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Hamaguchi T, Uchida N, Fujita-Nakata M, Nakanishi M, Tsuchido Y, Nagao M, Iinuma Y, Asahina M. Autochthonous Cryptococcus gattii genotype VGIIb infection in a Japanese patient with anti-granulocyte-macrophage colony-stimulating factor antibodies. J Infect Chemother 2024; 30:1069-1075. [PMID: 38479572 DOI: 10.1016/j.jiac.2024.03.009] [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: 11/24/2023] [Revised: 03/01/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
A 31-year-old Japanese man presented with cerebral and pulmonary cryptococcosis. Cryptococcus gattii (C. gattii) genotype VGIIb was detected in the patient's sputum and cerebrospinal fluid specimens. The serum levels of anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) antibodies were elevated in this patient, which has been associated with pulmonary alveolar proteinosis and is considered a risk factor for C. gattii infection. After undergoing >12 months of antifungal treatments, the patient showed improvements in symptoms and findings on brain and lung imaging. Several Japanese patients who develop C. gattii infection have also been reported; however, most of these patients have been infected outside Japan, as C. gattii infection is rare in Japan. Only one patient with C. gattii genotype VGIIb infection has been reported in Japan, and it is believed that this patient contracted the infection in China. In the present case, our patient has never been outside Japan, indicating that the infection originated in Japan. Our findings suggest that C. gattii might be spreading in Japan. Therefore, patients with positive serum anti-GM-CSF antibodies should be thoroughly monitored for C. gattii infection, even those living in Japan.
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Affiliation(s)
| | - Nobuaki Uchida
- Department of Neurology, Kanazawa Medical University, Ishikawa, Japan.
| | | | - Megumi Nakanishi
- Department of Neurology, Kanazawa Medical University, Ishikawa, Japan.
| | - Yasuhiro Tsuchido
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Miki Nagao
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yoshitsugu Iinuma
- Department of Infectious Diseases, Kanazawa Medical University, Ishikawa, Japan.
| | - Masato Asahina
- Department of Neurology, Kanazawa Medical University, Ishikawa, Japan.
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Ahmed S, Saini J, Netravathi M, Manohar P, Chandrashekar N. Cryptococcus gattii: A Poseur to Behold! Cureus 2022; 14:e28344. [PMID: 36168385 PMCID: PMC9506536 DOI: 10.7759/cureus.28344] [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: 08/24/2022] [Indexed: 11/05/2022] Open
Abstract
Cryptococcosis is an invasive systemic mycosis caused by Cryptococcus, a genus of yeast. Causative organisms for human cryptococcosis include Cryptococcus neoformans and Cryptococcus gattii. Disease due to C.neoformans is conventionally seen in patients with underlying immunosuppression, whereas C.gattii-related infection is usually seen in immunocompetent people. The fact that the infection can occur among otherwise healthy individuals underscores the importance of having a necessary understanding of the pathophysiology and clinical and radiological presentations of the disease. We report a case of disseminated pulmonary and central nervous system (CNS) cryptococcosis in an apparently immunocompetent individual with unusual radiological findings necessitating probing for alternative diagnoses. We have attempted to supplement and revise the existing data on the radiological manifestations of C.gattii.
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Kakeya H. Medical Mycology Seen Through a One Health Approach. Med Mycol J 2022; 63:11-15. [DOI: 10.3314/mmj.22.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Hiroshi Kakeya
- Department of Infection Control Science, Osaka City University Graduate School of Medicine
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Abstract
We previously reported a 39-year-old man who presented with pulmonary and cerebral Cryptococcus gattii (genotype VGIIa) infection and was successfully treated with liposomal amphotericin B and flucytosine induction therapy. Following induction therapy, oral fluconazole treatment was initiated as consolidation therapy. However, the patient complained of progressively worsening headache, presenting an elevated cerebrospinal fluid (CSF) cell count. The minimum inhibitory concentrations of the CSF isolate were 8 and 0.12 μg/mL for fluconazole and voriconazole, respectively. The oral administration of voriconazole for more than 18 months alleviated his symptoms. Voriconazole might be useful for controlling refractory cases of C. gattii infection.
