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Yatsonsky D, Gunn J, Zajac K, Burke C, Bair J. Orthopedic Manifestations of Disseminated Cryptococcal neoformans Infection in an Immunocompromised Patient: a Case Report. J Orthop Case Rep 2024; 14:19-24. [PMID: 38910993 PMCID: PMC11189094 DOI: 10.13107/jocr.2024.v14.i06.4488] [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: 03/25/2024] [Revised: 04/07/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Cryptococccus neoformans is a fungus which typically presents in immunocompromised hosts, commonly presenting as meningoencephalitis. There have been very few documented incidents of intramuscular manifestations of this pathogen. Case Report We report on a case of a 45-year-old caucasian male with disseminated Cryptococcus neoformans who developed cryptococcal intramuscular abscesses of all extremities and osteomyelitis of the left upper limb. Clinical treatment and surgical debridement of the forearm was performed. Persistent infection resulted in a left humeral amputation and ultimately the patient's death. This is one of the few documented intramuscular abscesses of Cryptococcus neoformans. Conclusion Orthopedic manifestations of cryptococcal infections are rare; however, awareness and prompt diagnosis may improve outcomes.
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Affiliation(s)
- David Yatsonsky
- Department of Orthopaedic Surgery, The University of Toledo Medical Center, Toledo, OH
| | - Jenna Gunn
- The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Kelsee Zajac
- The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Connor Burke
- The University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Jeffrey Bair
- Department of Orthopaedic Surgery, Section of Orthopaedic Trauma and Adult Reconstruction, ProMedica Toledo Hospital, Toledo, OH
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Tan X, Deng M, Fang Z, Yang Q, Zhang M, Wu J, Chen W. A nomogram to predict cryptococcal meningitis in patients with pulmonary cryptococcosis. Heliyon 2024; 10:e30281. [PMID: 38726150 PMCID: PMC11079104 DOI: 10.1016/j.heliyon.2024.e30281] [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: 08/30/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
Background The most serious manifestation of pulmonary cryptococcosis is complicated with cryptococcal meningitis, while its clinical manifestations lack specificity with delayed diagnosis and high mortality. The early prediction of this complication can assist doctors to carry out clinical interventions in time, thus improving the cure rate. This study aimed to construct a nomogram to predict the risk of cryptococcal meningitis in patients with pulmonary cryptococcosis through a scoring system. Methods The clinical data of 525 patients with pulmonary cryptococcosis were retrospectively analyzed, including 317 cases (60.38 %) with cryptococcal meningitis and 208 cases (39.62 %) without cryptococcal meningitis. The risk factors of cryptococcal meningitis were screened by univariate analysis, LASSO regression analysis and multivariate logistic regression analysis. Then the risk factors were incorporated into the nomogram scoring system to establish a prediction model. The model was validated by receiver operating characteristic (ROC) curve, decision curve analysis (DCA) and clinical impact curve. Results Fourteen risk factors for cryptococcal meningitis in patients with pulmonary cryptococcosis were screened out by statistical method, including 6 clinical manifestations (fever, headache, nausea, psychiatric symptoms, tuberculosis, hematologic malignancy) and 8 clinical indicators (neutrophils, lymphocytes, glutamic oxaloacetic transaminase, T cells, helper T cells, killer T cells, NK cells and B cells). The AUC value was 0.978 (CI 96.2 %∼98.9 %), indicating the nomogram was well verified. Conclusion The nomogram scoring system constructed in this study can accurately predict the risk of cryptococcal meningitis in patients with pulmonary cryptococcosis, which may provide a reference for clinical diagnosis and treatment of patients with cryptococcal meningitis.
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Affiliation(s)
- Xiaoli Tan
- Department of Respiration, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Min Deng
- Department of Infectious Diseases, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Zhixian Fang
- Department of Respiration, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Qi Yang
- Department of Respiration, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ming Zhang
- Department of Respiration, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jiasheng Wu
- Department of Respiratory and Critical Care Medicine, Jiaxing Second Hospital, Jiaxing, China
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wenyu Chen
- Department of Respiration, The Affiliated Hospital of Jiaxing University, Jiaxing, China
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Tan X, Zhang Y, Zhou J, Chen W, Zhou H. Construction and validation of a nomogram model to predict the poor prognosis in patients with pulmonary cryptococcosis. PeerJ 2024; 12:e17030. [PMID: 38487258 PMCID: PMC10939030 DOI: 10.7717/peerj.17030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
Background Patients with poor prognosis of pulmonary cryptococcosis (PC) are prone to other complications such as meningeal infection, recurrence or even death. Therefore, this study aims to analyze the influencing factors in the poor prognosis of patients with PC, so as to build a predictive nomograph model of poor prognosis of PC, and verify the predictive performance of the model. Methods This retrospective study included 410 patients (78.1%) with improved prognosis of PC and 115 patients (21.9%) with poor prognosis of PC. The 525 patients with PC were randomly divided into the training set and validation set according to the ratio of 7:3. The Least Absolute Shrinkage and Selection Operator (LASSO) algorithm was used to screen the demographic information, including clinical characteristics, laboratory test indicators, comorbidity and treatment methods of patients, and other independent factors that affect the prognosis of PC. These factors were included in the multivariable logistic regression model to build a predictive nomograph. The receiver operating characteristic curve (ROC), calibration curve and decision curve analysis (DCA) were used to verify the accuracy and application value of the model. Results It was finally confirmed that psychological symptoms, cytotoxic drugs, white blood cell count, hematocrit, platelet count, CRP, PCT, albumin, and CD4/CD8 were independent predictors of poor prognosis of PC patients. The area under the curve (AUC) of the predictive model for poor prognosis in the training set and validation set were 0.851 (95% CI: 0.818-0.881) and 0.949, respectively. At the same time, calibration curve and DCA results confirmed the excellent performance of the nomogram in predicting poor prognosis of PC. Conclusion The nomograph model for predicting the poor prognosis of PC constructed in this study has good prediction ability, which is helpful for improving the prognosis of PC and further optimizing the clinical management strategy.
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Affiliation(s)
- Xiaoli Tan
- Department of Respiratory, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yingqing Zhang
- Department of Respiratory, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jianying Zhou
- Department of Respiratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenyu Chen
- Department of Respiratory, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hua Zhou
- Department of Respiratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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4
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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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Conn BN, Lieberman JA, Chatman P, Cotton K, Essandoh MA, Ebqa’ai M, Nelson TL, Wozniak KL. Antifungal activity of eumelanin-inspired indoylenepheyleneethynylene against Cryptococcus neoformans. Front Microbiol 2024; 14:1339303. [PMID: 38293553 PMCID: PMC10826398 DOI: 10.3389/fmicb.2023.1339303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
Cryptococcus neoformans is an opportunistic fungal pathogen that causes meningitis in >152,000 immunocompromised individuals annually, leading to 112,000 yearly deaths. The four classes of existing antifungal agents target plasma membrane sterols (ergosterol), nucleic acid synthesis, and cell wall synthesis. Existing drugs are not highly effective against Cryptococcus, and antifungal drug resistance is an increasing problem. A novel antimicrobial compound, a eumelanin-inspired indoylenepheyleneethynylene, EIPE-1, was synthesized and has antimicrobial activity against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MSRA), but not towards Gram-negative organisms. Based on EIPE-1's antibacterial activity, we hypothesized that EIPE-1 could have antifungal activity. For these studies, we tested EIPE-1 against C. neoformans strain H99 and 6 additional cryptococcal clinical isolates. We examined antifungal activity, cytotoxicity, effects on fungal gene expression, and mechanism of action of EIPE-1. Results showed that EIPE-1 has fungicidal effects on seven cryptococcal strains with MICs ranging from 1.56 to 3.125 μg/mL depending on the strain, and it is non-toxic to mammalian cells. We conducted scanning and transmission electron microscopy on the exposed cells to examine structural changes to the organism following EIPE-1 treatment. Cells exposed displayed structural changes to their cell wall and membranes, with internal contents leaking out of the cells. To understand the effect of EIPE-1 on fungal gene expression, RNA sequencing was conducted. Results showed that EIPE-1 affects several processes involved stress response, ergosterol biosynthesis, capsule biosynthesis, and cell wall attachment and remodeling. Therefore, our studies demonstrate that EIPE-1 has antifungal activity against C. neoformans, which affects both cellular structure and gene expression of multiple fungal pathways involved in cell membrane stability and viability.
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Affiliation(s)
- Brittney N. Conn
- Department of Microbiology and Molecular Genetics, Oklahoma State University, Stillwater, OK, United States
| | - Jacob A. Lieberman
- Department of Microbiology and Molecular Genetics, Oklahoma State University, Stillwater, OK, United States
| | - Priscilla Chatman
- Department of Microbiology and Molecular Genetics, Oklahoma State University, Stillwater, OK, United States
| | - Kaitlyn Cotton
- Department of Microbiology and Molecular Genetics, Oklahoma State University, Stillwater, OK, United States
| | - Martha A. Essandoh
- Department of Chemistry, Oklahoma State University, Stillwater, OK, United States
| | - Mohammad Ebqa’ai
- Department of Chemistry, Oklahoma State University, Stillwater, OK, United States
| | - Toby L. Nelson
- Department of Chemistry, Oklahoma State University, Stillwater, OK, United States
| | - Karen L. Wozniak
- Department of Microbiology and Molecular Genetics, Oklahoma State University, Stillwater, OK, United States
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Guan ST, Huang YS, Huang ST, Hsiao FY, Chen YC. The incidences and clinical outcomes of cryptococcosis in Taiwan: A nationwide, population-based study, 2002-2015. Med Mycol 2024; 62:myad125. [PMID: 38126122 PMCID: PMC10802930 DOI: 10.1093/mmy/myad125] [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] [Received: 06/05/2023] [Revised: 10/28/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023] Open
Abstract
Large-scale epidemiological data on cryptococcosis other than cryptococcal meningitis (CM), human immunodeficiency virus (HIV)- or solid organ transplantation (SOT)-associated cryptococcosis are limited. This study investigated the disease burden of cryptococcosis in Taiwan over 14 years. Incident episodes of cryptococcosis, comorbidities, treatment, and outcomes were captured from Taiwan's National Health Insurance Research Database and National Death Registry between 2002 and 2015. Of 6647 episodes analyzed, the crude incidence rate per 100 000 population increased from 1.48 in 2002 to 2.76 in 2015, which was driven by the growing trend in the non-CM group (0.86-2.12) but not in the CM group (0.62-0.64). The leading three comorbidities were diabetes mellitus (23.62%), malignancy (22.81%), and liver disease (17.42%). HIV accounted for 6.14% of all episodes and was associated with the highest disease-specific incidence rate (269/100 000 population), but the value dropped 16.20% biennially. Within 90 days prior to cohort entry, 30.22% of episodes had systemic corticosteroid use. The in-hospital mortality of all episodes was 10.80%, which varied from 32.64% for cirrhosis and 13.22% for HIV to 6.90% for SOT. CM was associated with a higher in-hospital mortality rate than non-CM (19.15% vs. 6.33%). At diagnosis, only 48.53% of CM episodes were prescribed an amphotericin-based regimen. The incidence rate of cryptococcosis was increasing, especially that other than meningitis and in the non-HIV population. A high index of clinical suspicion is paramount to promptly diagnose, treat, and improve cryptococcosis-related mortality in populations other than those with HIV infection or SOT.
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Affiliation(s)
- Shang-Ting Guan
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, 2F.-220, No. 33, Linsen S. Rd., Zhongzheng Dist., Taipei City 100025, Taiwan
- Health Data Research Center, National Taiwan University, Taipei City 10051, Taiwan
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Shih-Tsung Huang
- Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei City 112304, Taiwan
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei City 112304, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, 2F.-220, No. 33, Linsen S. Rd., Zhongzheng Dist., Taipei City 100025, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei City 100025, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei City 100225, Taiwan
| | - Yee-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City 100225, Taiwan
- Department of Medicine, National Taiwan University College of Medicine, Taipei City 10051, Taiwan
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli County 35053, Taiwan
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Zhao H, Lu Y, Li S, Qin J, Xu M, Ye H, Yang Z, Rao J, Chen G, Su F, Hu Z, Xu L. Voriconazole plus flucytosine is not superior to amphotericin B deoxycholate plus flucytosine as an induction regimen for cryptococcal meningitis treatment. Mycoses 2024; 67:e13674. [PMID: 37986630 DOI: 10.1111/myc.13674] [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] [Received: 08/17/2023] [Revised: 10/21/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The efficacy and side effects of voriconazole plus 5-flucytosine (Vori + 5-FC) versus amphotericin B deoxycholate plus 5-flucytosine (AmBd + 5-FC) as an induction treatment for cryptococcal meningitis are unknown. METHODS Forty-seven patients treated with Vori + 5-FC and 92 patients treated with AmBd + 5-FC were included in the current study after propensity score matching (PSM) at a ratio of 1:2. Two-week laboratory test results and 90-day mortality were compared between the two groups. RESULTS After 2 weeks of induction treatment, the CSF Cryptococcus sterile culture rate was 57.1% in the Vori + 5-FC group and 76.5% in the AmBd + 5-FC group (p = .026). No difference was found in the normalization of CSF indicators (glucose, total protein, intracranial pressure and India ink sterile rate) between the two groups. Both the Vori + 5FC regimen and AmBd + 5-FC regimen obviously decreased haemoglobin concentrations, platelet counts and serum potassium levels (all p ≤ .010). Notably, the Vori + 5FC regimen did not influence serum creatinine levels (p = .263), while AmBd + 5FC increased serum creatinine levels (p = .019) after 2-week induction treatment. The Vori + 5-FC group and AmBd + 5-FC group had similar 90-day cumulative survival rates (89.9% vs. 87.8%, p = .926). CONCLUSION The Vori + 5-FC regimen was associated with low 2-week CSF sterile culture and was not superior to AmBd + 5-FC as induction therapy in terms of the 90-day cumulative survival rate of CM patients.
