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Nathani MASOOM, Manchanda VIKAS, Jorwal AKASH, Saxena SONAL, Kumar SURESH. Pulmonary cryptococcosis in chronic kidney disease. Indian J Med Microbiol 2024; 51:100688. [PMID: 39067857 DOI: 10.1016/j.ijmmb.2024.100688] [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: 06/19/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]
Abstract
Pulmonary cryptococcosis is a fungal infection caused by Cryptococcus species, with Cryptococcus neoformans being the most common agent, affecting the lungs. While it commonly occurs in immunocompromised individuals, such as those with HIV/AIDS or undergoing immunosuppressive therapy, its presentation in patients with chronic kidney disease (CKD) is relatively rare. However, it should be considered in the differential diagnosis of respiratory infections in patients with CKD, particularly in the context of immunosuppression.
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Affiliation(s)
- M A S O O M Nathani
- , , Department of Microbiology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi-110002, India..
| | - V I K A S Manchanda
- , , Department of Microbiology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi-110002, India..
| | - A K A S H Jorwal
- , , Department of Medicine, Lok Nayak Hospital, New Delhi-110002, India..
| | - S O N A L Saxena
- , , Department of Microbiology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi-110002, India..
| | - S U R E S H Kumar
- , , Department of Medicine, Lok Nayak Hospital, New Delhi-110002, India.
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Phang CR, Farooqi A, Sangwan Y. Unmasking the Unusual: Cryptococcal Pericarditis in a Patient with Liver Failure - a Rare Occurrence. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943530. [PMID: 39037967 PMCID: PMC11304632 DOI: 10.12659/ajcr.943530] [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: 12/17/2023] [Revised: 06/19/2024] [Accepted: 06/05/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Cryptococcosis is an invasive fungal infection caused by Cryptococcus species complex. C. neoformans is one of the pathogenic species within the genus. C. neoformans infections often present as an opportunistic infection in severely immunocompromised individuals. Infection of the pericardium in the setting of liver failure is uncommon. We present a case of cryptococcal pericarditis in a patient with liver failure. CASE REPORT A 47-year-old man with a past medical history of psoriatic arthritis, and alcohol use disorder presented to the emergency department with a 2-week history of progressively worsening generalized weakness, malaise, and yellowish skin changes. Physical examination revealed scleral icterus, jaundiced skin, and ascites. Initial laboratory workup revealed thrombocytopenia, transaminitis (aspartate transaminase (AST) level of 502 IU/L, alanine transaminase (ALT) level of 82 IU/L), hyperbilirubinemia (total bilirubin of 15.7 mg/dL), International Nationalized Ratio (INR) of 3.6, and lactic acidosis (lactic acid of 11.7 mmol/L). The patient developed encephalopathy and acute hypoxic respiratory failure requiring intubation. A bedside point-of-care cardiac ultrasound, performed following intubation, revealed a pericardial effusion without signs of tamponade. This finding was later confirmed by a formal transthoracic echocardiogram. Percutaneous pericardiocentesis was performed, and the pericardial fluid culture revealed the presence of C. neoformans. Human immunodeficiency virus (HIV) tests were negative. The patient received antifungal therapy. Due to his poor prognosis, he was transitioned to comfort care and eventually died. CONCLUSIONS This case report describes an unusual presentation of acute liver failure complicated by cryptococcal pericarditis, emphasizing the importance of considering atypical fungal infections in such patients.
