-care testing and prevalence of cryptococcal antigenaemia among patients with advanced HIV disease in Mumbai, India. BMJ Open 2023; 13:e070500. [PMID: 37349096 PMCID: PMC10314426 DOI: 10.1136/bmjopen-2022-070500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES To describe the implementation of screening for cryptococcal antigenaemia by point-of-care (POC) serum cryptococcal antigen (CrAg) lateral flow assay, measure the prevalence and factors associated with serum cryptococcal antigenaemia in the routine programmatic setting. DESIGN Cross-sectional study. SETTING Seventeen publicly funded antiretroviral therapy (ART) centres in Mumbai, India. PARTICIPANTS Serum CrAg screening was offered to all adolescents (>10 years of age) and adults with advanced HIV disease (AHD) (CD4 <200 cells/mm3 or with WHO clinical stage III/IV) regardless of symptoms of cryptococcal meningitis. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was to describe the implementation of serum CrAg screening and secondary outcome was to measure the prevalence of serum cryptococcal antigenaemia and its risk factors. RESULTS A total of 2715 patients with AHD were tested for serum CrAg by POC assay. Of these, 25 (0.9%) had a CrAg positive result. Among CrAg-positive patients, only one had symptoms. Serum CrAg positivity was 3.6% (6/169) and 1.6% (6/520) among those presenting with CD4 <100 cells/mm3 in the treatment naïve and treatment experienced group, respectively. On multivariable analysis, CD4 count <100 cells/mm3 (OR: 2.3, 95% CI 1.01 to 5.3; p=0.05) and people living with HIV who were treatment naïve (OR: 2.5, 95% CI 1.04 to 6.0; p=0.04) were significantly associated with a positive serum CrAg result. Lumbar puncture was obtained in 20/25 patients within 4 days (range: 1-4 days) of positive serum CrAg result and one person was confirmed to have meningitis. All serum CrAg-positive patients who had a negative cerebrospinal fluid CrAg were offered pre-emptive therapy. CONCLUSIONS Implementation of a POC CrAg assay was possible with existing ART centre staff. Initiation of pre-emptive therapy and management of cryptococcal antigenaemia are operationally feasible at ART centres. The Indian National AIDS Control Programme may consider reflexive CrAg screening of all AHD patients with CD4 <100 cells/mm3.
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Affiliation(s)
| | - Ramesh Reddy Allam
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Delhi, India
| | | | | | - Raman Mahajan
- International Training and Education HIV (I-TECH), Delhi, India
| | | | - Amol Palkar
- International Training and Education HIV (I-TECH), Delhi, India
| | | | - Sagar Koli
- International Training and Education HIV (I-TECH), Delhi, India
| | - Sachin Dhande
- International Training and Education HIV (I-TECH), Delhi, India
| | | | | | - Amit Harshana
- International Training and Education HIV (I-TECH), Delhi, India
| | - Reshu Agarwal
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Delhi, India
| | - Sunita Upadhyaya
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Delhi, India
| | - Melissa Nyendak
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Delhi, India
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Nelson BN, Daugherty CS, Sharp RR, Booth JL, Patel VI, Metcalf JP, Jones KL, Wozniak KL. Protective interaction of human phagocytic APC subsets with Cryptococcus neoformans induces genes associated with metabolism and antigen presentation. Front Immunol 2022; 13:1054477. [PMID: 36466930 PMCID: PMC9709479 DOI: 10.3389/fimmu.2022.1054477] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/25/2022] [Indexed: 09/01/2023] Open
Abstract
Cryptococcal meningitis is the most common cause of meningitis among HIV/AIDS patients in sub-Saharan Africa, and worldwide causes over 223,000 cases leading to more than 181,000 annual deaths. Usually, the fungus gets inhaled into the lungs where the initial interactions occur with pulmonary phagocytes such as dendritic cells and macrophages. Following phagocytosis, the pathogen can be killed or can replicate intracellularly. Previous studies in mice showed that different subsets of these innate immune cells can either be antifungal or permissive for intracellular fungal growth. Our studies tested phagocytic antigen-presenting cell (APC) subsets from the human lung against C. neoformans. Human bronchoalveolar lavage was processed for phagocytic APCs and incubated with C. neoformans for two hours to analyze the initial interactions and fate of the fungus, living or killed. Results showed all subsets (3 macrophage and 3 dendritic cell subsets) interacted with the fungus, and both living and killed morphologies were discernable within the subsets using imaging flow cytometry. Single cell RNA-seq identified several different clusters of cells which more closely related to interactions with C. neoformans and its protective capacity against the pathogen rather than discrete cellular subsets. Differential gene expression analyses identified several changes in the innate immune cell's transcriptome as it kills the fungus including increases of TNF-α (TNF) and the switch to using fatty acid metabolism by upregulation of the gene FABP4. Also, increases of TNF-α correlated to cryptococcal interactions and uptake. Together, these analyses implicated signaling networks that regulate expression of many different genes - both metabolic and immune - as certain clusters of cells mount a protective response and kill the pathogen. Future studies will examine these genes and networks to understand the exact mechanism(s) these phagocytic APC subsets use to kill C. neoformans in order to develop immunotherapeutic strategies to combat this deadly disease.