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Affiliation(s)
- Handan Zhao
- National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yanqiu Lu
- Chongqing Public Health Medical Center, Southwest University Public Health Hospital, Chongqing, China
| | - Shan Li
- Department of Infectious Diseases, The Ninth Hospital of Nanchang, Nanchang, China
| | - Jiangying Qin
- National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Miaomiao Xu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hui Ye
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, China
| | - Zongxing Yang
- Xixi Hospital of Hangzhou, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jianfeng Rao
- Department of Infectious Diseases, The Ninth Hospital of Nanchang, Nanchang, China
| | - Guochun Chen
- Department of Infectious Diseases, The Third Peoples' Hospital of Changzhou, Changzhou, China
| | - Feifei Su
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, China
| | - Zhiliang Hu
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lijun Xu
- National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Sanfilippo S, Docquier B, Schrooyen PL, Makhoul D, Le A. Bilateral Cryptococcal Choroiditis in a Human Immunodeficiency Virus-Infected Patient: A Case Report. Case Rep Ophthalmol 2024; 15:157-162. [PMID: 38357214 PMCID: PMC10866609 DOI: 10.1159/000535151] [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: 08/30/2023] [Accepted: 11/05/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction In this case report, we present a rare case of bilateral cryptococcal choroiditis following a diagnosis of meningitis in a 38-year-old woman with HIV. Case Presentation A Colombian woman, newly diagnosed with HIV, presented with respiratory distress followed by meningeal syndrome. Further evaluation revealed cryptococcal meningitis caused by Cryptococcus neoformans, confirmed through cerebrospinal fluid analysis and brain magnetic resonance imaging. The patient reported mild blurred vision, prompting an ophthalmic examination that included indocyanine green angiography. The findings revealed signs of HIV retinopathy and multifocal choroidal lesions in both eyes, suggestive of choroidal cryptococcosis. Treatment involved intravenous administration of amphotericin B and flucytosine, followed by oral fluconazole. Subsequently, the choroidal lesions gradually regressed, and regular monitoring demonstrated no signs of recurrence. Conclusion Cryptococcal choroiditis, though exceptionally rare, can occur in HIV-positive patients with disseminated cryptococcosis. Ophthalmologists should maintain a high index of suspicion for opportunistic infections, even in the absence of pronounced ocular symptoms, particularly in immunocompromised individuals. Early diagnosis and appropriate treatment are crucial for achieving favorable outcomes in such cases.
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Affiliation(s)
- Sara Sanfilippo
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Bastien Docquier
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Paul Louis Schrooyen
- Department of Ophthalmology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Dorine Makhoul
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Aurélie Le
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
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Giamberardino CD, Tenor JL, Toffaletti DL, Palmucci JR, Schell W, Boua JVK, Marius C, Stott KE, Steele SL, Hope W, Cilla D, Perfect JR. Pharmacodynamics of ATI-2307 in a rabbit model of cryptococcal meningoencephalitis. Antimicrob Agents Chemother 2023; 67:e0081823. [PMID: 37728934 PMCID: PMC10583688 DOI: 10.1128/aac.00818-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/22/2023] [Indexed: 09/22/2023] Open
Abstract
Cryptococcal meningoencephalitis (CM) is a devastating fungal disease with high morbidity and mortality. The current regimen that is standard-of-care involves a combination of three different drugs administered for up to one year. There is a critical need for new therapies due to both toxicity and inadequate fungicidal activity of the currently available antifungal drugs. ATI-2307 is a novel aryl amidine that disrupts the mitochondrial membrane potential and inhibits the respiratory chain complexes of fungi-it thus represents a new mechanism for direct antifungal action. Furthermore, ATI-2307 selectively targets fungal mitochondria via a fungal-specific transporter that is not present in mammalian cells. It has very potent in vitro anticryptococcal activity. In this study, the efficacy of ATI-2307 was tested in a rabbit model of CM. ATI-2307 demonstrated significant fungicidal activity at dosages between 1 and 2 mg/kg/d, and these results were superior to fluconazole and similar to amphotericin B treatment. When ATI-2307 was combined with fluconazole, the antifungal effect was greater than either therapy alone. While ATI-2307 has potent anticryptococcal activity in the subarachnoid space, its ability to reduce yeasts in the brain parenchyma was relatively less over the same study period. This new drug, with its unique mechanism of fungicidal action and ability to positively interact with an azole, has demonstrated sufficient anticryptococcal potential in this experimental setting to be further evaluated in clinical studies.
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Affiliation(s)
- Charles D. Giamberardino
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Jennifer L. Tenor
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Dena L. Toffaletti
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Julia R. Palmucci
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Wiley Schell
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | | | - Choiselle Marius
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Katharine E. Stott
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | | | - William Hope
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Don Cilla
- Appili Therapeutics Inc., Halifax, Nova Scotia, Canada
| | - John R. Perfect
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
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10
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Meagher RB, Lewis ZA, Ambati S, Lin X. DectiSomes: C-type lectin receptor-targeted liposomes as pan-antifungal drugs. Adv Drug Deliv Rev 2023; 196:114776. [PMID: 36934519 PMCID: PMC10133202 DOI: 10.1016/j.addr.2023.114776] [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] [Received: 01/04/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/19/2023]
Abstract
Combatting the ever-increasing threat from invasive fungal pathogens faces numerous fundamental challenges, including constant human exposure to large reservoirs of species in the environment, the increasing population of immunocompromised or immunosuppressed individuals, the unsatisfactory efficacy of current antifungal drugs and their associated toxicity, and the scientific and economic barriers limiting a new antifungal pipeline. DectiSomes represent a new drug delivery platform that enhances antifungal efficacy for diverse fungal pathogens and reduces host toxicity for current and future antifungals. DectiSomes employ pathogen receptor proteins - C-type lectins - to target drug-loaded liposomes to conserved fungal cognate ligands and away from host cells. DectiSomes represent one leap forward for urgently needed effective pan-antifungal therapy. Herein, we discuss the problems of battling fungal diseases and the state of DectiSome development.
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Affiliation(s)
- Richard B Meagher
- Department of Genetics, University of Georgia, Athens, GA 30602, USA
| | - Zachary A Lewis
- Department of Genetics, University of Georgia, Athens, GA 30602, USA; Department of Microbiology, University of Georgia, Athens, GA 30602, USA
| | - Suresh Ambati
- Department of Genetics, University of Georgia, Athens, GA 30602, USA
| | - Xiaorong Lin
- Department of Microbiology, University of Georgia, Athens, GA 30602, USA.
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11
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Samukawa S, Yoshimi R, Kojitani N, Uzawa Y, Takase-Minegishi K, Kirino Y, Soejima Y, Kato H, Nakajima H. Cryptococcal meningitis with atypical paradoxical inflammatory reactions after antifungal treatment in acquired immune deficiency syndrome: A case report. J Infect Chemother 2023; 29:347-352. [PMID: 36384196 DOI: 10.1016/j.jiac.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/24/2022] [Accepted: 11/07/2022] [Indexed: 11/14/2022]
Abstract
Cryptococcal meningitis (CM) is a life-threatening disease that primarily affects patients with human immunodeficiency virus (HIV). Antifungal therapy with antiretroviral treatment (ART) usually leads to the clinical remission of CM; however, in some cases, these treatments exacerbate intracranial inflammation because of paradoxical inflammatory reaction or immune reconstitution inflammatory syndrome (IRIS). Here we report two CM cases that presented atypical clinical courses attributed to paradoxical inflammatory reactions. The first case was a 43-year-old man with headache and vertigo diagnosed with CM and HIV. The patient's CM not only was refractory to the antifungal combination therapy of liposomal amphotericin B (L-AMB) and fluconazole (FLCZ) but suddenly worsened because of a paradoxical inflammatory reaction after 18 days of treatment. He passed away from brain herniation on day 23. The second case was a 43-year-old man diagnosed with CM and HIV. After receiving antifungal therapy and ART, the patient's status was stable for more than 3 years with undetectable HIV-RNA. He suddenly presented with brain inflammation and was diagnosed with IRIS due to CM (CM-IRIS). His brain lesions were migratory and refractory to various antifungal therapies such as L-AMB, FLCZ, flucytosine, and intrathecal amphotericin B. Although the cryptococcal antigen in the patient's cerebrospinal fluid gradually diminished after continuous antifungal therapies, his cognitive function declined, and right hemiparesis persisted. These two cases of CM presented atypical clinical courses, presumably because of paradoxical inflammatory reactions. It should be noted that the onset of CM-IRIS may not necessarily depend on the timing of ART initiation.
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Affiliation(s)
- Sei Samukawa
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan.
| | - Noriko Kojitani
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Yuji Uzawa
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Kaoru Takase-Minegishi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Yutaro Soejima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Hideaki Kato
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
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12
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The Pathological Activation of Microglia Is Modulated by Sexually Dimorphic Pathways. Int J Mol Sci 2023; 24:ijms24054739. [PMID: 36902168 PMCID: PMC10003784 DOI: 10.3390/ijms24054739] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/11/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023] Open
Abstract
Microglia are the primary immunocompetent cells of the central nervous system (CNS). Their ability to survey, assess and respond to perturbations in their local environment is critical in their role of maintaining CNS homeostasis in health and disease. Microglia also have the capability of functioning in a heterogeneous manner depending on the nature of their local cues, as they can become activated on a spectrum from pro-inflammatory neurotoxic responses to anti-inflammatory protective responses. This review seeks to define the developmental and environmental cues that support microglial polarization towards these phenotypes, as well as discuss sexually dimorphic factors that can influence this process. Further, we describe a variety of CNS disorders including autoimmune disease, infection, and cancer that demonstrate disparities in disease severity or diagnosis rates between males and females, and posit that microglial sexual dimorphism underlies these differences. Understanding the mechanism behind differential CNS disease outcomes between men and women is crucial in the development of more effective targeted therapies.
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Li YC, Tseng CC, Chien SC, Huang SH, Chang TW, Chen CT, Tu PH, Liu ZH, Huang YC. Middle cerebral artery infarction, A rare complication of intracranial cryptococcoma in an immunocompetent patient: A case report and literature review. Front Surg 2023; 10:1083833. [PMID: 36874457 PMCID: PMC9975338 DOI: 10.3389/fsurg.2023.1083833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/12/2023] [Indexed: 02/17/2023] Open
Abstract
Background This report presents the first case of intracranial cryptococcoma arising from the right frontal lobe causing right middle cerebral artery infarction. Intracranial cryptococcomas usually occur in the cerebral parenchyma, basal ganglia, cerebellum, pons, thalamus, and choroid plexus; they may mimic intracranial tumors, but seldom cause infarction. Of the 15 cases of pathology-confirmed intracranial cryptococcomas in the literature, no case has been complicated by middle cerebral artery (MCA) infarction. Here, we discuss a case of intracranial cryptococcoma with an ipsilateral middle cerebral artery infarction. Case Description A 40-year-old man was referred to our emergency room due to progressive headaches and acute left hemiplegia. The patient was a construction worker with no history of avian contact, recent travel, or human immunodeficiency virus (HIV) infection. Brain computed tomography (CT) showed an intra-axial mass, and subsequent magnetic resonance imaging (MRI) delineated a large mass of 53 mm in the right middle frontal lobe and a small lesion of 18 mm in the right caudate head, with marginal enhancement and central necrosis. A neurosurgeon was consulted in view of the intracranial lesion, and the patient underwent en-bloc excision of the solid mass. The pathology report later identified a Cryptococcus infection rather than malignancy. The patient underwent 4 weeks of postoperative treatment with amphotericin B plus flucytosine; he then received subsequent oral antifungal treatment for 6 months, and had neurologic sequelae that manifested as left side hemiplegia. Conclusion Diagnosis of fungal infections in the CNS remains challenging. This is especially true of Cryptococcus CNS infections that present as a space-occupying lesion in an immunocompetent patient. A Cryptococcus infection should be considered in the differential diagnoses in patients with brain mass lesions, as this infection can be misdiagnosed as a brain tumor.