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Affiliation(s)
- Chen Rong Phang
- Department of Internal Medicine, TidalHealth Peninsula Regional, Salisbury, MD, USA
| | - Azfar Farooqi
- Department of Internal Medicine, TidalHealth Peninsula Regional, Salisbury, MD, USA
| | - Yashvir Sangwan
- Department of Interventional Pulmonology, TidalHealth Peninsula Regional, Salisbury, MD, USA
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3
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Stempinski PR, Greengo SD, Casadevall A. Growth on Douglas fir media facilitates Cryptococcus virulence factor production and enhances fungal survival against environmental and immune stressors. Med Mycol 2024; 62:myae068. [PMID: 38982313 DOI: 10.1093/mmy/myae068] [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: 04/11/2024] [Revised: 06/27/2024] [Accepted: 07/08/2024] [Indexed: 07/11/2024] Open
Abstract
The yeasts Cryptococcus neoformans and Cryptococcus gattii are fungal pathogens that can be isolated from the environment, including the surfaces of many plants. Cryptococcus gattii caused an outbreak on Vancouver Island, British Columbia beginning in 1999 that has since spread to the Pacific Northwest of the United States. Coastal Douglas fir (Pseudotsuga menziesii) is an important lumber species and a major component of the ecosystems in this area. Previous research has explored Cryptococcus survival and mating on Douglas fir plants and plant-derived material, but no studies have been done on the production of cryptococcal virulence factors by cells grown on those media. Here, we investigated the effects of growth on Douglas fir-derived media on the production of the polysaccharide capsule and melanin, two of the most important cryptococcal virulence factors. We found that while the capsule was mostly unchanged by growth in Douglas fir media compared to cells grown in defined minimal media, Cryptococcus spp. can use substrates present in Douglas fir to synthesize functional and protective melanin. These results suggest mechanisms by which Cryptococcus species may survive in the environment and emphasize the need to explore how association with Douglas fir trees could affect its epidemiology for human cryptococcosis.
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Affiliation(s)
- Piotr R Stempinski
- Department of Molecular Microbiology and Immunology, Johns Hopkins School of Public Health, Baltimore, Maryland 21205, USA
| | - Seth D Greengo
- Department of Molecular Microbiology and Immunology, Johns Hopkins School of Public Health, Baltimore, Maryland 21205, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins School of Public Health, Baltimore, Maryland 21205, USA
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de Holanda Fonseca DL, Silva DMWD, de Albuquerque Maranhão FC. Molecular characterization of clinical and environmental isolates from the Cryptococcus neoformans/C. Gattii species complexes of Maceió, Alagoas, Brazil. Braz J Microbiol 2024; 55:1369-1380. [PMID: 38619732 PMCID: PMC11153433 DOI: 10.1007/s42770-024-01313-1] [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: 07/03/2023] [Accepted: 03/21/2024] [Indexed: 04/16/2024] Open
Abstract
Cryptococcosis is one of the major life-threatening opportunistic/systemic fungal diseases of worldwide occurrence, which can be asymptomatic or establish pneumonia and meningoencephalitis mainly in immunosuppressed patients, caused by the Cryptococcus neoformans and C. gattii species complexes. Acquisition is by inhaling fungal propagules from avian droppings, tree hollows and decaying wood, and the association of the molecular types with geographic origin, virulence and antifungal resistance have epidemiological importance. Since data on cryptococcosis in Alagoas are limited, we sought to determine the molecular types of etiological agents collected from clinical and environmental sources. We evaluated 21 isolates previously collected from cerebrospinal fluid and from environment sources (pigeon droppings and tree hollows) in Maceió-Alagoas (Brazil). Restriction fragment length polymorphism of URA5 gene was performed to characterize among the eight standard molecular types (VNI-VNIV and VGI-VGIV). Among isolates, 66.67% (14) were assigned to C. neoformans VNI - 12 of them (12/14) recovered from liquor and 2 from a tree hollow (2/14). One isolate from pigeon droppings (4.76%) corresponded to C. neoformans VNIV, while five strains from tree hollows and one from pigeon droppings (6, 28.57%) to C. gattii VGII. VNI-type was present in clinical and environmental samples and most C. neoformans infections were observed in HIV-positive patients, while types VNIV and VGII were prevalent in environmental sources in Alagoas. This is the first molecular characterization of Cryptococcus spp. in Alagoas, our study provides additional information on the ecoepidemiology of Cryptococcus spp. in Brazil, contributing to a closer view of the endemic species.