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Affiliation(s)
- Benjamin N. Nelson
- Department of Microbiology and Molecular Genetics, Oklahoma State University, Stillwater, OK, United States
| | - Cheyenne S. Daugherty
- Department of Microbiology and Molecular Genetics, Oklahoma State University, Stillwater, OK, United States
| | - Rachel R. Sharp
- Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - J. Leland Booth
- Department of Medicine, Pulmonary, Critical Care & Sleep Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Vineet I. Patel
- Department of Medicine, Pulmonary, Critical Care & Sleep Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Jordan P. Metcalf
- Department of Medicine, Pulmonary, Critical Care & Sleep Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Veterans Affairs Medical Center, Oklahoma City, OK, United States
| | - Kenneth L. Jones
- Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Karen L. Wozniak
- Department of Microbiology and Molecular Genetics, Oklahoma State University, Stillwater, OK, United States
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de Oliveira FFM, Paredes V, de Sousa HR, D'Áurea Moura ÁN, Riasco-Palacios J, Casadevall A, Felipe MSS, Nicola AM. Thioredoxin Reductase 1 Is a Highly Immunogenic Cell Surface Antigen in Paracoccidioides spp., Candida albicans, and Cryptococcus neoformans. Front Microbiol 2020; 10:2930. [PMID: 31993026 PMCID: PMC6964600 DOI: 10.3389/fmicb.2019.02930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/05/2019] [Indexed: 11/16/2022] Open
Abstract
The increasing number of immunocompromised people has made invasive fungal infections more common. The antifungal armamentarium, in contrast, is limited to a few classes of drugs, with frequent toxicity and low efficacy pointing to the need for new agents. Antibodies are great candidates for novel antifungals, as their specificity can result in lower toxicity. Additionally, the immunomodulatory activity of antibodies could treat the underlying cause of many invasive mycoses, immune disfunction. In a previous comparative genomics study, we identified several potential targets for novel antifungals. Here we validate one of these targets, thioredoxin reductase (TRR1), to produce antibodies that could be useful therapeutic tools. Recombinant TRR1 proteins were produced by heterologous expression in Escherichia coli of genes encoding the proteins from Candida albicans, Cryptococcus neoformans, and Paracoccidioides lutzii. These proteins were then used to immunize mice, followed by detection of serum antibodies against them by ELISA and western blot. A first set of experiments in which individual mice were immunized repeatedly with TRR1 from a single species showed that all three were highly immunogenic, inducing mostly IgG1 antibodies, and that antibodies produced against one species cross-reacted with the others. In a second experiment, individual mice were immunized three times, each with the protein from a different species. The high titers of antibodies confirmed the presence of antigenic epitopes that were conserved in fungi but absent in humans. Immunofluorescence with sera from these immunized mice detected the protein in the cytoplasm and on the cell surface of fungi from all three species. These results validate TRR1 as a good target for potentially broad-spectrum antifungal antibodies.
