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Messina FA, Benchetrit A, Bocassi A, Romero MDLM, Bauer S, Marín E, Bertera F, Onis G, Enzenhofer M, Sánchez M, Mammana L, Mijalovsky D, Santiso G. Meningeal cryptococcosis and SARS-CoV-2 infection in people living with HIV/AIDS. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:206-216. [PMID: 37721913 PMCID: PMC10586798 DOI: 10.7705/biomedica.6872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/17/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Fungal infections in patients with COVID-19 was one of the most debated topics during the pandemic. OBJECTIVES To analyze the clinical characteristics and evolution of people living with HIV/AIDS and coinfection with cryptococcus and COVID-19 (group A) or without it (group B). MATERIALS AND METHODS This is an analytical and retrospective study. We reviewed medical records of patients with meningeal cryptococcosis between April 2020 and May 2021. RESULTS We studied 65 people living with HIV/AIDS and with cryptococcosis infection diagnosed from April 2020 to May 2021. Fifteen patients with HIV/AIDS suffered from cryptococcosis and COVID-19, and out of these, 14 presented meningitis (group A), while 28 suffered from meningeal cryptococcosis, but did not have COVID-19 (group B). CONCLUSIONS No statistically significant differences were observed between the two groups (A and B) considering: intracranial hypertension, presence of Cryptococcus antigens in cerebrospinal fluid, sensorium deterioration or mortality. The detection of Cryptococcus antigens in serum by lateral flow assay was highly effective to rapidly diagnose cryptococcosis in patients with HIV/AIDS who also developed COVID-19. Patients of both groups consulted for cryptoccocosis sometime after, in comparison with the pre-pandemic cases related to this infection.
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Affiliation(s)
- Fernando Antonio Messina
- Unidad Micología, Hospital de Enfermedades Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina.
| | - Andrés Benchetrit
- Sala 21, Hospital de Enfermedades Infecciosas F. J. Muñiz Hospital, Buenos Aires, Argentina.
| | - Andrea Bocassi
- Laboratorio Central Hospital de Infecciosas, Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | | | - Sofía Bauer
- División SIDA, Hospital de infecciosas Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | - Emmanuel Marín
- Unidad Micología, Hospital de Enfermedades Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina.
| | - Facundo Bertera
- División Farmacia, Hospital de infecciosas Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | - Guillermo Onis
- Sala 20, Hospital de Infecciosas Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | - Matías Enzenhofer
- División SIDA, Hospital de infecciosas Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | - Milagro Sánchez
- División SIDA, Hospital de infecciosas Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | - Lilia Mammana
- Unidad Virología, Hospital de Infecciosas F. J. Muñiz Hospital, Buenos Aires, Argentina.
| | - Dana Mijalovsky
- División SIDA, Hospital de infecciosas Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | - Gabriela Santiso
- Unidad Micología, Hospital de Enfermedades Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina.
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Messina F, Santiso G, Arechavala A, Romero M, Depardo R, Marin E. Preemptive Therapy in Cryptococcosis Adjusted for Outcomes. J Fungi (Basel) 2023; 9:631. [PMID: 37367567 DOI: 10.3390/jof9060631] [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: 04/28/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
Cryptococcosis is one of the most serious opportunistic diseases in patients living with HIV. For this reason, early diagnosis and appropriate treatment are important. OBJECTIVES The aim of the study was to understand the development of patients diagnosed with cryptococcosis by detection of Cryptococcus antigen in serum by lateral flow assay (CrAg LFA) without nervous system involvement and with treatment in accordance with the results. MATERIALS AND METHODS A retrospective, longitudinal, analytical study was performed. Seventy patients with cryptococcosis initially diagnosed by serum CrAg LFA without meningeal involvement between January 2019 and April 2022 were analyzed for medical records. The treatment regimen was adapted to the results of blood culture, respiratory material, and pulmonary tomography imaging. RESULTS Seventy patients were included, 13 had probable pulmonary cryptococcosis, 4 had proven pulmonary cryptococcosis, 3 had fungemia, and 50 had preemptive therapy without microbiological or imaging findings compatible with cryptococcosis. Among the 50 patients with preemptive therapy, none had meningeal involvement or cryptococcosis recurrences to date. CONCLUSION Preemptive therapy avoided progression to meningitis in CrAg LFA-positive patients. Preemptive therapy with dose adjustment of fluconazole in patients with the mentioned characteristics was useful despite the use of lower doses than recommended.