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Affiliation(s)
- Ying-Ching Li
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chun-Chia Tseng
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Shuo-Chi Chien
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Sheng-Han Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Tin-Wei Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chun-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
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14
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LOUA OO, ALLE AKAKPO AE, OUEDRAOGO D, CISSOKO Y, SOUMARÉ M, KONATÉ I, DAO S. [Neuromeningeal cryptococcosis in an HIV-negative patient with pulmonary tuberculosis in the Infectious and tropical diseases department of the University teaching hospital Point G of Bamako, Mali]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2022; 2:mtsi.v2i4.2022.282. [PMID: 36815177 PMCID: PMC9940277 DOI: 10.48327/mtsi.v2i4.2022.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/05/2022] [Indexed: 02/24/2023]
Abstract
Neuromeningeal cryptococcosis and pulmonary tuberculosis are respectively serious mycotic and bacterial infections occurring in a subject regardless of its HIV serological status. We report here a case of neuromeningeal cryptococcosis associated with pulmonary tuberculosis and malnutrition in an HIV-seronegative patient with a CD4 count of 750/mm3, to highlight some particularities opposed to certain literatures. This is an 18-year-old patient, housewife, from Bamako, admitted in the Infectious and tropical diseases department of the University teaching hospital Point G of Bamako on March 13, 2022 for fever and impaired consciousness. Her symptomatology appears to have gradually set in over a month, preceded by headache resistant to paracetamol, jet vomiting and irregular dry cough, initially treated with ceftriaxone, artesunate and paracetamol for confirmed malaria and suspicion of bacterial meningitis before admission. In whom no known medical-surgical history, no use of topical corticosteroids, no immunosuppressive therapy, no alcohol or tobacco, and no immunosuppressive pathology was found. The diagnoses of neuromeningeal cryptococcosis, pulmonary tuberculosis and undernutrition were retained in view of clinical and microbiological arguments. Diabetes, sickle cell disease, viral hepatitis B and C, kidney failure and cancer, which are immunosuppressive pathologies, were not found. She was successfully treated with first-line oral antituberculous drugs and fluconazole infusion. Three interests are drawn from this clinical case: neuromeningeal cryptococcosis is not only the prerogative of HIV-positive subjects, a high CD4 count does not always mean immunocompetence and fluconazole is an effective therapeutic alternative for neuromeningeal cryptococcosis.
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Affiliation(s)
- Ouo-Ouo LOUA
- Service de Maladies infectieuses et tropicales du Centre hospitalier universitaire du Point G, Bamako, Mali,*
| | - Amavi Essénam ALLE AKAKPO
- Service de Maladies infectieuses et tropicales du Centre hospitalier universitaire du Point G, Bamako, Mali
| | - Dramane OUEDRAOGO
- Service de Maladies infectieuses et tropicales du Centre hospitalier universitaire du Point G, Bamako, Mali
| | - Yacouba CISSOKO
- Service de Maladies infectieuses et tropicales du Centre hospitalier universitaire du Point G, Bamako, Mali,Faculté de Médecine et d'odontostomatologie de l'Université des Sciences, des techniques et des technologies, Bamako, Mali
| | - Mariam SOUMARÉ
- Service de Maladies infectieuses et tropicales du Centre hospitalier universitaire du Point G, Bamako, Mali
| | - Issa KONATÉ
- Service de Maladies infectieuses et tropicales du Centre hospitalier universitaire du Point G, Bamako, Mali,Faculté de Médecine et d'odontostomatologie de l'Université des Sciences, des techniques et des technologies, Bamako, Mali
| | - Sounkalo DAO
- Service de Maladies infectieuses et tropicales du Centre hospitalier universitaire du Point G, Bamako, Mali,Faculté de Médecine et d'odontostomatologie de l'Université des Sciences, des techniques et des technologies, Bamako, Mali,Centre de recherche et de formation sur la Tuberculose et le VIH (CEREFO), Bamako, Mali
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15
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Pratt EJ, Mancera-Andrade EI, Bicker KL. Synthesis and Characterization of Derivatives of the Antifungal Peptoid RMG8-8. ACS OMEGA 2022; 7:36663-36671. [PMID: 36278036 PMCID: PMC9583092 DOI: 10.1021/acsomega.2c04778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
Cryptococcal meningitis, caused by the fungal pathogen Cryptococcus neoformans, is a devastating disease with a mortality rate of over 80%. Due to the increasing prevalence of resistance to antifungals and the high mammalian toxicity of current treatments, the development of new antifungal therapies is vital. In an effort to improve the biological properties of a previously discovered antifungal peptoid, termed RMG8-8, an iterative structure-activity relationship study was conducted. This three-round study sought to optimize the structure of RMG8-8 by focusing on three main structural components: the lipophilic tail, aliphatic side chains, and aromatic side chains. In addition to antifungal testing against C. neoformans, cytotoxicity testing was also performed on all derivatives against human liver cells, and select promising compounds were tested for hemolytic activity against human red blood cells. A number of derivatives containing unique aliphatic or aromatic side chains had antifungal activity similar to RMG8-8 (MIC = 1.56 μg/mL), but all of these compounds were more toxic than RMG8-8. While no derivative was improved across all biological tests, modest improvements were made to the hemolytic activity with compound 9, containing isobutyl side chains in positions 2 and 5, compared to RMG8-8 (HC10 = 130 and 75 μg/mL, respectively). While this study did not yield a dramatically optimized RMG8-8 derivative, this result was not totally unexpected given the remarkable selectivity of this compound from discovery. Nonetheless, this study is an important step in the development of RMG8-8 as a viable antifungal therapeutic.
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16
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Xu L, Zhu J, Wang X, Zeng G, Gao Z, Liu J. Clinical features and risk factors of surgical site infections in HIV-negative patients with cryptococcal meningitis underwent ventriculoperitoneal shunt operations: a retrospective study. BMC Infect Dis 2022; 22:736. [PMID: 36104794 PMCID: PMC9476323 DOI: 10.1186/s12879-022-07719-2] [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: 06/02/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background To investigate the clinical features and risk factors of ventriculoperitoneal shunt (VPS) associated surgical site infections (SSIs) in HIV-negative patients with cryptococcal meningitis (CM). Methods We retrospectively reviewed the medical records of HIV-negative patients with CM underwent VPS operation admitted to The Third Affiliated Hospital of Sun Yat-sen University in Southwest China over the past 7 years. Results 193 patients were included, of whom 25 (12.95%) had SSIs in 6 (median duration, 1–48 days) days after operation. Compared with patients without SSIs, patient with SSIs tended to be shorter preoperative stay. 52% patients in SSIs group and 25% patients in no-SSIs group underwent VPS operations within 3 days after admission (p = 0.017). Although body temperature and infectious indicators slightly elevated postoperative in both groups. The patients with SSIs experienced more fever; more central nervous system symptoms; higher PCT value and lower cerebrospinal fluid (CSF) glucose in contrast to the no-SSIs group. Multivariate regression analysis found a 2.653 fold increase in the risk of infection for every 1 °C increase in postoperative body temperature. Among the 25 patients, 9 patients had positive culture results, three samples reported to be oxacillin resistant coagulase-negative Staphylococci. Conclusions SSIs was one of the serious surgical complications after VPS operation. High body temperature, the occurrence of dizziness and headache, low postoperative hemoglobin are risk factors. Postoperative patients with high fever, high PCT and low CSF glucose should be paid more attention to.
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Seffah K, Agyeman W, Madeo JL, Ahmad A. Cryptococcus Infection in an Immunocompetent Patient. Cureus 2022; 14:e27635. [PMID: 36072174 PMCID: PMC9437374 DOI: 10.7759/cureus.27635] [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] [Accepted: 08/02/2022] [Indexed: 12/02/2022] Open
Abstract
Cryptococcal meningitis is a fungal infection of the CNS, generally thought of as an opportunistic infection in those with T-cell immunodeficiencies including AIDS (usually with a CD4 count of less than 100), chronic steroid use, hematological malignancies, and transplant recipients. It can have irreversible CNS morbidity, including vision loss, intracranial hypertension, and cognitive decline. Diagnosis depends on cerebrospinal fluid (CSF) analysis, in which cultures and cryptococcal antigen are most sensitive. CSF PCR can also be done. Most patients have disseminated disease, and blood cultures are also positive. Outcomes remain guarded, with a poor prognosis (morbidity and high mortality) among survivors. This article presents a case of cryptococcal meningitis in an immunocompetent individual, where absolutely no identifiable risk factor was present.
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Zhou Z, Zhu C, Ip M, Liu M, Zhu Z, Liu R, Li X, Zeng L, Wu W. Molecular Epidemiology and Antifungal Resistance of Cryptococcus neoformans From Human Immunodeficiency Virus-Negative and Human Immunodeficiency Virus-Positive Patients in Eastern China. Front Microbiol 2022; 13:942940. [PMID: 35865921 PMCID: PMC9294546 DOI: 10.3389/fmicb.2022.942940] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Cryptococcosis is an opportunistic and potentially lethal infection caused by Cryptococcus neoformans and Cryptococcus gattii complex, which affects both immunocompromised and immunocompetent people, and it has become a major public health concern worldwide. In this study, we characterized the molecular epidemiology and antifungal susceptibility of 133 C. neoformans isolates from East China Invasive Fungal Infection Group (ECIFIG), 2017–2020. Isolates were identified to species level by matrix-assisted laser desorption ionization-time of flight mass spectrometry and confirmed by IGS1 sequencing. Whole-genome sequencing (WGS) was conducted on three multidrug-resistant isolates. Among the 133 strains, 61 (45.86%) were isolated from HIV-positive patients and 72 (54.16%) were isolated from HIV-negative patients. In total, C. neoformans var. grubii accounted for 97.74% (130/133), while C. neoformans var. neoformans was rare (2.06%, 3/133). The strains were further classified into nine sequence types (STs) dominated by ST5 (90.23%, 120/133) with low genetic diversity. No association was observed between STs and HIV status. All strains were wild type to voriconazole, while high antifungal minimal inhibitory concentrations (MICs) above the epidemiological cutoff values (ECVs) were observed in C. neoformans strains, and more than half of isolates were non-wild-type to amphotericin B (89.15%, 109/133). Eight isolates were resistant to fluconazole, and eight isolates were non-wild type to 5-fluorocytosine. Furthermore, WGS has verified the novel mutations of FUR1 in 5-fluorocytosine-resistant strains. In one isolate, aneuploidy of chromosome 1 with G484S mutation of ERG11 was observed, inducing high-level resistance (MIC: 32 μg/ml) to fluconazole. In general, our data showed that there was no significant difference between HIV-positive and HIV-negative patients on STs, and we elucidate the resistant mechanisms of C. neoformans from different perspectives. It is important for clinical therapy and drug usage in the future.
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Affiliation(s)
- Ziyi Zhou
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chendi Zhu
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Manjiao Liu
- State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, China
| | - Zhaoqin Zhu
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Ryon Liu
- State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, China
| | - Xiaomin Li
- State Key Laboratory of Translational Medicine and Innovative Drug Development, Jiangsu Simcere Diagnostics Co., Ltd., Nanjing, China
| | - Lingbing Zeng
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Lingbing Zeng,
| | - Wenjuan Wu
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Wenjuan Wu,
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Tissue Engineering Approaches to Uncover Therapeutic Targets for Endothelial Dysfunction in Pathological Microenvironments. Int J Mol Sci 2022; 23:ijms23137416. [PMID: 35806421 PMCID: PMC9266895 DOI: 10.3390/ijms23137416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 02/07/2023] Open
Abstract
Endothelial cell dysfunction plays a central role in many pathologies, rendering it crucial to understand the underlying mechanism for potential therapeutics. Tissue engineering offers opportunities for in vitro studies of endothelial dysfunction in pathological mimicry environments. Here, we begin by analyzing hydrogel biomaterials as a platform for understanding the roles of the extracellular matrix and hypoxia in vascular formation. We next examine how three-dimensional bioprinting has been applied to recapitulate healthy and diseased tissue constructs in a highly controllable and patient-specific manner. Similarly, studies have utilized organs-on-a-chip technology to understand endothelial dysfunction's contribution to pathologies in tissue-specific cellular components under well-controlled physicochemical cues. Finally, we consider studies using the in vitro construction of multicellular blood vessels, termed tissue-engineered blood vessels, and the spontaneous assembly of microvascular networks in organoids to delineate pathological endothelial dysfunction.
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Luo L, Yang J, Wang C, Wu J, Li Y, Zhang X, Li H, Zhang H, Zhou Y, Lu A, Chen S. Natural products for infectious microbes and diseases: an overview of sources, compounds, and chemical diversities. SCIENCE CHINA. LIFE SCIENCES 2022; 65:1123-1145. [PMID: 34705221 PMCID: PMC8548270 DOI: 10.1007/s11427-020-1959-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022]
Abstract
As coronavirus disease 2019 (COVID-19) threatens human health globally, infectious disorders have become one of the most challenging problem for the medical community. Natural products (NP) have been a prolific source of antimicrobial agents with widely divergent structures and a range vast biological activities. A dataset comprising 618 articles, including 646 NP-based compounds from 672 species of natural sources with biological activities against 21 infectious pathogens from five categories, was assembled through manual selection of published articles. These data were used to identify 268 NP-based compounds classified into ten groups, which were used for network pharmacology analysis to capture the most promising lead-compounds such as agelasine D, dicumarol, dihydroartemisinin and pyridomycin. The distribution of maximum Tanimoto scores indicated that compounds which inhibited parasites exhibited low diversity, whereas the chemistries inhibiting bacteria, fungi, and viruses showed more structural diversity. A total of 331 species of medicinal plants with compounds exhibiting antimicrobial activities were selected to classify the family sources. The family Asteraceae possesses various compounds against C. neoformans, the family Anacardiaceae has compounds against Salmonella typhi, the family Cucurbitacea against the human immunodeficiency virus (HIV), and the family Ancistrocladaceae against Plasmodium. This review summarizes currently available data on NP-based antimicrobials against refractory infections to provide information for further discovery of drugs and synthetic strategies for anti-infectious agents.