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Affiliation(s)
| | - Denise Maria Wanderlei da Silva
- Institute of Biological and Health Sciences, Sector of Microbiology, Laboratory of Clinical Microbiology, Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Fernanda Cristina de Albuquerque Maranhão
- Institute of Biological and Health Sciences, Sector of Microbiology, Laboratory of Clinical Microbiology, Federal University of Alagoas, Av. Lourival de Melo Mota, S/N, Tabuleiro do Martins, Maceió, 57072-900, Alagoas, Brazil.
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Silva IR, Souza MACE, Machado RR, Oliveira RBD, Leite EA, César IDC. Enhancing oral bioavailability of an antifungal thiazolylhydrazone derivative: Development and characterization of a self-emulsifying drug delivery system. Int J Pharm 2024; 655:124011. [PMID: 38493843 DOI: 10.1016/j.ijpharm.2024.124011] [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: 02/06/2024] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
RN104 (2-[2-(cyclohexylmethylene)hydrazinyl)]-4-phenylthiazole) is a thiazolylhydrazone derivative with prominent antifungal activity. This work aimed to develop a self-emulsifying drug delivery system (SEDDS) loaded with RN104 to improve its biopharmaceutical properties and enhance its oral bioavailability. Medium chain triglycerides, sorbitan monooleate, and polysorbate 80 were selected as components for the SEDDS formulation based on solubility determination and a pseudo-ternary phase diagram. The formulation was optimized using the central composite design in response surface methodology. The optimized condition consisted of medium chain triglycerides, sorbitan monooleate, and polysorbate 80 in a mass ratio of 65.5:23.0:11.5, achieving maximum drug loading (10 mg/mL) and minimum particle size (118.4 ± 0.7 nm). The developed RN104-SEDDS was fully characterized using dynamic light scattering, in vitro release studies, stability assessments, polarized light microscopy, and transmission electron microscopy. In vivo pharmacokinetic studies in mice demonstrated that RN104-SEDDS significantly improved oral bioavailability compared to free RN104 (the relative bioavailability was 2133 %). These results clearly indicated the successful application of SEDDS to improve the pharmacokinetic profile and to enhance the oral bioavailability of RN104, substantiating its potential as a promising antifungal drug candidate.
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Affiliation(s)
- Iara Rinco Silva
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, CEP: 31270-901 Belo Horizonte, Minas Gerais, Brazil
| | - Mateus Araújo Castro E Souza
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, CEP: 31270-901 Belo Horizonte, Minas Gerais, Brazil
| | - Renes Resende Machado
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, CEP: 31270-901 Belo Horizonte, Minas Gerais, Brazil
| | - Renata Barbosa de Oliveira
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, CEP: 31270-901 Belo Horizonte, Minas Gerais, Brazil
| | - Elaine Amaral Leite
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, CEP: 31270-901 Belo Horizonte, Minas Gerais, Brazil
| | - Isabela da Costa César
- Departamento de Produtos Farmacêuticos, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, CEP: 31270-901 Belo Horizonte, Minas Gerais, Brazil.
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Roosen L, Maes D, Musetta L, Himmelreich U. Preclinical Models for Cryptococcosis of the CNS and Their Characterization Using In Vivo Imaging Techniques. J Fungi (Basel) 2024; 10:146. [PMID: 38392818 PMCID: PMC10890286 DOI: 10.3390/jof10020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Infections caused by Cryptococcus neoformans and Cryptococcus gattii remain a challenge to our healthcare systems as they are still difficult to treat. In order to improve treatment success, in particular for infections that have disseminated to the central nervous system, a better understanding of the disease is needed, addressing questions like how it evolves from a pulmonary to a brain disease and how novel treatment approaches can be developed and validated. This requires not only clinical research and research on the microorganisms in a laboratory environment but also preclinical models in order to study cryptococci in the host. We provide an overview of available preclinical models, with particular emphasis on models of cryptococcosis in rodents. In order to further improve the characterization of rodent models, in particular the dynamic aspects of disease manifestation, development, and ultimate treatment, preclinical in vivo imaging methods are increasingly used, mainly in research for oncological, neurological, and cardiac diseases. In vivo imaging applications for fungal infections are rather sparse. A second aspect of this review is how research on models of cryptococcosis can benefit from in vivo imaging methods that not only provide information on morphology and tissue structure but also on function, metabolism, and cellular properties in a non-invasive way.