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Affiliation(s)
- Fabiana Freire Mendes de Oliveira
- Faculty of Medicine, University of Brasília, Brasília, Brazil.,Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Verenice Paredes
- Faculty of Medicine, University of Brasília, Brasília, Brazil.,Karan Technologies Research and Development, Brasília, Brazil
| | | | - Ágata Nogueira D'Áurea Moura
- Department of Microbiology, Institute of Biomedical Sciences II, University of São Paulo, São Paulo, Brazil.,Department of Dermatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Maria Sueli Soares Felipe
- Graduate Program in Genomic Sciences and Biotechnology, Catholic University of Brasília, Brasília, Brazil
| | - André Moraes Nicola
- Faculty of Medicine, University of Brasília, Brasília, Brazil.,Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Karan Technologies Research and Development, Brasília, Brazil.,Graduate Program in Genomic Sciences and Biotechnology, Catholic University of Brasília, Brasília, Brazil
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Zimelewicz Oberman D, Patrucco L, Cuello Oderiz C. Central Nervous System Vasculitis for Cryptococcosis in an Immunocompetent Patient. Diseases 2018; 6:E75. [PMID: 30200288 PMCID: PMC6163809 DOI: 10.3390/diseases6030075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 08/25/2018] [Accepted: 08/28/2018] [Indexed: 02/03/2023] Open
Abstract
Cryptococcal meningitis is a life-threatening condition caused by a fungal pathogen, Cryptococcus neoformans, that can infect both immunosuppressed and immunocompetent hosts. It is an important cause of morbidity and mortality in severely immunodeficient patients. However, in an immunocompetent patient it represents a diagnostic challenge, mainly because it is extremely rare, but also because of its nonspecific clinical manifestation. Neurovascular involvement in cryptococcal meningitis is rare and not well known and only few reports have described this association. We describe a cryptococcal meningitis in an immunocompetent patient associated with central nervous system vasculitis.
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Affiliation(s)
| | - Liliana Patrucco
- Department of Neurology, Hospital Italiano de Buenos Aires, Potosí 1199, Argentina.
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Sorrell TC, Juillard PG, Djordjevic JT, Kaufman-Francis K, Dietmann A, Milonig A, Combes V, Grau GER. Cryptococcal transmigration across a model brain blood-barrier: evidence of the Trojan horse mechanism and differences between Cryptococcus neoformans var. grubii strain H99 and Cryptococcus gattii strain R265. Microbes Infect 2015; 18:57-67. [PMID: 26369713 DOI: 10.1016/j.micinf.2015.08.017] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/30/2015] [Accepted: 08/31/2015] [Indexed: 12/29/2022]
Abstract
Cryptococcus neoformans (Cn) and Cryptococcus gattii (Cg) cause neurological disease and cross the BBB as free cells or in mononuclear phagocytes via the Trojan horse mechanism, although evidence for the latter is indirect. There is emerging evidence that Cn and the North American outbreak Cg strain (R265) more commonly cause neurological and lung disease, respectively. We have employed a widely validated in vitro model of the BBB, which utilizes the hCMEC/D3 cell line derived from human brain endothelial cells (HBEC) and the human macrophage-like cell line, THP-1, to investigate whether transport of dual fluorescence-labelled Cn and Cg across the BBB occurs within macrophages. We showed that phagocytosis of Cn by non-interferon (IFN)-γ stimulated THP-1 cells was higher than that of Cg. Although Cn and Cg-loaded THP-1 bound similarly to TNF-activated HBECs under shear stress, more Cn-loaded macrophages were transported across an intact HBEC monolayer, consistent with the predilection of Cn for CNS infection. Furthermore, Cn exhibited a higher rate of expulsion from transmigrated THP-1 compared with Cg. Our results therefore provide further evidence for transmigration of both Cn and Cg via the Trojan horse mechanism and a potential explanation for the predilection of Cn to cause CNS infection.
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Affiliation(s)
- Tania C Sorrell
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney and Westmead Millennium Institute for Medical Research, Westmead, NSW 2145, Australia.
| | - Pierre-Georges Juillard
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney and Westmead Millennium Institute for Medical Research, Westmead, NSW 2145, Australia; Fungal Pathogenesis Laboratory, Centre for Infectious Diseases and Microbiology, Westmead Millennium Institute, Westmead 2145, Australia; Vascular Immunology Unit, Department of Pathology, School of Medical Sciences, University of Sydney, NSW 2006, Australia
| | - Julianne T Djordjevic
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney and Westmead Millennium Institute for Medical Research, Westmead, NSW 2145, Australia; Fungal Pathogenesis Laboratory, Centre for Infectious Diseases and Microbiology, Westmead Millennium Institute, Westmead 2145, Australia
| | - Keren Kaufman-Francis
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney and Westmead Millennium Institute for Medical Research, Westmead, NSW 2145, Australia; Fungal Pathogenesis Laboratory, Centre for Infectious Diseases and Microbiology, Westmead Millennium Institute, Westmead 2145, Australia