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Affiliation(s)
- Makoto Nakao
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Kohei Fujita
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Sousuke Arakawa
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Shuntaro Hayashi
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Saori Tomita
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Hidefumi Sato
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
| | - Hideki Muramatsu
- Department of Respiratory Medicine, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Japan
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Xue X, Deng H, Zhao L, Zang X, Asuquo IP, Meng M, Ma X, Qin C, Meng Y, Wu C, Gao J, Pan L. Cryptococcosis caused by cryptococcus gattii: 2 case reports and literature review. Medicine (Baltimore) 2020; 99:e23213. [PMID: 33327239 PMCID: PMC7738107 DOI: 10.1097/md.0000000000023213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/30/2020] [Accepted: 10/17/2020] [Indexed: 12/05/2022] Open
Abstract
Cryptococcosis caused by Cryptococcus gattii, is a life threatening fungal infection with recently increasing prevalence. C. gattii is a species complex comprising multiple independent species. However, many biological characteristics and clinical features of cryptococcosis due to C. gattii are relatively less well defined. In this paper, we identify two cases of C. gattii infection, and laboratory findings of genotype VGI and VGII in two groups of apparently immunocompetent Chinese individuals respectively. Upon detailed review of all 35 cases of C. gattii infections, it was observed that C. gattii can cause debilitating illness in both immunocompetent and immunocompromised individuals. Cryptococcosis due to C. gattii is a serious systemic fungal infection, with pulmonary central nervous system tropism. Epidemiologically, C. gattii infection is not only restricted in tropical and subtropical regions, but also in other geographical settings.
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Affiliation(s)
- Xinying Xue
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University
| | - Hui Deng
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University
| | - Longting Zhao
- Department of Infectious diseases, Rizhao Central Hospital, Rizhao, China
| | - Xuelei Zang
- Department of Microbiology, Chinese PLA General Hospital, Beijing
| | | | - Mingming Meng
- Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xidong Ma
- Department of Respiratory Disease, School of Clinical Medicine, Weifang Medical University, Weifang, Shandong
| | - Chong Qin
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University
| | - Yao Meng
- Department of Chest surgery, Beijing Shijitan Hospital, Capital Medical University
| | | | - Jie Gao
- Department of Pathology, General Hospital of PLA, Beijing
| | - Lei Pan
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University
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Setianingrum F, Rautemaa-Richardson R, Denning DW. Pulmonary cryptococcosis: A review of pathobiology and clinical aspects. Med Mycol 2019; 57:133-150. [PMID: 30329097 DOI: 10.1093/mmy/myy086] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/05/2018] [Indexed: 01/13/2023] Open
Abstract
Pulmonary cryptococcosis is an important opportunistic invasive mycosis in immunocompromised patients, but it is also increasingly seen in immunocompetent patients. The main human pathogens are Cryptococcus neoformans and C. gattii, which have a worldwide distribution. In contrast to cryptococcal meningitis, pulmonary cryptococcosis is still underdiagnosed because of limitations in diagnostic tools. It can mimic lung cancer, pulmonary tuberculosis, bacterial pneumonia, and other pulmonary mycoses both clinically and radiologically. Pulmonary nodules are the most common radiological feature, but these are not specific to pulmonary cryptococcosis. The sensitivity of culture of respiratory samples for Cryptococcus is poor and a positive result may also reflect colonisation. Cryptococcal antigen (CrAg) with lateral flow device is a fast and sensitive test and widely used on serum and cerebrospinal fluid, but sera from patients with pulmonary cryptococcosis are rarely positive in the absence of disseminated disease. Detection of CrAg from respiratory specimens might assist the diagnosis of pulmonary cryptococcosis but there are very few data. Molecular detection techniques such as multiplex reverse transcription polymerase chain reaction (RT-PCR) could also provide better sensitivity but these still require validation for respiratory specimens. The first line of treatment for pulmonary cryptococcosis is fluconazole, or amphotericin B and flucytosine for those with central nervous system involvement. Pulmonary cryptococcosis worsens the prognosis of cryptococcal meningitis. In this review, we summarize the biological aspects of Cryptococcus and provide an update on the diagnosis and management of pulmonary cryptococcosis.