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Affiliation(s)
- Lara Roosen
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
| | - Dries Maes
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
| | - Luigi Musetta
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
| | - Uwe Himmelreich
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, 3000 Leuven, Belgium
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Dai Q, Wang Y, Ying Q, Ye Q. Cryptococcosis with pulmonary cavitation in an immunocompetent child: a case report and literature review. BMC Infect Dis 2024; 24:162. [PMID: 38321369 PMCID: PMC10845742 DOI: 10.1186/s12879-024-09061-1] [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: 10/12/2023] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Pulmonary cryptococcosis (PC) rarely occurs in immunocompetent children. CASE PRESENTATION A 13-year-old boy was admitted to the First Affiliated Hospital of Ningbo University in February 2023 with complaints of cough and chest pain. Physical examination showed slightly moist rales in the right lung. Chest computed tomography (CT) suggested a lung lesion and cavitation. Blood routine test, lymphocyte subsets, immunoglobulin, and complement tests indicated that the immune system was normal. However, the serum cryptococcal antigen test was positive. Next-generation sequencing revealed Cryptococcus infection. The child was diagnosed with PC and was discharged after treating with fluconazole 400 mg. Four months later, chest CT showed that the lung lesion diminished, and reexamination of serum cryptococcal antigen test turned positive. CONCLUSION PC should be considered in an immunocompetent child with pulmonary cavities with nonspecific symptoms.
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Affiliation(s)
- Qiaoyan Dai
- Department of Pediatrics, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, China
- Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Yingshuo Wang
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310000, China
| | - Qianqian Ying
- Department of Pediatrics, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, China
- Department of pediatrics, Ningbo First Hospital, Ningbo, 315000, China
| | - Qidong Ye
- Department of Pediatrics, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, China.
- Department of pediatrics, Ningbo First Hospital, Ningbo, 315000, China.
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Tassaneeyasin T, Eksombatchai D, Chantharit P, Singhsnaeh A, Boonsarngsuk V. A case of naganishial pleuritis in a kidney transplant recipient. Respirol Case Rep 2024; 12:e01304. [PMID: 38404952 PMCID: PMC10885170 DOI: 10.1002/rcr2.1304] [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: 01/09/2024] [Accepted: 02/06/2024] [Indexed: 02/27/2024] Open
Abstract
The Naganishia species is a mycosis, previously classified as a non-neoformans Cryptococcus species. The increased number of naganishial infections occurs predominantly in immunocompromised conditions, especially in people living with HIV with low CD4 cell count, primary immunodeficiencies, and iatrogenic immunosuppression. The lungs can serve as the primary site of infection, leading to various pulmonary manifestations. However, naganishial pleural effusions are unrecognized and challenged in diagnosis because of their presentation, which can mimic tuberculous pleural effusion. Herein, we report the case of a 53-year-old man who had undergone kidney transplantation for more than 2 years and presented with chest tightness and dyspnea. Computed chest tomography demonstrated left pleural nodules and pleural effusion, later confirmed as exudative pleural effusion with a lymphocyte predominance. Pleuroscopy revealed multiple small pleural nodules, and biopsies of these nodules were performed. Naganishia spp. was identified by the 18S rRNA sequencing technique.