| | - Anelia Dietmann
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; Vascular Immunology Unit, Department of Pathology, School of Medical Sciences, University of Sydney, NSW 2006, Australia
| | - Alban Milonig
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria; Vascular Immunology Unit, Department of Pathology, School of Medical Sciences, University of Sydney, NSW 2006, Australia
| | - Valery Combes
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney and Westmead Millennium Institute for Medical Research, Westmead, NSW 2145, Australia; Vascular Immunology Unit, Department of Pathology, School of Medical Sciences, University of Sydney, NSW 2006, Australia
| | - Georges E R Grau
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney and Westmead Millennium Institute for Medical Research, Westmead, NSW 2145, Australia; Vascular Immunology Unit, Department of Pathology, School of Medical Sciences, University of Sydney, NSW 2006, Australia
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7
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Day J, Imran D, Ganiem AR, Tjahjani N, Wahyuningsih R, Adawiyah R, Dance D, Mayxay M, Newton P, Phetsouvanh R, Rattanavong S, Chan AK, Heyderman R, van Oosterhout JJ, Chierakul W, Day N, Kamali A, Kibengo F, Ruzagira E, Gray A, Lalloo DG, Beardsley J, Binh TQ, Chau TTH, Chau NVV, Cuc NTK, Farrar J, Hien TT, Van Kinh N, Merson L, Phuong L, Tho LT, Thuy PT, Thwaites G, Wertheim H, Wolbers M. CryptoDex: a randomised, double-blind, placebo-controlled phase III trial of adjunctive dexamethasone in HIV-infected adults with cryptococcal meningitis: study protocol for a randomised control trial. Trials 2014; 15:441. [PMID: 25391338 PMCID: PMC4289250 DOI: 10.1186/1745-6215-15-441] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 09/16/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cryptococcal meningitis (CM) is a severe AIDS-defining illness with 90-day case mortality as high as 70% in sub-Saharan Africa, despite treatment. It is the leading cause of death in HIV patients in Asia and Africa.No major advance has been made in the treatment of CM since the 1970s. The mainstays of induction therapy are amphotericin B and flucytosine, but these are often poorly available where the disease burden is highest. Adjunctive treatments, such as dexamethasone, have had dramatic effects on mortality in other neurologic infections, but are untested in CM. Given the high death rates in patients receiving current optimal treatment, and the lack of new agents on the horizon, adjuvant treatments, which offer the potential to reduce mortality in CM, should be tested.The principal research question posed by this study is as follows: does adding dexamethasone to standard antifungal therapy for CM reduce mortality? Dexamethasone is a cheap, readily available, and practicable intervention. METHOD A double-blind placebo-controlled trial with parallel arms in which patients are randomised to receive either dexamethasone or placebo, in addition to local standard of care. The study recruits patients in both Asia and Africa to ensure the relevance of its results to the populations in which the disease burden is highest. The 10-week mortality risk in the control group is expected to be between 30% and 50%, depending on location, and the target hazard ratio of 0.7 corresponds to absolute risk reductions in mortality from 30% to 22%, or from 50% to 38%. Assuming an overall 10-week mortality of at least 30% in our study population, recruitment of 824 patients will be sufficient to observe the expected number of deaths. Allowing for some loss to follow-up, the total sample size for this study is 880 patients. To generate robust evidence across both continents, we aim to recruit roughly similar numbers of patients from each continent. The primary end point is 10-week mortality. Ethical approval has been obtained from Oxford University's Tropical Research Ethics Committee (OxTREC), and as locally mandated at each site. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number: ISRCTN59144167 26-July-2012.
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Affiliation(s)
- Jeremy Day
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Darma Imran
- />Cipto Mangunkusum Hospital, Jakarta, Indonesia
| | | | | | - Retno Wahyuningsih
- />Cipto Mangunkusum Hospital, Jakarta, Indonesia
- />Department of Parasitology, Indonesia Christian University, School of Medicine, Jakarta, Indonesia
| | - Robiatul Adawiyah
- />Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - David Dance
- />Laos Oxford Mahosot Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos
| | - Mayfong Mayxay
- />Laos Oxford Mahosot Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos
| | - Paul Newton
- />Laos Oxford Mahosot Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos
| | | | - Sayaphet Rattanavong
- />Laos Oxford Mahosot Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Laos
| | | | - Robert Heyderman
- />Malawi-Liverpool-Wellcome Trust, Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Wirongrong Chierakul
- />Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Nick Day
- />Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Anatoli Kamali
- />MRC/UVRI Uganda Research Unit on AIDS, Entebbe/Masaka, Uganda
| | - Freddie Kibengo
- />MRC/UVRI Uganda Research Unit on AIDS, Entebbe/Masaka, Uganda
| | - Eugene Ruzagira