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Affiliation(s)
- Lu Luo
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Jun Yang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Cheng Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100006, China
| | - Jie Wu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Yafang Li
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Xu Zhang
- weMED Health, Houston, 77054, USA
| | - Hui Li
- Institute of Botany, Chinese Academy of Sciences, Beijing, 100093, China
| | - Hui Zhang
- Akupunktur Akademiet, Aabyhoej, Aarhus, 8230, Denmark
| | - Yumei Zhou
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, 518033, China
| | - Aiping Lu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, 999077, China
| | - Shilin Chen
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
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Faruq R, Plichtova L, Bhagat N, Saul Z. A Case of Cryptococcal Meningitis and Fungemia With Relapse in an HIV-Negative, Non-transplant Patient on Azathioprine Therapy for Mixed Connective Tissue Disorder. Cureus 2022; 14:e24356. [PMID: 35607540 PMCID: PMC9123404 DOI: 10.7759/cureus.24356] [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] [Accepted: 04/19/2022] [Indexed: 12/02/2022] Open
Abstract
Cryptococcal meningitis typically occurs in immunocompromised patients. Approximately 80% of cryptococcal infections occur in HIV patients. Non-HIV, non-transplant recipient patients are the least numerous population groups affected by cryptococcal infections. While this group includes patients on biologics and corticosteroids, very few cases have been reported in patients on azathioprine. Cryptococcal meningitis requires antifungal therapy, the duration of which varies among different population groups. Inadequate duration of antibiotics among these groups is one of the most common reasons for relapse; therefore, it is crucial to consider patient demographic when determining antifungal duration. Here, we report a 68-year-old male with a history of mixed connective tissue disease on azathioprine for six years, who was admitted to the hospital with worsening lethargy. Several days into admission, the patient developed low-grade fevers. Subsequent blood cultures grew Cryptococcus neoformans. He was started on liposomal amphotericin B. Lumbar puncture (LP) was done, which demonstrated positive cryptococcal antigen, and flucytosine was added to the treatment regimen. Repeat CSF culture demonstrated no fungal organisms. Amphotericin B was discontinued after 20 days of therapy. Following clinical improvement, he was subsequently discharged on oral fluconazole. One week following discharge, the patient was readmitted with worsening fevers and altered mental status. CSF studies demonstrated the growth of Cryptococcus on culture. Liposomal amphotericin B was reinitiated, and fluconazole was continued. Imaging showed hydrocephalus, which worsened despite ventriculoperitoneal shunt. The patient expired following transition to comfort care. In conclusion, cryptococcal meningitis should be considered as a differential in non-HIV, non-transplant patients on azathioprine presenting with fever and worsening lethargy, and 4-6 weeks of induction therapy is required in this patient group to prevent relapse.
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22
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Fang L, Zhang J, Lv F. Disseminated cryptococcosis with varicella-zoster virus coinfection of idiopathic CD4 + T lymphocytopenia: a case report and literature review. Virol J 2022; 19:38. [PMID: 35248113 PMCID: PMC8898517 DOI: 10.1186/s12985-022-01765-7] [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: 11/06/2021] [Accepted: 02/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background Idiopathic CD4 + T lymphocytopenia (ICL) is a rare immunodeficiency syndrome, unaccompanied by various opportunistic infections. Cryptococcus and varicella-zoster viruse are the most common opportunistic infections. Method We described a case of disseminated cryptococcosis with varicella-zoster virus coinfection in a patient with ICL and reviewed all published reports. A total of 26 cases with cryptococcal meningitis in ICL were enrolled. Discussion ICL remains poorly understood to clinicians. Patients with cryptococcal meningitis in ICL mostly suffered with headache and fever in a subacute or chronic period, while some patients might have atypical manifestations which makes a difficulty for early diagnosis. Some characteristics of cerebrospinal fluid can help to predict the prognosis of the disease. Cryptococcosis with varicella-zoster virus coinfection is rare but serious. Conclusion We recommed CD4 + T cells should be assessed in patients with unusual or recurrent infections. As the underlying pathophysiology is poorly understood, there is no standard therapy for ICL. Increased awareness of the disease and early prevention for CD4 reduction are needed.
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Gutierrez-Gongora D, Geddes-McAlister J. Peptidases: promising antifungal targets of the human fungal pathogen, Cryptococcus neoformans. Facets (Ott) 2022. [DOI: 10.1139/facets-2021-0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cryptococcus neoformans is a globally important fungal pathogen, primarily inflicting disease on immunocompromised individuals. The widespread use of antifungal agents in medicine and agriculture supports the development of antifungal resistance through evolution, and the emergence of new strains with intrinsic resistance drives the need for new therapeutics. For C. neoformans, the production of virulence factors, including extracellular peptidases (e.g., CnMpr-1 and May1) with mechanistic roles in tissue invasion and fungal survival, constitute approximately 2% of the fungal proteome and cover five classes of enzymes. Given their role in fungal virulence, peptidases represent promising targets for anti-virulence discovery in the development of new approaches against C. neoformans. Additionally, intracellular peptidases, which are involved in resistance mechanisms against current treatment options (e.g., azole drugs), as well as capsule biosynthesis and elaboration of virulence factors, present additional opportunities to combat the pathogen. In this review, we highlight key cryptococcal peptidases with defined or predicted roles in fungal virulence and assess sequence alignments against their human homologs. With this information, we define the feasibility of the select peptidases as “druggable” targets for inhibition, representing prospective therapeutic options against the deadly fungus.
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Affiliation(s)
- Davier Gutierrez-Gongora
- The Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario N1G 2W1, Canada
- Centro de Estudio de Proteínas, Facultad de Biología, Universidad de La Habana, La Habana, Cuba
| | - Jennifer Geddes-McAlister
- The Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario N1G 2W1, Canada
- Canadian Proteomics and Artificial Intelligence Research and Training Consortium
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24
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Zhang M, Zhou Z, Wang D, Zhou A, Song G, Chen X, Guo J, Wu W. OUP accepted manuscript. Med Mycol 2022; 60:6517704. [PMID: 35099022 DOI: 10.1093/mmy/myac009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Min Zhang
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Ziyi Zhou
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Dongjiang Wang
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Aiping Zhou
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Guobin Song
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Xingchun Chen
- Department of Clinical Laboratory, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, 530021, Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jian Guo
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
| | - Wenjuan Wu
- Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 200120, Shanghai, China
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Guevara N, Akande A, Chang MF, Atallah J, Epstein C. A case report of a brain herniation secondary to cryptococcal meningitis with elevated intracranial pressure in a patient with Human Immunodeficiency Virus/Acquired immunodeficiency syndrome (HIV/AIDS). IDCases 2022; 29:e01554. [PMID: 35845828 PMCID: PMC9278440 DOI: 10.1016/j.idcr.2022.e01554] [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: 04/11/2022] [Revised: 06/19/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background Cryptococcal meningitis is a major opportunistic infection in individuals with HIV. The worldwide annual incidence is estimated to be approximately one million cases per year, with the most significant burden in sub-Saharan Africa. HIV-associated cryptococcal meningitis continues to have a high mortality rate despite widespread availability and use of HAART. Case 36-year-old male with a past medical history of AIDS and a CD4 count of 35 cells/mm3 presented with altered mental status initially thought to be related to using crystalline methamphetamine as reported by EMS. However, a lumbar puncture performed in the emergency department showed elevated CSF opening pressure of 29 cmH2O and positive CSF and serum cryptococcal antigen. The patient was admitted and commenced treatment according to the current IDSA guideline but continued to have waxing and waning mental status. On the fourth day of admission, he complained of headache, had a witnessed seizure, and was taken emergently for a CT scan of the brain, which was negative for any acute intracranial process, but suffered a cardiac arrest before it could be done. He was intubated and transferred to the intensive care unit. CT brain follow-up showed anoxic encephalopathy, development of marked cerebral edema, and complete effacement of the basilar cisterns, suggestive of downward transtentorial herniation; he continued to deteriorate and expired on the seventh day of admission. Objectives Describe a case of brain death secondary to increased intracranial pressure due to cryptococcal meningitis in a patient with HIV/AIDS. Explain the mechanisms of elevation in intracranial pressure in patients with cryptococcal meningitis. Discuss the options for managing elevated intracranial pressure in patients with cryptococcal meningitis. Create awareness in the medical community about the importance of prompt and efficient management of increased intracranial pressure in patients with cryptococcal meningitis.
Conclusion This case highlights the importance of aggressive management of elevated intracranial pressure in cryptococcal meningitis. It reiterates the need for more data regarding the optimal timing and frequency of therapeutic lumbar puncture and the use of temporary lumbar drainage catheters and ventriculostomy to manage this potentially fatal complication.
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Correa K, Craver S, Sandhu A. An Uncommon Presentation of Cryptococcal Meningitis in an Immunocompetent Patient: A Case Report. Clin Pract Cases Emerg Med 2021; 5:450-454. [PMID: 34813442 PMCID: PMC8610466 DOI: 10.5811/cpcem.2021.8.53368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Meningitis is a serious and potentially life-threatening infection of the central nervous system. Cryptococcus neoformans is a rare fungal cause of meningitis that commonly presents with atypical symptoms. Although this infection is most common in immunocompromised patients, it also occurs in immunocompetent patients. This case report describes an atypical presentation of cryptococcal meningitis in a seemingly immunocompetent patient. Case Report A 40-year-old immunocompetent patient with no significant past medical history had visited the emergency department (ED) five times within a span of 30 days reporting dental pain and headache. Throughout each of the visits, no clear symptoms signaling the need for a meningitis workup were observed, as the patient had been afebrile, displayed no nuchal rigidity, and his presenting symptoms subsided within the ED after treatment. A lumbar puncture was performed after emergency medical services brought the patient in for his sixth ED visit, initially for stroke-like symptoms and altered mental status. Spinal fluid was indicative of cryptococcal meningitis. Conclusion This case highlights the challenge of identifying cryptococcal meningitis in the ED, particularly in immunocompetent patients who do not display classic meningitis symptoms. It also highlights the importance of keeping a broad differential and carefully ruling out diagnoses when patients return to the ED multiple times for the same complaint.
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Affiliation(s)
- Kelly Correa
- Henry Ford Wyandotte Hospital, Department of Emergency Medicine and Graduate Medical Education, Wyandotte, Michigan
| | - Scott Craver
- Ascension St. Vincent Indianapolis Hospital, Department of Emergency Medicine, Indianapolis, Indiana
| | - Amar Sandhu
- Henry Ford Wyandotte Hospital, Department of Emergency Medicine, Wyandotte, Michigan
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Cost-Effectiveness Analysis of the Implementation of Cryptococcal Antigen Lateral Flow Assay for the Diagnosis of Cryptococcal Meningitis in Symptomatic People Living With Human Immunodeficiency Virus in Brazil. Value Health Reg Issues 2021; 29:53-59. [PMID: 34801886 DOI: 10.1016/j.vhri.2021.09.006] [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] [Received: 04/10/2021] [Revised: 07/25/2021] [Accepted: 09/11/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Cryptococcal meningitis constitutes a significant source of mortality in the developing world. Annually, approximately 625 000 deaths occur worldwide among patients with human immunodeficiency virus (HIV) infection. This study aims to assess the cost-effectiveness of implementing cryptococcal antigen lateral flow assay (CRAG-LFA) screening in Brazil compared with the current practice. METHODS An economic evaluation using a Monte Carlo microsimulation was conducted, considering the perspective of the Brazilian Public Health System, to calculate the cost-effectiveness of 4 diagnosis tests: (1) CRAG-LFA, (2) the cryptococcal antigen latex agglutination (CRAG-LA) test, (3) India ink, and (4) nontracking as a baseline. The time horizon comprised 1 year for the intervention and 5 years for the budgetary impact analysis. Two primary effectiveness outcomes were considered: years of life and quality-adjusted life-years. RESULTS CRAG-LFA has extended dominance vis à vis CRAG-LA and India ink. CRAG-LFA would cost $418.46 more than CRAG-LA for the treatment of each symptomatic patient living with HIV, with an incremental cost effectiveness ratio of $2478.75/quality-adjusted life year. The budgetary impact analysis estimated that the incorporation of CRAG-LFA would have an additional cost of $1 959 236.50 in 5 years. CONCLUSIONS These findings suggest that, for patients living with HIV in the Brazilian Public Health System, the adoption of CRAG-LFA screening is cost-effective compared with the use of CRAG-LA and India ink. It represents an opportunity to prevent cryptococcal meningitis and its mortality in Brazil.