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Affiliation(s)
- Tanapat Tassaneeyasin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineRamathibodi Hospital, Mahidol UniversitySalayaThailand
| | - Dararat Eksombatchai
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineRamathibodi Hospital, Mahidol UniversitySalayaThailand
| | - Prawat Chantharit
- Division of Infectious Diseases, Department of Medicine, Faculty of MedicineRamathibodi Hospital, Mahidol UniversitySalayaThailand
| | - Arunee Singhsnaeh
- Department of Pathology, Faculty of MedicineRamathibodi Hospital, Mahidol UniversitySalayaThailand
| | - Viboon Boonsarngsuk
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of MedicineRamathibodi Hospital, Mahidol UniversitySalayaThailand
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Baomo L, Guofen Z, Jie D, Liu X, Shuru C, Jing L. Disseminated cryptococcosis in a patient with idiopathic CD4 + T lymphocytopenia presenting as prostate and adrenal nodules: diagnosis from pathology and mNGS, a case report. BMC Infect Dis 2024; 24:26. [PMID: 38166809 PMCID: PMC10763445 DOI: 10.1186/s12879-023-08926-1] [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: 05/07/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
Disseminated Cryptococcosis infection typically occurs in immunocompromised patients, often manifested as pneumonia or meningoencephalitis. Cases with involvement of either prostate or adrenal glands are less frequent. We describe a case of an immunocompromised 62-year-old man with new-found Idiopathic CD4 + T lymphocytopenia who presented with urinary irritation symptoms followed by headache. The patient was finally diagnosed as disseminated cryptococcosis of prostate, adrenal gland involvement with the help of combining histopathology of formalin-fixed, paraffin-embedded tissue with metagenomic next-generation sequencing technique to identify C neoformans sensu stricto in prostate, adrenal gland tissues. Clinicians should be aware of atypical presentations of cryptococcal disease. In this case of cryptococcosis in immunocompromised patients, we find that cryptococcosis can affect varied organs simultaneously and should be considered in the differential of infectious diseases. And mNGS technology helps to confirm the diagnosis.
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Affiliation(s)
- Liu Baomo
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zeng Guofen
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, 510630, Guangzhou, China
| | - Dong Jie
- Department of Infectious Diseases, Zhuhai People's Hospital(Zhuhai Hospital affiliated with Jinan University), 519000, Zhuhai, China
| | - Xie Liu
- Department of Infectious Diseases, Shenzhen Longhua District People's Hospital, 518110, Shenzhen, China
| | - Chen Shuru
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, 510630, Guangzhou, China.
| | - Liu Jing
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, 510630, Guangzhou, China.
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Beardsley J. Pathogens of importance in lung disease-Implications of the WHO fungal priority pathogen list. Respirology 2024; 29:21-23. [PMID: 37956991 PMCID: PMC10952795 DOI: 10.1111/resp.14623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Justin Beardsley
- University of Sydney Infectious Disease InstituteSydneyNew South WalesAustralia
- Westmead Institute for Medical ResearchSydneyNew South WalesAustralia
- Department of Infectious DiseasesWestmead Hospital, NSW HealthSydneyNew South WalesAustralia
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Li Y, Chen D, Liu S, Lin J, Wang W, Huang J, Tan L, Liang L, Wang Z, Peng K, Li Q, Jian W, Zhang Y, Peng C, Chen H, Zhang X, Zheng J. Supervised training models with or without manual lesion delineation outperform clinicians in distinguishing pulmonary cryptococcosis from lung adenocarcinoma on chest CT. Mycoses 2024; 67:e13692. [PMID: 38214431 DOI: 10.1111/myc.13692] [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: 10/04/2023] [Revised: 12/16/2023] [Accepted: 12/22/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The role of artificial intelligence (AI) in the discrimination between pulmonary cryptococcosis (PC) and lung adenocarcinoma (LA) warrants further research. OBJECTIVES To compare the performances of AI models with clinicians in distinguishing PC from LA on chest CT. METHODS Patients diagnosed with confirmed PC or LA were retrospectively recruited from three tertiary hospitals in Guangzhou. A deep learning framework was employed to develop two models: an undelineated supervised training (UST) model utilising original CT images, and a delineated supervised training (DST) model utilising CT images with manual lesion annotations provided by physicians. A subset of 20 cases was randomly selected from the entire dataset and reviewed by clinicians through a network questionnaire. The sensitivity, specificity and accuracy of the models and the clinicians were calculated. RESULTS A total of 395 PC cases and 249 LA cases were included in the final analysis. The internal validation results for the UST model showed a sensitivity of 85.3%, specificity of 81.0%, accuracy of 83.6% and an area under the curve (AUC) of 0.93. Similarly, the DST model exhibited a sensitivity of 88.2%, specificity of 88.1%, accuracy of 88.2% and an AUC of 0.94. The external validation of the two models yielded AUC values of 0.74 and 0.77, respectively. The average sensitivity, specificity and accuracy of 102 clinicians were determined to be 63.1%, 53.7% and 59.3%, respectively. CONCLUSIONS Both models outperformed the clinicians in distinguishing between PC and LA on chest CT, with the UST model exhibiting comparable performance to the DST model.