- />MRC/UVRI Uganda Research Unit on AIDS, Entebbe/Masaka, Uganda
| | - Alastair Gray
- />Nuffield Department of Population Health, University of Oxford Health Economics Research Centre, Oxford, UK
| | - David G Lalloo
- />Wellcome Trust Tropical Centre Liverpool, Liverpool, UK
| | - Justin Beardsley
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Tran Thi Hong Chau
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Jeremy Farrar
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Tinh Hien
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Laura Merson
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Lan Phuong
- />Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Loc Truong Tho
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Guy Thwaites
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Heiman Wertheim
- />National Hospital for Tropical Diseases Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Marcel Wolbers
- />Wellcome Trust Major Overseas Programme Vietnam, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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8
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Lai CC, Lin WR, Chen CY, Chang K, Lu PL, Chen YH, Lee KM, Chang TC, Lin CY. Acute Meningitis Caused by Cladosporium sphaerospermum. Am J Med Sci 2013; 346:523-5. [DOI: 10.1097/maj.0b013e3182a59b5f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Khan MA, Aljarbou A, Khan A, Owais M. Immune stimulating and therapeutic potential of tuftsin-incorporated nystatin liposomes against Cryptococcus neoformans in leukopenic BALB/C mice. ACTA ACUST UNITED AC 2012; 66:88-97. [DOI: 10.1111/j.1574-695x.2012.00992.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 03/14/2012] [Accepted: 05/13/2012] [Indexed: 11/26/2022]
Affiliation(s)
| | - Ahmed Aljarbou
- Department of Pharmaceutics, College of Pharmacy; Qassim University; Buraidah; Saudi Arabia
| | | | - Mohammad Owais
- Interdisciplinary Biotechnology Unit; Aligarh Muslim University; Aligarh; India
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Li DM, de Hoog GS. Cerebral phaeohyphomycosis--a cure at what lengths? THE LANCET. INFECTIOUS DISEASES 2009; 9:376-83. [PMID: 19467477 DOI: 10.1016/s1473-3099(09)70131-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cerebral phaeohyphomycosis is a fungal infection of the brain typically caused by Cladophialophora bantiana, Exophiala dermatitidis, and Rhinocladiella mackenziei, all of which belong to the order Chaetothyriales. The disease results in black, necrotic brain tissue, black pus, and black cerebrospinal fluid. Pathogens usually reach the brain through the bloodstream or lymphatic fluid and occasionally through direct spreading or accidental inoculation. Patients can present with hemiparesis, tonic spasm, headache, fever, sensory variation, cerebral irritation, and even psychotic behavioural changes. Radiological images are characterised by ring-enhanced signs and hyperdense and hypodense lesions. Pathological features frequently include black-to-brown necrotic tissue or dark-coloured pus, granulomatous inflammation, giant cell vasculitis, and pigmented fungal elements, which are easily seen on a direct potassium hydroxide smear, a rapid method for diagnosis. Black fungi can be cultured from a biopsy specimen. Combined antifungal chemotherapy, surgical debridement, and careful immunological interventions are strongly recommended to eradicate these intractable infections.
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Affiliation(s)
- Dong Ming Li
- Peking University Third Hospital, Beijing, China.
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Hart KA, Flaminio MJBF, LeRoy BE, Williams CO, Dietrich UM, Barton MH. Successful resolution of cryptococcal meningitis and optic neuritis in an adult horse with oral fluconazole. J Vet Intern Med 2008; 22:1436-40. [PMID: 18823407 DOI: 10.1111/j.1939-1676.2008.0189.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- K A Hart
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.
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Suárez-Rivera M, Abadeer RA, Kott MM, Braun MC. Cryptococcosis associated with crescentic glomerulonephritis. Pediatr Nephrol 2008; 23:827-30. [PMID: 18253761 DOI: 10.1007/s00467-007-0732-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 11/19/2007] [Accepted: 11/27/2007] [Indexed: 11/29/2022]
Abstract
Crescentic glomerulonephritis (CGN) is an uncommon form of renal injury in childhood. Whereas many infectious processes are known to be linked to CGN, fungal infections typically are not. This report describes an 11-year-old girl who presented with CGN, cutaneous anergy, and cryptococcal mediastinitis. Whereas cryptococcal disease in children is usually associated with immunodeficiency (inherited or acquired), extensive immunologic evaluation of the patient was notable only for relative CD4 lymphopenia with normal CD4/CD8 ratios. Testing for human immunodeficiency virus was negative. Clinical and diagnostic studies are presented, along with a review of the literature regarding glomerular disease and cryptococcal infections.
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Affiliation(s)
- Marta Suárez-Rivera
- Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, University of Texas Health Science Center-Houston, 6431 Fannin Street, Houston, TX 77030, USA
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