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Affiliation(s)
- Findra Setianingrum
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, UK
- Parasitology Department, Universitas Indonesia, Jakarta, Indonesia
| | - Riina Rautemaa-Richardson
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, UK
- Mycology Reference Centre Manchester, ECMM Centre of Excellence in Clinical and Laboratory Mycology and Clinical Studies, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Infectious Diseases, Wythenshawe Hospital Manchester University NHS Foundation Trust, Manchester, UK
| | - David W Denning
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, UK
- Department of Infectious Diseases, Wythenshawe Hospital Manchester University NHS Foundation Trust, Manchester, UK
- National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Damasceno-Escoura AH, de Souza ML, de Oliveira Nunes F, Pardi TC, Gazotto FC, Florentino DH, Mora DJ, Silva-Vergara ML. Epidemiological, Clinical and Outcome Aspects of Patients with Cryptococcosis Caused by Cryptococcus gattii from a Non-endemic Area of Brazil. Mycopathologia 2018; 184:65-71. [PMID: 30415450 DOI: 10.1007/s11046-018-0304-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 10/19/2018] [Indexed: 11/28/2022]
Abstract
Cryptococcosis by Cryptococcus gattii occurs mainly in immunocompetent hosts, however, during the last decades, a growing number of cases in immunocompromised individuals have been noticed around the world. This report presents epidemiological, clinical and outcome aspects of patients with cryptococcosis caused by this species from a non-endemic area in Brazil. Of 278 Cryptococcus spp. clinical isolates recovered during the same period, 267 (96%) were molecularly identified as Cryptococcus neoformans VNI genotype and 11 (4%) as C. gattii VGII genotype by URA-5 RFLP. Of the 11 C. gattii patients, eight were male, mean age of 47.5 years. Of these, four were HIV-infected, one was kidney transplanted, one presented low CD4+ T cells values of unknown cause, another presented chronic liver disease meanwhile the remaining four were apparently immunocompetent. Disseminated disease and cryptococcal meningitis were present in four patients each. Most patients received amphotericin B plus fluconazole. Seven out of the 11 patients cured and four died before or during the therapy. The increased number of individuals with cryptococcosis by this species during the last decades needs to be carefully evaluated specially those who are HIV-infected. Nevertheless, Cryptococcus species differentiation is currently relevant in order to better know their relation with geographical, clinical host preference and outcome particularities.
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Affiliation(s)
- Alessandro Henrique Damasceno-Escoura
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Matheus Lucas de Souza
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Felipe de Oliveira Nunes
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Thiago César Pardi
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Fernanda Castro Gazotto
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Danilo Heitor Florentino
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Delio José Mora
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil
| | - Mario León Silva-Vergara
- Internal Medicine Department, Infectious Diseases Unit, Triângulo Mineiro Federal University, Medicina Tropical, Caixa Postal 118, Uberaba, Minas Gerais, CEP 38001-170, Brazil.
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Li L, Zhuang L, Zhou J, Shao C. Pulmonary cryptococcosis coexisting with adenocarcinoma: a case report and review of the literature. J Med Case Rep 2018; 12:327. [PMID: 30384858 PMCID: PMC6214163 DOI: 10.1186/s13256-018-1853-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/19/2018] [Indexed: 02/06/2023] Open
Abstract
Background Pulmonary cryptococcosis is a common fungal infection frequently seen in immunocompromised patients. Owing to its nonspecific clinical and radiographic features, the differential diagnosis with secondary tuberculosis, malignant tumor, and bacterial pneumonia is sometimes difficult. Many case reports have focused on misdiagnosis of pulmonary cryptococcosis as a malignant tumor. But to the best of our knowledge, the coexistence of pulmonary cryptococcosis and malignant tumor is rarely presented. Case presentation A 52-year-old immunocompetent Han Chinese woman was presented to our emergency department complaining of headache and vomiting accompanied by postural changes. She was diagnosed with pulmonary cryptococcosis according to results of laboratory tests, computed tomography, and percutaneous lung biopsy. Owing to the poor therapeutic effects of 6-month fluconazole treatment, she underwent a second percutaneous lung biopsy and was diagnosed with pulmonary cryptococcosis coexisting with adenocarcinoma. Delayed treatment of malignant tumor resulted in lymph node metastasis, higher pathologic stage, and probably poorer prognosis. Conclusions Our patient’s case serves as a reminder not to misdiagnose pulmonary cryptococcosis coexisting with adenocarcinoma.
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Affiliation(s)
- Liyang Li
- Shanghai Respiratory Research Institute, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Liang Zhuang
- Cadre Ward, Sanming First Hospital, Sanming, 365000, Fujian Province, China
| | - Jian Zhou
- Shanghai Respiratory Research Institute, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Changzhou Shao
- Shanghai Respiratory Research Institute, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Akins PT, Jian B. The Frozen Brain State of Cryptococcus gattii: A Globe-Trotting, Tropical, Neurotropic Fungus. Neurocrit Care 2018; 30:272-279. [DOI: 10.1007/s12028-018-0538-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cryptococcus gattii genotype VGIIa infection imported from Vancouver Island to Japan. J Infect Chemother 2018; 24:573-575. [PMID: 29352650 DOI: 10.1016/j.jiac.2017.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/19/2017] [Accepted: 12/16/2017] [Indexed: 11/23/2022]
Abstract
A 71-year-old Japanese man with travel history to the Vancouver Island, Canada was diagnosed the pulmonary and central nervous system infections caused by Cryptococcus gattii genotype VGIIa. This is the first imported case of Cryptococcus gattii genotype VGIIa infection from endemic area of North America to Japan. He was recovery with no residual neurological dysfunction by early resection of brain mass and antifungal therapy. Early surgical resection of cerebellar cryptococcoma may shorten the length of induction therapy with antifungal drugs.
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