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Affiliation(s)
- Yun Li
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Deyan Chen
- Shenyang Neusoft Intelligent Medical Technology Research Institute Co., Ltd, Shenyang, China
| | - Shuyi Liu
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junfeng Lin
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Wang
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou International Campus, Guangzhou, China
- Department of Information, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jinhai Huang
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lunfang Tan
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lina Liang
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhufeng Wang
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kang Peng
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiasheng Li
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Jian
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Youwen Zhang
- Department of Neurology, Gaozhou People's Hospital, Gaozhou, China
| | - Chengbao Peng
- Shenyang Neusoft Intelligent Medical Technology Research Institute Co., Ltd, Shenyang, China
| | - Huai Chen
- Department of Radiology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xia Zhang
- Shenyang Neusoft Intelligent Medical Technology Research Institute Co., Ltd, Shenyang, China
| | - Jinping Zheng
- National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Kung VM, Ferraz C, Kennis M, Franco-Paredes C, Tuells J, Vargas Barahona L, Shapiro L, Thompson GR, Chastain DB, Henao-Martínez AF. Diabetes Mellitus Type 2 as a Risk Factor and Outcome Modifier for Cryptococcosis in HIV Negative, Non-transplant Patients, a Propensity Score Match Analysis. Curr Microbiol 2023; 80:396. [PMID: 37907808 DOI: 10.1007/s00284-023-03512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023]
Abstract
Cryptococcosis is an opportunistic fungal infection of worldwide distribution with significant associated morbidity and mortality. HIV, organ transplantation, malignancy, cirrhosis, sarcoidosis, and immunosuppressive medications are established risk factors for cryptococcosis. Type 2 diabetes mellitus (DM2) has been hypothesized as a risk factor and an outcome modifier for cryptococcosis. We aimed to compare outcomes among HIV-negative, non-transplant (NHNT) patients with and without DM2. We queried a global research network to identify NHNT patients (n = 3280). We performed a propensity score-matched (PSM) analysis comparing clinical outcomes among cryptococcosis patients by DM status. We also characterize adults with cryptococcosis and DM2 as the only risk factor. After PSM, NHNT patients with DM2 were more likely to develop cognitive dysfunction [9% vs. 6%, OR 1.6; 95% CI (1.1-2.3); P = 0.01] but had similar mortality, hospitalization, ICU, and stroke risk after acquiring cryptococcosis when compared to NHNT patients without DM2. Pulmonary cryptococcosis was the most common site of infection. Among 44 cryptococcosis patients with DM2 as the only identifiable risk factor for disease, the annual incidence of cryptococcosis was 0.001%, with a prevalence of 0.002%. DM2 is associated with increased cognitive dysfunction risk in NHNT patients with cryptococcosis. It is rare for DM2 to be the only identified risk factor for developing cryptococcosis. Kidney disease, hyperglycemia, and immune dysfunction can increase the risk of cryptococcosis in patients with DM2.