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Bosch C, Volschenk H, Botha A. The copper transporter, Ctr4, and the microtubule-associated protein, Cgp1, are important for Cryptococcus neoformans adaptation to nitrogen availability. FEMS Microbiol Lett 2021; 368:6402899. [PMID: 34665227 DOI: 10.1093/femsle/fnab134] [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: 08/11/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
Nitrogen limitation was previously shown to be an important regulator of several genes associated with virulence in Cryptococcus neoformans. Among the most highly expressed genes under low-nitrogen conditions were CTR4 and CGP1, encoding a copper transporter and a microtubule-associated protein, respectively. However, the functional association of these genes with nitrogen limitation-a nutritional stress experienced in both environment and host-remains to be determined. Moreover, whether increased CTR4 and CGP1 expression is linked to the enhanced cryptococcal drug tolerance previously observed in low-nitrogen conditions is yet to be elucidated. Therefore, the present study explored the role of Cgp1 and Ctr4 in C. neoformans nitrogen stress adaptation and antifungal susceptibility. Our results showed that these genes play a role in the growth of C. neoformans in nitrogen-limited media, nitrogen source assimilation and growth on nitrogen-poor woody debris. Furthermore, we demonstrate that both Ctr4 and Cgp1 contribute to oxidative stress and antifungal susceptibility, with a ctr4∆ mutant being more susceptible to fluconazole and a cgp1∆ mutant being more susceptible to fluconazole and amphotericin B. Overall, our findings improve our understanding of the role of Ctr4 and Cgp1 in cryptococcal drug tolerance and adaptation to nitrogen availability.
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Affiliation(s)
- Caylin Bosch
- Department of Microbiology, Stellenbosch University, Matieland, Stellenbosch 7602, South Africa
| | - Heinrich Volschenk
- Department of Microbiology, Stellenbosch University, Matieland, Stellenbosch 7602, South Africa
| | - Alfred Botha
- Department of Microbiology, Stellenbosch University, Matieland, Stellenbosch 7602, South Africa
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MAKADZANGE TA, HLUPENI A, MACHEKANO R, BOYD K, MTISI T, NYAMAYARO P, ROSS C, VALLABHANENI S, BALACHANDRA S, CHONZI P, NDHLOVU CE. Survival following screening and preemptive antifungal therapy for subclinical cryptococcal disease in advanced HIV infection. AIDS 2021; 35:1929-1938. [PMID: 34101629 PMCID: PMC8416705 DOI: 10.1097/qad.0000000000002971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Our study's primary objective was to compare 1-year survival rates between serum cryptococcal antigen (sCrAg)-positive and sCrAg-negative HIV-positive individuals with CD4+ cell counts less than 100 cells/μl without symptoms of meningitis in Zimbabwe. DESIGN This was a prospective cohort study. METHODS Participants were enrolled as either sCrAg-positive or sCrAg-negative and followed up for 52 weeks or less, with death as the outcome. Lumbar punctures were recommended to all sCrAg-positives and inpatient management with intravenous amphotericin B and high-dose fluconazole was recommended to those with disseminated Cryptococcus. Antiretroviral therapy was initiated immediately in sCrAg-negatives and after at least 4 weeks following initiation of antifungals in sCrAg-positives. Multivariable logistic regression models were used to determine risk factors for mortality. RESULTS We enrolled 1320 participants and 130 (9.8%) were sCrAg positive, with a median sCrAg titre of 1 : 20. Sixty-six (50.8%) sCrAg-positives had lumbar punctures and 16.7% (11/66) had central nervous system (CNS) dissemination. Cryptococcal blood cultures were performed in 129 sCrAg-positives, with 10 (7.8%) being positive. One-year (48-52 weeks) survival rates were 83.9 and 76.1% in sCrAg-negatives and sCrAg-positives, respectively, P = 0.011. Factors associated with increased mortality were a positive sCrAg, CD4+ cell count less than 50 cells/μl and having presumptive tuberculosis (TB) symptoms. CONCLUSION Our study reports a high prevalence of subclinical cryptococcal antigenemia and reiterates the importance of TB and a positive sCrAg as risk factors for mortality in advanced HIV disease (AHD). Therefore, TB and sCrAg screening remains a crucial component of AHD package, hence it should always be part of the comprehensive clinical evaluation in AHD patients.
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Affiliation(s)
| | - Admire HLUPENI
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Rhoderick MACHEKANO
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Kathryn BOYD
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Takudzwa MTISI
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Primrose NYAMAYARO
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Christine ROSS
- US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | - Prosper CHONZI
- Health Services Department, City of Harare, Harare, Zimbabwe
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Green RM, Bicker KL. Discovery and Characterization of a Rapidly Fungicidal and Minimally Toxic Peptoid against Cryptococcus neoformans. ACS Med Chem Lett 2021; 12:1470-1477. [PMID: 34531956 DOI: 10.1021/acsmedchemlett.1c00327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/20/2021] [Indexed: 01/20/2023] Open
Abstract
A limited number of antifungals are available to treat infections caused by fungal pathogens such as Cryptococcus neoformans and Candida albicans. Current clinical antifungals are generally toxic, and increasing resistance to these therapies is being observed, necessitating new, effective, and safe antifungals. Peptoids, or N-substituted glycines, have shown promise as antimicrobial agents against bacteria, fungi, and parasites. Herein we report the discovery and characterization of an antifungal peptoid termed RMG8-8. This compound was originally discovered from a combinatorial peptoid library using the Peptoid Library Agar Diffusion assay to screen against C. albicans. Though the efficacy of RMG8-8 against C. albicans was modest (25 μg/mL), the efficacy against C. neoformans was excellent (1.56 μg/mL). Cytotoxicity against a panel of cell lines proved RMG8-8 to be minimally toxic, with selectivity ratios ranging from 34 to 121. Additional studies were carried out to determine the pharmacological importance of each peptoid monomer in RMG8-8, characterize the killing kinetics of this compound against C. neoformans (t 1/2 = 6.5 min), and evaluate plasma protein binding and proteolytic stability. Finally, a liposomal lysis assay suggested that RMG8-8 likely exerts fungal killing through membrane permeabilization, the generally accepted mechanism of action for most antimicrobial peptides and peptoids.
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Affiliation(s)
- R. Madison Green
- Department of Chemistry, Middle Tennessee State University, 1301 E. Main St., Murfreesboro, Tennessee 37132, United States
| | - Kevin L. Bicker
- Department of Chemistry, Middle Tennessee State University, 1301 E. Main St., Murfreesboro, Tennessee 37132, United States
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Gressler AE, Volke D, Firacative C, Schnabel CL, Müller U, Krizsan A, Schulze-Richter B, Brock M, Brombacher F, Escandón P, Hoffmann R, Alber G. Identification of Disease-Associated Cryptococcal Proteins Reactive With Serum IgG From Cryptococcal Meningitis Patients. Front Immunol 2021; 12:709695. [PMID: 34367172 PMCID: PMC8342929 DOI: 10.3389/fimmu.2021.709695] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/21/2021] [Indexed: 01/16/2023] Open
Abstract
Cryptococcus neoformans, an opportunistic fungal pathogen ubiquitously present in the environment, causes cryptococcal meningitis (CM) mainly in immunocompromised patients, such as AIDS patients. We aimed to identify disease-associated cryptococcal protein antigens targeted by the human humoral immune response. Therefore, we used sera from Colombian CM patients, with or without HIV infection, and from healthy individuals living in the same region. Serological analysis revealed increased titers of anti-cryptococcal IgG in HIV-negative CM patients, but not HIV-positive CM patients, compared to healthy controls. In contrast, titers of anti-cryptococcal IgM were not affected by CM. Furthermore, we detected pre-existing IgG and IgM antibodies even in sera from healthy individuals. The observed induction of anti-cryptococcal IgG but not IgM during CM was supported by analysis of sera from C. neoformans-infected mice. Stronger increase in IgG was found in wild type mice with high lung fungal burden compared to IL-4Rα-deficient mice showing low lung fungal burden. To identify the proteins targeted by human anti-cryptococcal IgG antibodies, we applied a quantitative 2D immunoproteome approach identifying cryptococcal protein spots preferentially recognized by sera from CM patients or healthy individuals followed by mass spectrometry analysis. Twenty-three cryptococcal proteins were recombinantly expressed and confirmed to be immunoreactive with human sera. Fourteen of them were newly described as immunoreactive proteins. Twelve proteins were classified as disease-associated antigens, based on significantly stronger immunoreactivity with sera from CM patients compared to healthy individuals. The proteins identified in our screen significantly expand the pool of cryptococcal proteins with potential for (i) development of novel anti-cryptococcal agents based on implications in cryptococcal virulence or survival, or (ii) development of an anti-cryptococcal vaccine, as several candidates lack homology to human proteins and are localized extracellularly. Furthermore, this study defines pre-existing anti-cryptococcal immunoreactivity in healthy individuals at a molecular level, identifying target antigens recognized by sera from healthy control persons.
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Affiliation(s)
- A Elisabeth Gressler
- Institute of Immunology, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - Daniela Volke
- Institute of Bioanalytical Chemistry, Leipzig University, Leipzig, Germany
| | - Carolina Firacative
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Christiane L Schnabel
- Institute of Immunology, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - Uwe Müller
- Institute of Immunology, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - Andor Krizsan
- Institute of Bioanalytical Chemistry, Leipzig University, Leipzig, Germany
| | - Bianca Schulze-Richter
- Institute of Immunology, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - Matthias Brock
- Fungal Genetics and Biology Group, School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Frank Brombacher
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Cape Town, South Africa
| | | | - Ralf Hoffmann
- Institute of Bioanalytical Chemistry, Leipzig University, Leipzig, Germany
| | - Gottfried Alber
- Institute of Immunology, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
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Bosch C, Toplis B, Vreulink JM, Volschenk H, Botha A. Nitrogen concentration affects amphotericin B and fluconazole tolerance of pathogenic cryptococci. FEMS Yeast Res 2021; 20:5740677. [PMID: 32073632 DOI: 10.1093/femsyr/foaa010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/17/2020] [Indexed: 01/19/2023] Open
Abstract
Environmental stress often causes phenotypic changes among pathogenic cryptococci, such as altered antifungal susceptibility, changes in capsule and melanin formation, as well as altered levels of the membrane sterol and antifungal target, ergosterol. We therefore hypothesised that nitrogen limitation, a prevalent environmental stress in the natural habitat of these yeasts, might affect virulence and antifungal susceptibility. We tested the effect of different nitrogen concentrations on capsule, melanin and ergosterol biosynthesis, as well as amphotericin B (AmB) and fluconazole (FLU) susceptibility. This was achieved by culturing cryptococcal strains representing Cryptococcus neoformans and Cryptococcus gattii in media with high (0.53 g/l), control (0.42 g/l) and low (0.21 g/l) NH4Cl concentrations. India ink staining was used to determine capsule thickness microscopically, while melanin and ergosterol content were determined spectrophotometrically. We found that lower nitrogen concentrations enhanced both ergosterol and capsule biosynthesis, while a variable effect was observed on melanisation. Evaluation of drug tolerance using time-kill methodology, as well as tests for FLU heteroresistance, revealed that the low nitrogen cultures had the highest survival percentages in the presence of both AmB and FLU, and showed the highest frequency of FLU heteroresistance, suggesting that nitrogen concentration may indeed influence drug tolerance.
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Affiliation(s)
- Caylin Bosch
- Department of Microbiology, Stellenbosch University, Van der Bijl Street, Stellenbosch, South Africa
| | - Barbra Toplis
- Department of Microbiology, Stellenbosch University, Van der Bijl Street, Stellenbosch, South Africa
| | - Jo-Marie Vreulink
- Department of Microbiology, Stellenbosch University, Van der Bijl Street, Stellenbosch, South Africa
| | - Heinrich Volschenk
- Department of Microbiology, Stellenbosch University, Van der Bijl Street, Stellenbosch, South Africa
| | - Alfred Botha
- Department of Microbiology, Stellenbosch University, Van der Bijl Street, Stellenbosch, South Africa
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Fisher KM, Montrief T, Ramzy M, Koyfman A, Long B. Cryptococcal meningitis: a review for emergency clinicians. Intern Emerg Med 2021; 16:1031-1042. [PMID: 33420904 DOI: 10.1007/s11739-020-02619-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cryptococcal Meningitis (CM) remains a high-risk clinical condition, and many patients require emergency department (ED) management for complications and stabilization. OBJECTIVE This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of CM. DISCUSSION This review evaluates the diagnosis, management, and empiric treatment of suspected CM in the ED. CM can easily evade diagnosis with a subacute presentation, and should be considered in any patient with a headache, neurological deficit, or who is immunocompromised. As a definitive diagnosis of CM will not be made in the ED, management of a patient with suspected CM includes prompt diagnostic testing and initiation of empiric treatment. Multiple types of newer Cryptococcal antigen tests provide high sensitivity and specificity both in serum and cerebrospinal fluid (CSF). Patients should be treated empirically for bacterial, fungal, and viral meningitis, specifically with amphotericin B and flucytosine for presumed CM. Additionally, appropriate resuscitation and supportive care, including advanced airway management, management of increased intracranial pressure (ICP), antipyretics, intravenous fluids, and isolation, should be initiated. Antiretroviral therapy (ART) should not be initiated in the ED for those found or known to be HIV-positive for risk of immune reconstitution inflammatory syndrome (IRIS). CONCLUSIONS CM remains a rare clinical presentation, but carries significant morbidity and mortality. Physicians must rapidly diagnose these patients while evaluating for other diseases and complications. Early consultation with an infectious disease specialist is imperative, as is initiating symptomatic care.