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Affiliation(s)
- Vanessa M Kung
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E. 19Th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
| | - Carolina Ferraz
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E. 19Th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
| | - Matthew Kennis
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E. 19Th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
| | - Carlos Franco-Paredes
- Hospital Infantil de México, Federico Gomez, Mexico City, Mexico
- Department of Microbiology, Pathology and Immunology, Colorado State University, Fort Collins, USA
| | - Jose Tuells
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, San Vicente del Raspeig, Alicante, Spain
| | - Lilian Vargas Barahona
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E. 19Th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
| | - Leland Shapiro
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E. 19Th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
- Division of Infectious Diseases, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | | | - Daniel B Chastain
- Department of Clinical and Administrative Pharmacy, UGA College of Pharmacy, SWGA Clinical Campus, Phoebe Putney Memorial Hospital, Albany, GA, USA
| | - Andrés F Henao-Martínez
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, 12700 E. 19Th Avenue, Mail Stop B168, Aurora, CO, 80045, USA.
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Kim J, Graebel K, Kumar A, Sandesh F, Patel S, Golzarian H. Cryptococcus neoformans presenting as a large pulmonary cavitary lesion in an immunocompetent female. IDCases 2023; 34:e01921. [PMID: 37965384 PMCID: PMC10641486 DOI: 10.1016/j.idcr.2023.e01921] [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: 08/01/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
Pulmonary cryptococcus is a rare but fatal fungal infection historically associated with Human Immunodeficiency Virus (HIV) and immunosuppression, yet increasingly also being recognized in immunocompetent patients as a result of antiretroviral therapy and improved HIV control reducing HIV-associated cryptococcus in advanced countries. Appropriate management may be delayed if left unrecognized. We present the case of an immunocompetent middle-aged female with nonspecific respiratory symptoms who was found to have a large cavitary lung mass resulting in external compression of the pulmonary vein, ultimately leading to a diagnosis of pulmonary Cryptococcus neoformans. By presenting this case, we hope to elucidate the challenges in diagnosing and managing this fatal disease in timely fashion.
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Affiliation(s)
- Jason Kim
- Mercy Health – St. Rita’s Medical Center, Internal Medicine Residency Program, Lima, OH, USA
| | - Katherine Graebel
- Mercy Health – St. Rita’s Medical Center, Internal Medicine Residency Program, Lima, OH, USA
| | - Aakash Kumar
- Mercy Health – St. Rita’s Medical Center, Internal Medicine Residency Program, Lima, OH, USA
| | - Fnu Sandesh
- Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Shivangi Patel
- Ohio University Heritage College of Osteopathic Medicine, USA
| | - Hafez Golzarian
- Mercy Health – St. Rita’s Medical Center, Internal Medicine Residency Program, Lima, OH, USA
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14
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Sung D, Singh S, Goswami SK. Cryptococcal Pneumonia in a Patient on Tyrosine Kinase Inhibitor Therapy: How Common Is It? Cureus 2023; 15:e47884. [PMID: 38022346 PMCID: PMC10681705 DOI: 10.7759/cureus.47884] [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] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Cryptococcal pneumonia is identified as a fungal infection of the lungs, with Cryptococcus neoformans and Cryptococcus gattii as the most common culprits. Cryptococcus neoformans primarily affects immunocompromised individuals while Cryptococcus gattii infections occur mostly in immunocompetent hosts. We present a 76-year-old male on ibrutinib due to a history of chronic lymphocytic leukemia who had multiple hospitalizations for pneumonia and was later diagnosed with cryptococcal pneumonia through positive bronchoalveolar lavage fungal culture and lymph node biopsy.
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Affiliation(s)
- Deny Sung
- Internal Medicine, St. Joseph's Medical Center, Stockton, USA
| | - Shubani Singh
- Internal Medicine, St. Joseph's Medical Center, Stockton, USA
| | - Sanjeev K Goswami
- Pulmonary and Critical Care Medicine, St. Joseph's Medical Center, Stockton, USA
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15
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Barros N, Rosenblatt RE, Phipps MM, Fomin V, Mansour MK. Invasive fungal infections in liver diseases. Hepatol Commun 2023; 7:e0216. [PMID: 37639701 PMCID: PMC10462082 DOI: 10.1097/hc9.0000000000000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/07/2023] [Indexed: 08/31/2023] Open
Abstract
Patients with liver diseases, including decompensated cirrhosis, alcohol-associated hepatitis, and liver transplant recipients are at increased risk of acquiring invasive fungal infections (IFIs). These infections carry high morbidity and mortality. Multiple factors, including host immune dysfunction, barrier failures, malnutrition, and microbiome alterations, increase the risk of developing IFI. Candida remains the most common fungal pathogen causing IFI. However, other pathogens, including Aspergillus, Cryptococcus, Pneumocystis, and endemic mycoses, are being increasingly recognized. The diagnosis of IFIs can be ascertained by the direct observation or isolation of the pathogen (culture, histopathology, and cytopathology) or by detecting antigens, antibodies, or nucleic acid. Here, we provide an update on the epidemiology, pathogenesis, diagnosis, and management of IFI in patients with liver disease and liver transplantation.
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Affiliation(s)
- Nicolas Barros
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Division of Infectious Diseases, Department of Medicine, Indiana University Health, Indianapolis, Indiana, USA
| | - Russell E. Rosenblatt
- Department of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Meaghan M. Phipps
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Vladislav Fomin
- Department of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Michael K. Mansour
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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16
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Lynch JP, Kontoyiannis DP. Special Issue "Diagnosis and Treatment of Invasive Pulmonary Fungal Infections". J Fungi (Basel) 2023; 9:744. [PMID: 37504732 PMCID: PMC10381693 DOI: 10.3390/jof9070744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023] Open
Abstract
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care, Interventional Pulmonology, Sleep, and Clinical Immunology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Chen S, Yu G, Chen M, You Y, Gu L, Wang Q, Wang H, Lai G, Yu Z, Wen W. Comparison of different therapeutic approaches for pulmonary cryptococcosis in kidney transplant recipients: a 15-year retrospective analysis. Front Med (Lausanne) 2023; 10:1107330. [PMID: 37484845 PMCID: PMC10361058 DOI: 10.3389/fmed.2023.1107330] [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: 01/12/2023] [Accepted: 06/15/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Organ transplant recipients are at increased risk of developing pulmonary cryptococcosis (PC) due to weakened cell-mediated immunity caused by immunosuppressors. However, the nonspecific symptoms associated with PC can often lead to misdiagnosis and inappropriate treatment. Methods We conducted a retrospective analysis of data from 23 kidney transplant recipients with PC between April 2006 to January 2021. Results The median time from transplantation to the diagnosis of pathology-proven PC 4.09 years. Seventeen patients presented respiratory symptoms, including sputum-producing cough and dyspnea. Additionally, three patients also developed central nervous system (CNS) infections. Chest CT scans frequently revealed nodule-shaped lesions, which can mimic lung carcinoma. Serological tests did not demonstrate any specific changes. Nine patients received surgical resection as treatment. Fourteen patients were treated with antifungal medication only. No recurrence was observed in all 23 patients. Conclusion Our study suggests that fever and sputum-producing cough are common symptoms of PC, and cryptococcal meningitis should not be excluded if corresponding symptoms occur. Fluconazole is a common and effective antifungal agent. Surgical resection should be considered for patients who do not respond well to antifungal therapy. Clinicians should be aware of these findings when evaluating transplant recipients with respiratory symptoms.
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Affiliation(s)
- Shuyang Chen
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guoqing Yu
- Department of Nephrology, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
| | - Meiyan Chen
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
| | - Yanjing You
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
| | - Lei Gu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Wang
- The Third Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huijuan Wang
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
| | - Guoxiang Lai
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
| | - Zongyang Yu
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
| | - Wen Wen
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Dongfang Hospital of Xiamen University, The 900th Hospital of the Joint Logistic Support Force, Fuzhou, China
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