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Affiliation(s)
- Kathryn Marie Fisher
- Department of Emergency Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA
| | - Tim Montrief
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, 3550 Terrace St., Pittsburgh, PA, 15261, USA
| | - Mark Ramzy
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, 3550 Terrace St., Pittsburgh, PA, 15261, USA
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA.
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Tsai ST, Lin FY, Chen PS, Chiang HY, Kuo CC. Three-year mortality in cryptococcal meningitis: Hyperglycemia predict unfavorable outcome. PLoS One 2021; 16:e0251749. [PMID: 34048463 PMCID: PMC8162582 DOI: 10.1371/journal.pone.0251749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/02/2021] [Indexed: 11/18/2022] Open
Abstract
Existing evidence revealed grave prognosis for cryptococcal meningitis (CM), particularly its short-term mortality. However, its long-term survival and prognostic factors remained unknown. This study investigated 3-year mortality and analyzed its predictive factors in patients with CM. This retrospective cohort study with 83 cerebrospinal fluid culture-confirmed CM patients was conducted at China Medical University Hospital from 2003 to 2016. The 3-year mortality rate in patients with CM was 54% (45 deaths among 83 patients). Advanced age, human immunodeficiency virus (HIV) seronegative state, low Glasgow Coma Scale score on admission, decreased hemoglobin and hyperglycemia on diagnosis were associated with 3-year mortality. After multivariate adjustment in the Cox proportional hazard model, only severe hyperglycemia (serum glucose ≥200 mg/dL) on diagnosis could predict 3-year mortality.
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Affiliation(s)
- Sheng-Ta Tsai
- Department of Neurology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Fu-Yu Lin
- Department of Neurology, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- * E-mail:
| | - Pei-Shan Chen
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
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Donlin MJ, Lane TR, Riabova O, Lepioshkin A, Xu E, Lin J, Makarov V, Ekins S. Discovery of 5-Nitro-6-thiocyanatopyrimidines as Inhibitors of Cryptococcus neoformans and Cryptococcus gattii. ACS Med Chem Lett 2021; 12:774-781. [PMID: 34055225 DOI: 10.1021/acsmedchemlett.1c00038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/31/2021] [Indexed: 12/27/2022] Open
Abstract
Opportunistic infections from pathogenic fungi present a major challenge to healthcare because of a very limited arsenal of antifungal drugs, an increasing population of immunosuppressed patients, and increased prevalence of resistant clinical strains due to overuse of the few available antifungals. Cryptococcal meningitis is a life-threatening opportunistic fungal infection caused by one of two species in the Cryptococcus genus, Cryptococcus neoformans and Cryptococcus gattii. Eighty percent of cryptococcosis diseases are caused by C. neoformans that is endemic in the environment. The standard of care is limited to old antifungals, and under a high standard of care, mortality remains between 10 and 30%. We have identified a series of 5-nitro-6-thiocyanatopyrimidine antifungal drug candidates using in vitro and computational machine learning approaches. These compounds can inhibit C. neoformans growth at submicromolar levels, are effective against fluconazole-resistant C. neoformans and a clinical strain of C. gattii, and are not antagonistic with currently approved antifungals.
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Affiliation(s)
- Maureen J. Donlin
- Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St. Louis, Missouri 63104, United States
- Institute for Drug and Biotherapeutic Development, Saint Louis University, St. Louis, Missouri 63103, United States
| | - Thomas R. Lane
- Collaborations Pharmaceuticals, Inc., Raleigh, North Carolina 27606, United States
| | - Olga Riabova
- Department of Biology, Saint Louis University, St. Louis, Missouri 63103, United States
| | - Alexander Lepioshkin
- Department of Biology, Saint Louis University, St. Louis, Missouri 63103, United States
| | - Evan Xu
- Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, St. Louis, Missouri 63104, United States
| | - Jeffrey Lin
- Department of Biology, Saint Louis University, St. Louis, Missouri 63103, United States
| | - Vadim Makarov
- Research Center of Biotechnology RAS, 119071 Moscow, Russia
| | - Sean Ekins
- Collaborations Pharmaceuticals, Inc., Raleigh, North Carolina 27606, United States
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Toivonen A, Eriksson M, Friberg N, Hautala T, Kääriäinen S, Leppäaho-Lakka J, Mikkola J, Nieminen T, Oksi J, Salonen JH, Suomalainen P, Vänttinen M, Jarva H, Jääskeläinen AJ. Clinical characteristics and evaluation of the incidence of cryptococcosis in Finland 2004-2018. Infect Dis (Lond) 2021; 53:684-690. [PMID: 33974504 DOI: 10.1080/23744235.2021.1922753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Cryptococcosis is one of the major causes of mortality among HIV patients worldwide. Though most often associated with late stage HIV infection/AIDS, a significant number of cases occur in other immunocompromised patients such as solid organ transplant recipients and patients with hematological malignancies. Immunocompromised patients are a heterogeneous group and their number increases constantly. Since little is known about the incidence and the clinical features of cryptococcosis in Northern Europe, our aim was to investigate the clinical characteristics of cryptococcosis patients in Finland. METHODS We retrospectively reviewed the laboratory confirmed cryptococcosis cases in Finland during 2004-2018. Only those who were treated for cryptococcosis were included in the study. Initial laboratory findings and medical records were also collected. RESULTS A total of 22 patients with cryptococcosis were included in our study. The annual incidence of cryptococcosis was 0.03 cases per 100,000 population. Ten patients were HIV-positive and 12 out of 22 were HIV-negative. Hematological malignancy was the most common underlying condition among HIV-negative patients. CONCLUSIONS To our knowledge, this is the first study of the clinical presentation and incidence of cryptococcosis in Finland. We demonstrate that invasive cryptococcal infection occurs not only in HIV/AIDS patients or otherwise immunocompromised patients but also in immunocompetent individuals. Even though cryptococcosis is extremely rare in Finland, its recognition is important since the prognosis depends on rapid diagnostics and early antifungal therapy.
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Affiliation(s)
- Anne Toivonen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mari Eriksson
- Inflammation Center, Department of Infectious Disease, Helsinki University Hospital, Helsinki, Finland
| | - Nathalie Friberg
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo Hautala
- Research Unit of Biomedicine, University of Oulu and Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Sohvi Kääriäinen
- Infection Control Unit, Seinäjoki Central Hospital, Seinäjoki, Finland and National Institute for Health and Welfare, Helsinki, Finland
| | | | - Janne Mikkola
- Department of Infection Control and Infectious Diseases, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | | | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Juha H Salonen
- Department of Infectious Diseases, Vaasa Central Hospital, Vaasa, Finland
| | - Pekka Suomalainen
- Department of Infectious Diseases, South Karelia Central Hospital, Lappeenranta, Finland
| | - Markku Vänttinen
- Infectious Diseases Unit, Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Jarva
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland and Department of Bacteriology and Immunology and Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Annemarjut J Jääskeläinen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Kitonsa J, Kiwanuka J, Anywaine Z, Kansiime S, Katumba K, Aeron N, Beardsley J, Kibengo F, Gray A, Kaleebu P, Day J. Quality of life and associated factors among HIV positive patients after completion of treatment for Cryptococcal meningitis. PLoS Negl Trop Dis 2021; 15:e0008983. [PMID: 33657099 PMCID: PMC7959361 DOI: 10.1371/journal.pntd.0008983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 03/15/2021] [Accepted: 11/13/2020] [Indexed: 11/30/2022] Open
Abstract
Background Cryptococcal meningitis (CCM) remains one of the leading causes of mortality among HIV infected patients. Due to factors such as the severity of CCM pathology, the quality of life (QOL) of patients post-treatment is likely to be poor. Few studies have reported on QOL of CCM patients post treatment completion. We used data collected among patients in the CryptoDex trial (ISRCTN59144167) to determine QOL and associated factors at week 10 and six months from treatment initiation. Methodology CryptoDex was a double-blind placebo-controlled trial of adjunctive dexamethasone in HIV infected adults with CCM, conducted between 2013 and 2015 in six countries in Asia and Africa. QOL was determined using the descriptive and Visual Analog Scales (VAS) of the EuroQol Five-Dimension-Three-Level (EQ-5D-3L) tool. We derived index scores, and described these and the VAS scores at 10 weeks and 6 months; and used linear regression to determine the relationship between various characteristics and VAS scores at both time points. VAS scores were interpreted as very good (81–100), good (51–80), normal (31–50) and bad/very bad (0–30). Results Of 451 patients enrolled in the trial, 238 had QOL evaluations at week 10. At baseline, their mean age (SD) was 35.2(8.5) years. The mean index scores (SD) were 0.785(0.2) and 0.619(0.4) among African and Asian patients respectively at week 10, and 0.879(0.2) and 0.731(0.4) among African and Asian patients respectively at month six. The overall mean VAS score (SD) at 10 weeks was 57.2 (29.7), increasing significantly to 72(27.4) at month six (p<0.001). At week 10, higher VAS score was associated with greater weight (p = 0.007) and being African (p<0.001), while lower VAS score was associated with positive yeast culture at day 14 (p = 0.026). At month six, higher VAS score remained associated with African origin (p = 0.006) while lower VAS score was associated with positive yeast culture (p = 0.006). Lower VAS scores were associated with higher number of inpatient days at 10 weeks and 6 months (p = 0.003 and 0.002 respectively). Conclusion QOL was good among patients that had completed therapy for CCM, but below perfect. Strategies to improve QOL among CCM survivors are required. In spite of the remarkable reduction in Cryptococcal meningitis (CCM) related morbidity and mortality with increased use of antiretroviral therapy, incidence remains unacceptably high especially in sub-Saharan Africa and Asia where more than 90% of the cases and deaths occur. Due to factors such as the severity of CCM pathology, the quality of life (QOL) of patients post-treatment is also likely to be poor. Few studies have reported on QOL of CCM patients post treatment completion. We used data collected among patients in the CryptoDex trial (ISRCTN59144167) to determine self-perceived QOL and associated factors among 238 survivors at week 10 and 203 survivors at six months from treatment initiation. We determined QOL using the descriptive and Visual Analog Scales (VAS) of the EuroQol Five-Dimension-Three-Level (EQ-5D-3L) tool. We found that while self-perceived QOL was only relatively good among this cohort of patients who had survived through treatment for CCM, it continued to improve over the 6 months following diagnosis. Low weight at diagnosis, prolonged hospital admission, positive yeast culture at day 14/treatment completion, and being Asian were associated with lower QOL. QOL is an important outcome that should be considered among HIV infected patients treated for serious infections such as CCM.
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Affiliation(s)
- Jonathan Kitonsa
- Medical Research Council / Uganda Virus Research institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- * E-mail: ,
| | - Julius Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University Kampala, Uganda
| | - Zacchaeus Anywaine
- Medical Research Council / Uganda Virus Research institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Sheila Kansiime
- Medical Research Council / Uganda Virus Research institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Kenneth Katumba
- Medical Research Council / Uganda Virus Research institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Namirembe Aeron
- Medical Research Council / Uganda Virus Research institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Justin Beardsley
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme Vietnam, Ho Chi Minh City, Vietnam
- Marie Bashir Institute, Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Freddie Kibengo
- Medical Research Council / Uganda Virus Research institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Pontiano Kaleebu
- Medical Research Council / Uganda Virus Research institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jeremy Day
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme Vietnam, Ho Chi Minh City, Vietnam
- Nuffield Department of Clinical Medicine, University of Oxford, Old Road Campus, Headington, Oxford,United Kingdom
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Lee KP, Su HC, Chen PL, Sung PS. Short-term corticosteroid pulse therapy in the treatment of post-infectious spinal arachnoiditis following cryptococcal meningoencephalitis: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gu Z. An improved staining method of cell cycle analysis with Sybr Green I for fungi: Cryptococcus neoformans and Saccharomyces cerevisiae. Cell Cycle 2021; 20:271-282. [PMID: 33463377 PMCID: PMC7889188 DOI: 10.1080/15384101.2020.1870334] [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: 11/20/2019] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022] Open
Abstract
Cryptococcus neoformans is a pathogenic fungus which causes millions of deaths and infections, especially threatening immunocompromised individuals. During the development of new drugs, the ubiquitination has been found to play an important role in the regulation of the virulence and cell cycle of this fungus. Based on this mechanism, ubiquitination-related mutant strains exhibiting cell cycle arrest have been established for drug development for the fungus. However, flow cytometry detection of the cell cycle in fungi is generally difficult because the thick cell wall and capsule of fungi generally contribute to a nonspecific signal of cytometry. In this study, an improved method, derived from Saccharomyces cerevisiae assays, is developed to specifically stain C. neoformans, in whose cell cycle the G1 and G2 peaks are separated enough to be allowed for cell cycle analysis. As a result, the improved method facilitates the detection of the alterations in the cell cycle of C. neoformans with a mutation that results in cell cycle arrest, which distinctly delays the cell division of C. neoformans. Thus, the improved method reported here provides detailed technical information regarding assays on C. neoformans and, more importantly, offers a solution for assessing the cell cycle in other fungi in the future. Abbreviation: PI: propidium iodide.
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Affiliation(s)
- Zhongkai Gu
- Institutes of Biomedical Sciences, Fudan University, Shanghai, People’s Republic of China
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Mkoko P, Du Preez J, Naidoo S. Intracranial pressure management in patients with human immunodeficiency virus-associated cryptococcal meningitis in a resource-constrained setting. South Afr J HIV Med 2021; 21:1171. [PMID: 33391836 PMCID: PMC7756785 DOI: 10.4102/sajhivmed.v21i1.1171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022] Open
Abstract
Background Cryptococcal meningitis (CCM) is the leading cause of meningitis in people living with HIV (PLWH) in sub-Saharan Africa (SSA). The mortality and morbidity associated with CCM remain high. Combination of antifungal therapy, diligent management of intracranial pressure (IP) and the correct timing of the introduction of antiretroviral therapy (ART) minimise the risk of mortality and morbidity. The absence of spinal manometers in many healthcare centres in SSA challenges the accurate measurement of cerebrospinal fluid (CSF) pressure and its control. Objectives We hypothesised that four lumbar punctures (LPs) in the first week of the diagnosis and treatment of CCM would reduce IP such that in-hospital mortality and morbidity of HIV-associated CCM (HIV/CCM) would be significantly reduced. Methods We conducted a retrospective study to assess whether receipt of four or more LPs in the first week of the diagnosis and treatment with combination antifungal therapy of HIV/CCM would be associated with the reduction of in-hospital mortality in adult PLWH. Results From 01 January 2016 to 31 December 2016, 116 adult patients were admitted to the Dora Nginza District Hospital in Zwide, Port Elizabeth, South Africa. After exclusion of 11 (two were younger than 18 years, two had missing hospital records and seven demised or left the hospital before 7 days of hospitalisation), 105 patients were included in the analysis. The mean age was 39.4 (standard deviation [s.d.] ± 9.7) years, 64.8% were male. All were PLWH. A total of 52.4% had defaulted ART and 25.7% were ART naïve. Forty-three patients received four or more LPs (mean = 4.58 [± 0.96]) in the first week of hospitalisation with an associated in-hospital mortality of 11.6% (n = 5/43) compared with 62 patients who received less than four LPs (mean = 2.18 [± 0.80]) with an in-hospital mortality of 29% (n = 18/62) and a relative risk of 0.80 (95% CI, 0.66–0.97), p = 0.034. Conclusion In the current study of adult PLWH presenting to hospital with HIV/CCM, four or more LPs in the first 7 days following admission and the initiation of treatment were associated with a 17.4% reduction in absolute risk of in-hospital mortality and a 20% reduction in relative risk of in-hospital mortality. This mortality difference was noted in patients who survived and were in hospital at the time of the 7-day study census and persisted until the time of hospital discharge.
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Affiliation(s)
- Philasande Mkoko
- Department of Medicine, Division of Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Dora Nginza Hospital, Port Elizabeth, South Africa
| | - Jessica Du Preez
- Department of Medicine, Dora Nginza Hospital, Port Elizabeth, South Africa
| | - Senlika Naidoo
- Department of Medicine, Dora Nginza Hospital, Port Elizabeth, South Africa.,Department of Medicine, Livingstone Hospital, Port Elizabeth, South Africa
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A Summary on Up-To-Date Research on Fungal Siderophores on Disease, Treatment and Pathogenicity Based on Text Mining, Bioinformatics and Experts’ Opinion. Fungal Biol 2021. [DOI: 10.1007/978-3-030-53077-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Choopara I, Teethaisong Y, Arunrut N, Thunyaharn S, Kiatpathomchai W, Somboonna N. Specific and sensitive, ready-to-use universal fungi detection by visual color using ITS1 loop-mediated isothermal amplification combined hydroxynaphthol blue. PeerJ 2021; 9:e11082. [PMID: 33777539 PMCID: PMC7982077 DOI: 10.7717/peerj.11082] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
Being ubiquitous, fungi are common opportunistic pathogens to humans that can lead to invasive and life-threatening infections in immunocompromised individuals. Eukaryote-resembling cell membrane and filamentous branches make the fungal diagnosis difficult. This study therefore developed a ready-to-use ITS1 loop-mediated isothermal amplification combined with hydroxynaphthol blue (LAMP-HNB) for rapid, sensitive and specific colorimetric detection of universal fungi in all phyla. The ITS1 LAMP-HNB could identify every evolutionary phylum of fungi according to sequence analyses. We tested a total of 30 clinically relevant fungal isolates (representing three major human pathogenic phyla of fungi, namely Zygomycota, Ascomycota and Basidiomycota) and 21 non-fungal isolates, and the ITS1 LAMP-HNB properly identified all isolates, with a detection limit of as low as 4.6 ag (9.6 copies), which was identical to ITS1 and 18S rDNA PCR. The assays were also validated on the feasibility of point-of-care diagnostic with real food (dry peanuts, chili and garlics) and blood samples. Furthermore, the shelf life of our ready-to-use ITS1 LAMP activity (≥50%) was more than 40 days at 30 °C with 3-5% polyvinyl alcohol or glycerol additive. The results supported the ready-to-use ITS1 LAMP-HNB for simple detection of fungi contamination with high sensitivity in local and resource-constrained areas to prevent opportunistic fungal species infections.
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Affiliation(s)
- Ilada Choopara
- Program in Biotechnology, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | - Yothin Teethaisong
- Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | - Narong Arunrut
- Bioengineering and Sensing Technology Research Team, National Center for Genetic Engineering and Biotechnology, Pathum Thani, Thailand
| | - Sudaluck Thunyaharn
- Faculty of Medical Technology, Nakhonratchasima College, Nakhon Ratchasima, Thailand
| | - Wansika Kiatpathomchai
- Bioengineering and Sensing Technology Research Team, National Center for Genetic Engineering and Biotechnology, Pathum Thani, Thailand
| | - Naraporn Somboonna
- Department of Microbiology, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
- Microbiome Research Unit for Probiotics in Food and Cosmetics, Chulalongkorn University, Bangkok, Thailand
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Zhang K, Li H, Zhang L, Liao W, Ling L, Li X, Lin J, Xu B, Pan W, Zhang Q. Cerebrospinal fluid microscopy as an index for predicting the prognosis of cryptococcal meningitis patients with and without HIV. Future Microbiol 2020; 15:1645-1652. [PMID: 33251866 DOI: 10.2217/fmb-2020-0086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the clinical data and quantitative cerebrospinal fluid for associations with the outcome of cryptococcal meningitis (CM) patients in the hospital. Patients & methods: We retrospectively analyzed a total of 139 CM patients comprising 108 without HIV and 31 with HIV admitted in a Jiang Xi hospital. Resμlts: We found that CM patients with the high fungal burden (≥10 yeasts/μl) (26.3%) had a worse prognosis than those with the low fungal burden (<10 yeasts/μl). (4.9%) (p = 0.0007 <0.05). Conclusion: In CM patients, a fungal burden of 10 yeasts/μl in the first cerebrospinal fluid test may be used as an indicator of patient prognosis, and we can personalize patients' treatment based on the fungal burden to improve prognosis.
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Affiliation(s)
- Keming Zhang
- Shanghai Key Laboratory of Molecμlar Medical Mycology, Shanghai Institute of Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, PR China.,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, PR China
| | - Hang Li
- Shanghai Key Laboratory of Molecμlar Medical Mycology, Shanghai Institute of Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, PR China.,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, PR China
| | - Lei Zhang
- Shanghai Key Laboratory of Molecμlar Medical Mycology, Shanghai Institute of Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, PR China.,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, PR China
| | - Wanqing Liao
- Shanghai Key Laboratory of Molecμlar Medical Mycology, Shanghai Institute of Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, PR China.,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, PR China
| | - Liyan Ling
- Department of Laboratory Medicine, Pinghu Second People's Hospital, Zhejiang, 314200, PR China
| | - Xiaojing Li
- Department of Dermatology, Affiliated Hospital of Hebei University of Engineering, Hebei, 430000, PR China
| | - Jianjun Lin
- Department of Clinical Laboratory, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, Zhejiang, 315000, PR China
| | - Bin Xu
- Department of Neurology, Jiangxi Chest Hospital, Jiangxi, 330000, PR China
| | - Weihua Pan
- Shanghai Key Laboratory of Molecμlar Medical Mycology, Shanghai Institute of Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, PR China.,Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, PR China
| | - Qilong Zhang
- Department of Neurology, Jiangxi Chest Hospital, Jiangxi, 330000, PR China.,Department of Neurology, Jiangxi Provincial people's Hospital, Jiangxi, 330000, PR China
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Kitonsa J, Nsubuga R, Mayanja Y, Kiwanuka J, Nikweri Y, Onyango M, Anywaine Z, Ggayi AB, Kibengo FM, Kaleebu P, Day J. Determinants of two-year mortality among HIV positive patients with Cryptococcal meningitis initiating standard antifungal treatment with or without adjunctive dexamethasone in Uganda. PLoS Negl Trop Dis 2020; 14:e0008823. [PMID: 33253210 PMCID: PMC7728283 DOI: 10.1371/journal.pntd.0008823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/10/2020] [Accepted: 10/03/2020] [Indexed: 11/18/2022] Open
Abstract
Globally, early initiation of antiretroviral therapy for HIV led to a reduction in the estimated mortality from cryptococcal meningitis (CCM) from 624,700 in 2009 to 181,100 in 2014. However, CCM remains one of the leading causes of mortality among HIV infected patients especially in sub-Saharan Africa where 75% of the deaths occur. Most of the studies evaluating mortality have reported short-term mortality (at or before 10 weeks of therapy). We determined mortality and associated factors among patients treated for CCM in the CryptoDex trial (ISRCTN59144167) in Uganda, and the effect of dexamethasone adjunctive therapy on mortality at two years. We conducted a retrospective cohort study between May 2017 and July 2017 to determine the long term survival (up to 2 years post-randomization) of all patients who had been enrolled into the CryptoDex trial in Uganda. The CryptoDex trial recruited between April 2013 and February 2015. We estimated mortality rates and determined factors affecting mortality at two years using Cox regression. The study followed up 211 participants, 127 (60.2%) of whom were male. Sixteen participants (7.58%) were diagnosed with HIV at the same admission when CCM was diagnosed. By two years following randomization 127 (60%) participants had died, a mortality rate of 67 deaths per 100 person-years. Mortality was associated with Glasgow coma score (GCS) below 15 (adjusted Hazard ratio (aHR) 1.77, 95% CI: 1.02-2.44), p = 0.040; weight (aHR 0.97, per 1 Kg increase; 95% CI: 0.94-0.99), p = 0.003; and presence of convulsions (aHR 2.31, 95% CI: 1.32-4.04), p = 0.004, while dexamethasone use and fungal burden had no effect. Long-term mortality in CCM patients remains high even among patients receiving recommended therapy. Strategies to improve long-term survival in CCM patients are urgently needed, especially targeting those with reduced GCS, low weight, and convulsions.
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Affiliation(s)
- Jonathan Kitonsa
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- * E-mail: ,
| | - Rebecca Nsubuga
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Yunia Mayanja
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Yofesi Nikweri
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Martin Onyango
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Zacchaeus Anywaine
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Abu-Baker Ggayi
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Freddie Mukasa Kibengo
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Pontiano Kaleebu
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jeremy Day
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme Vietnam, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, Oxford, United Kingdom
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Opportunistic Cryptococcal Antigenemia in the HAART Era at HIV Epidemic Settings of Northwest Ethiopia. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2020; 2020:5017120. [PMID: 32963654 PMCID: PMC7492940 DOI: 10.1155/2020/5017120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/23/2020] [Accepted: 08/28/2020] [Indexed: 11/20/2022]
Abstract
Background Cryptococcus neoformans is a frequent opportunistic infection in patients with the acquired immunodeficiency syndrome. While the advent of ART reduces the occurrence of cryptococcal meningitis in HIV patients, cryptococcal disease remains a leading cause of morbidity and mortality in the developing world especially in sub-Saharan Africa which is the epicenter of HIV. This study aimed to assess the cryptococcal antigenemia, CD4+ Th cell counts, HIV RNA viral load, and clinical presentations among HIV-positive patients in Northwest Ethiopia. Method A total of two hundred (200) HIV-positive patients were recruited for this study. Cryptococcus antigenemia prevalence in plasma samples of HIV‐positive patients was determined by using Antigen lateral flow assay (CrAg‐LFA) also, and CD4+ Th cell counts and HIV‐RNA levels were quantified from blood specimen. Patients' demographic data, clinical manifestation, and concurrent opportunistic infection were recorded. Result The sex distributions of study participants were 105(52.5%) male and 94(47.5%) female with an age range of 15–65 (mean 39.42 ± 9) years. All patients had a CD4+ T-cell count <100 cells/µl with the median 54 cells/μl and median HIV-RNA viral load 2.16 × 105 RNA copies/ml (50–3.66 × 105 RNA copies/ml); the prevalence of cryptococcal antigenemia was found to be 4% in HIV-positive patients. More than half and two third of CrAg‐positive patients had a CD4 count <25 cells/μl and HIV viral load >10,000 copies/ml, respectively, as well; Tuberculosis, Candidiasis, and herpes zoster are the most often observed concurrent infections while cryptococcal antigenemia is significantly associated with oral candidiasis (p < 0.001). Conclusion Although the advent of ART, early diagnosis of cryptococcosis, and application of antifungal interventions, HIV-induced cryptococcal antigenemia positivity in HIV infected individuals is still the countries' big challenge. Thus, stringent follow-up and case management should be considered.
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Kischkel B, Rossi SA, Santos SR, Nosanchuk JD, Travassos LR, Taborda CP. Therapies and Vaccines Based on Nanoparticles for the Treatment of Systemic Fungal Infections. Front Cell Infect Microbiol 2020; 10:463. [PMID: 33014889 PMCID: PMC7502903 DOI: 10.3389/fcimb.2020.00463] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Treatment modalities for systemic mycoses are still limited. Currently, the main antifungal therapeutics include polyenes, azoles, and echinocandins. However, even in the setting of appropriate administration of antifungals, mortality rates remain unacceptably high. Moreover, antifungal therapy is expensive, treatment periods can range from weeks to years, and toxicity is also a serious concern. In recent years, the increased number of immunocompromised individuals has contributed to the high global incidence of systemic fungal infections. Given the high morbidity and mortality rates, the complexity of treatment strategies, drug toxicity, and the worldwide burden of disease, there is a need for new and efficient therapeutic means to combat invasive mycoses. One promising avenue that is actively being pursued is nanotechnology, to develop new antifungal therapies and efficient vaccines, since it allows for a targeted delivery of drugs and antigens, which can reduce toxicity and treatment costs. The goal of this review is to discuss studies using nanoparticles to develop new therapeutic options, including vaccination methods, to combat systemic mycoses caused by Candida sp., Cryptococcus sp., Paracoccidioides sp., Histoplasma sp., Coccidioides sp., and Aspergillus sp., in addition to providing important information on the use of different types of nanoparticles, nanocarriers and their corresponding mechanisms of action.
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Affiliation(s)
- Brenda Kischkel
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Laboratory of Medical Mycology-Institute of Tropical Medicine of São Paulo/LIM53/Medical School, University of São Paulo, São Paulo, Brazil
| | - Suélen A Rossi
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Laboratory of Medical Mycology-Institute of Tropical Medicine of São Paulo/LIM53/Medical School, University of São Paulo, São Paulo, Brazil
| | - Samuel R Santos
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Laboratory of Medical Mycology-Institute of Tropical Medicine of São Paulo/LIM53/Medical School, University of São Paulo, São Paulo, Brazil
| | - Joshua D Nosanchuk
- Departments of Medicine [Division of Infectious Diseases], Microbiology and Immunology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - Luiz R Travassos
- Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil
| | - Carlos P Taborda
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Laboratory of Medical Mycology-Institute of Tropical Medicine of São Paulo/LIM53/Medical School, University of São Paulo, São Paulo, Brazil
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Xu L, Yu J, Zheng B, Su F, Yang Z, Guo Y, Tao R, Dai X, Huang Y, Shi J, Zhang Z, Chen Y, Zhu B. HIV Infection Does Not Increase 10-Week Mortality of Chinese Cryptococcal Meningitis Patients. AIDS Res Hum Retroviruses 2020; 36:734-741. [PMID: 32539429 DOI: 10.1089/aid.2020.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The role of HIV infection in precipitating different clinical features in cryptococcal meningitis (CM) patients remains controversial. One hundred twelve CM patients living with HIV/AIDS (CM+HIV+ patients) and 112 CM patients living without HIV/AIDS (CM+HIV- patients) were enrolled after propensity score matching. Demographic characteristics, symptoms, routine blood tests, and biochemical and cerebrospinal fluid (CSF) profiles were compared between the two groups. Kaplan-Meier analysis and Cox proportional hazards model was used to assess 10-week mortality. CM+HIV+ patients frequently occurred in young (mean age 40.3 ± 10.5) and male (89.3%) populations who also experienced leukopenia, neutropenia, lymphocytopenia, thrombocytopenia, and hypoalbuminemia, less headaches (66.9%), and higher cryptococcemia (23.2%) (all p < .050); they also had higher glucose (2.6 ± 1.1 mmol/L), increased smear positivity (78.8%), and decreased white blood cells [8.0 (2.0-28.0) × 106/L] in initial CSF assay (all p < .050). The 10-week cumulative survival rate was 84.6% for CM+HIV+ patients and 88.5% for CM+HIV- patients (p = .345). Age <35.0 years (hazard ratio (HR) 3.0 (1.0-8.9), p = .046), intracranial pressure (ICP) >250.0 mmH2O (HR: 4.8 (1.1-21.6), p = .041), and treatment lacking amphotericin B [HR: 6.5 (1.9-21.4), p = .003] were independent risk factors for 10-week mortality in CM+HIV+ patients. There are significant clinical differences in CM patients living with or without HIV/AIDS. However, the 10-week survival rate was similar between the two groups. Younger population, high ICP, and treatment lacking amphotericin B were independent risk factors for 10-week mortality of Chinese CM+HIV+ patients.
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Affiliation(s)
- Lijun Xu
- National Clinical Research Center for Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the Department of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jianhua Yu
- Department II of Infectious Diseases, Xixi Hospital of Hangzhou, Hangzhou, China
| | - Bin Zheng
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Feifei Su
- Department of Infectious Diseases, Wenzhou Central Hospital, Wenzhou, China
| | - Zongxing Yang
- Department II of Infectious Diseases, Xixi Hospital of Hangzhou, Hangzhou, China
| | - Yongzheng Guo
- National Clinical Research Center for Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the Department of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ran Tao
- National Clinical Research Center for Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the Department of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiahong Dai
- Department of Infectious Diseases, Shulan Hospital, Hangzhou, China
| | - Ying Huang
- National Clinical Research Center for Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the Department of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jinchuan Shi
- Department II of Infectious Diseases, Xixi Hospital of Hangzhou, Hangzhou, China
| | - Zhongdong Zhang
- Department II of Infectious Diseases, Xixi Hospital of Hangzhou, Hangzhou, China
| | - Yaokai Chen
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Biao Zhu
- National Clinical Research Center for Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the Department of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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48
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Silva E Souza E, Barcellos VDA, Sbaraini N, Reuwsaat JCV, Schneider RDO, da Silva AC, Garcia AWA, von Poser GL, Barbosa EG, Lima JPMS, Vainstein MH. A Plumieridine-Rich Fraction From Allamanda polyantha Inhibits Chitinolytic Activity and Exhibits Antifungal Properties Against Cryptococcus neoformans. Front Microbiol 2020; 11:2058. [PMID: 32983042 PMCID: PMC7483551 DOI: 10.3389/fmicb.2020.02058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/05/2020] [Indexed: 12/28/2022] Open
Abstract
Cryptococcosis is a fungal infection caused mainly by the pathogenic yeasts Cryptococcus neoformans and Cryptococcus gattii. The infection initiates with the inhalation of propagules that are then deposited in the lungs. If not properly treated, cryptococci cells can disseminate and reach the central nervous system. The current recommended treatment for cryptococcosis employs a three-stage regimen, with the administration of amphotericin B, flucytosine and fluconazole. Although effective, these drugs are often unavailable worldwide, can lead to resistance development, and may display toxic effects on the patients. Thus, new drugs for cryptococcosis treatment are needed. Recently, an iridoid named plumieridine was found in Allamanda polyantha seed extract; it exhibited antifungal activity against C. neoformans with a MIC of 250 μg/mL. To address the mode of action of plumieridine, several in silico and in vitro experiments were performed. Through a ligand-based a virtual screening approach, chitinases were identified as potential targets. Confirmatory in vitro assays showed that C. neoformans cell-free supernatant incubated with plumieridine displayed reduced chitinase activity, while chitinolytic activity was not inhibited in the insoluble cell fraction. Additionally, confocal microscopy revealed changes in the distribution of chitooligomers in the cryptococcal cell wall, from a polarized to a diffuse cell pattern state. Remarkably, further assays have shown that plumieridine can also inhibit the chitinolytic activity from the supernatant and cell-free extracts of bacteria, insect and mouse-derived macrophage cells (J774.A1). Together, our results suggest that plumieridine can be a broad-spectrum chitinase inhibitor.
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Affiliation(s)
- Eden Silva E Souza
- Bioinformatics Multidisciplinary Environment, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | | | - Nicolau Sbaraini
- Centro de Biotecnologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Adriana Corrêa da Silva
- Centro de Biotecnologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil
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49
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Lin CJ, Chang YL, Yang YL, Chen YL. Natural alkaloid tryptanthrin exhibits novel anticryptococcal activity. Med Mycol 2020; 59:myaa074. [PMID: 32823278 DOI: 10.1093/mmy/myaa074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 12/15/2022] Open
Abstract
Cryptococcal meningitis is a prevalent invasive fungal infection that causes around 180 000 deaths annually. Currently, treatment for cryptococcal meningitis is limited and new therapeutic options are needed. Historically, medicinal plants are used to treat infectious and inflammatory skin infections. Tryptanthrin is a natural product commonly found in these plants. In this study, we demonstrated that tryptanthrin had antifungal activity with minimum inhibitory concentration (MIC) of 2 μg/ml against Cryptococcus species and of 8 μg/ml against Trichophyton rubrum. Further analysis demonstrated that tryptanthrin exerted fungistatic and potent antifungal activity at elevated temperature. In addition, tryptanthrin exhibited a synergistic effect with the calcineurin inhibitors FK506 and cyclosporine A against Cryptococcus neoformans. Furthermore, our data showed that tryptanthrin induced cell cycle arrest at the G1/S phase by regulating the expression of genes encoding cyclins and the SBF/MBF complex (CLN1, MBS1, PCL1, and WHI5) in C. neoformans. Screening of a C. neoformans mutant library further revealed that tryptanthrin was associated with various transporters and signaling pathways such as the calcium transporter (Pmc1) and protein kinase A signaling pathway. In conclusion, tryptanthrin exerted novel antifungal activity against Cryptococcus species through a mechanism that interferes with the cell cycle and signaling pathways. LAY SUMMARY The natural product tryptanthrin had antifungal activity against Cryptococcus species by interfering cell cycle and exerted synergistic effects with immunosuppressants FK506 and cyclosporine A. Our findings suggest that tryptanthrin may be a potential drug or adjuvant for the treatment of cryptococcosis.
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Affiliation(s)
- Chi-Jan Lin
- Department of Plant Pathology and Microbiology, National Taiwan University, Taipei, 10617, Taiwan
| | - Ya-Lin Chang
- Department of Plant Pathology and Microbiology, National Taiwan University, Taipei, 10617, Taiwan
| | - Yu-Liang Yang
- Agricultural Biotechnology Research Center, Academia Sinica, Taipei, 11529, Taiwan
| | - Ying-Lien Chen
- Department of Plant Pathology and Microbiology, National Taiwan University, Taipei, 10617, Taiwan
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50
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Cryptococcal Meningitis: A Rare Complication in HIV-Negative Patients with Nephrotic Syndrome in A Chinese Teaching Hospital. Mycopathologia 2020; 185:959-969. [PMID: 32789738 DOI: 10.1007/s11046-020-00482-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/04/2020] [Indexed: 10/20/2022]
Abstract
Cryptococcal meningitis (CM) is a rare complication in HIV-negative patients with nephrotic syndrome (NS), and knowledge about the clinical profile of NS with CM is limited. We performed a retrospective study of all patients with CM-NS admitted to the Jiangxi Chest Hospital (JCH) between 2011 and 2019 and systematically reviewed cases of CM-NS reported in the Chinese language. Among a total of 226 CM patients referred to the JCH, seven had NS (3.1%); these patients were combined with 22 CM-NS cases reported in the Chinese language for analysis. Headache, fever, nausea, and meningeal irritation were the most common initial symptoms, and the median time from symptom onset to CM diagnostic confirmation was 30 days. One patient initially tested negative for CM but was later confirmed to be positive. Among the 29 analysed patients, 41.4% (12/29) were misdiagnosed with other complications, including four patients from the JCH (4/7, 57.1%) and eight patients from published reports (8/22, 36.3%). The overall mortality rate was 17.2% (5/29); among these patients, 60% (3/5) were misdiagnosed. Induction treatment with amphotericin B plus 5-fluorocytosine (9/29) or amphotericin B plus fluconazole (7/29) successfully cleared the infection. Fluconazole may be a suitable alternative if 5-fluorocytosine is not readily available or not tolerated, and repetitive testing is important to reach a conclusive diagnosis in NS patients suspected of having CM.
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