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Affiliation(s)
- Fernando Messina
- Mycology Unit, Infectious Diseases Hospital F.J. Muñiz, Buenos Aires C1282AEN, Argentina
| | - Gabriela Santiso
- Mycology Unit, Infectious Diseases Hospital F.J. Muñiz, Buenos Aires C1282AEN, Argentina
| | - Alicia Arechavala
- Mycology Unit, Infectious Diseases Hospital F.J. Muñiz, Buenos Aires C1282AEN, Argentina
| | - Mercedes Romero
- Mycology Unit, Infectious Diseases Hospital F.J. Muñiz, Buenos Aires C1282AEN, Argentina
| | - Roxana Depardo
- Mycology Unit, Infectious Diseases Hospital F.J. Muñiz, Buenos Aires C1282AEN, Argentina
| | - Emmanuel Marin
- Mycology Unit, Infectious Diseases Hospital F.J. Muñiz, Buenos Aires C1282AEN, Argentina
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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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Ohnishi YDO, Pantoja ASL, Abraão LSDO, Alves NG, Ohnishi MDDO, Libonati RMF, Ventura AMRDS, Palácios VRDCM. Cryptococcal meningitis in patients with and without acquired immunodeficiency. Acta Trop 2022; 227:106228. [PMID: 34864000 DOI: 10.1016/j.actatropica.2021.106228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/12/2021] [Indexed: 11/01/2022]
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de Oliveira L, Melhem MDSC, Buccheri R, Chagas OJ, Vidal JE, Diaz-Quijano FA. Early clinical and microbiological predictors of outcome in hospitalized patients with cryptococcal meningitis. BMC Infect Dis 2022; 22:138. [PMID: 35139801 PMCID: PMC8830130 DOI: 10.1186/s12879-022-07118-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cryptococcal meningitis causes high mortality in immunocompromised and immunocompetent patients. The objective of this study was to identify early predictors of clinical outcome, available at the first days of hospitalization, in patients with cryptococcal meningitis in a tertiary center in Brazil. Methods Ninety-six cases of cryptococcal meningitis with clinical, epidemiological and laboratory data, and identification and antifungal susceptibility of the strains were analyzed. Quantitative CSF yeast counts were performed by direct microscopic exam with a Fuchs-Rosenthal cell counting chamber using an institutional protocol. Univariable and multiple analyses using logistic regression were performed to identify predictors, available at the beginning of hospitalization, of in-hospital mortality. Moreover, we performed a secondary analysis for a composite outcome defined by hospital mortality and intensive care unit transfer. Results The species and the antifungal susceptibility were not associated with the outcomes evaluated. The variables significantly associated with the mortality were age (OR = 1.08, 95% CI 1.02–1.15), the cerebrospinal fluid (CSF) yeasts count (OR = 1.65, 95% CI 1.20–2.27), systemic arterial hypertension (OR = 22.63, 95% CI 1.64–312.91) and neurological impairment identified by computed tomography (OR = 41.73, 95% CI 3.10–561.65). At the secondary analysis, CSF yeast count was also associated with the composite outcome, in addition to the culture of Cryptococcus spp. from bloodstream and cerebral toxoplasmosis. The associations were consistent with survival models evaluated. Conclusions Age and CSF yeast count were independently associated with in-hospital mortality of patients with cryptococcal meningitis but Cryptococcus species identification and antifungal susceptibility were not associated with the outcomes. Quantitative CSF yeast counts used in this study can be evaluated and implemented in other low and middle-income settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07118-7.
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Affiliation(s)
- Lidiane de Oliveira
- Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, CEP 01246-904, Brazil.
| | - Marcia de Souza Carvalho Melhem
- Mycology Unit of Adolfo Lutz Institute, Public Health Reference Laboratory, Secretary of Health, Av. Dr.Arnaldo, 351, São Paulo, SP, CEP 05411-000, Brazil.,School of Medicine, Federal University of Mato Grosso do Sul, Bairro Universitário, Av. Costa e Silva, s/no, Campo Grande, MS, CEP 79070-900, Brazil
| | - Renata Buccheri
- Department of Neurology, Emílio Ribas Institute of Infectious Diseases, Av. Dr. Arnaldo 165, São Paulo, SP, CEP 05411-000, Brazil
| | - Oscar José Chagas
- Department of Neurology, Emílio Ribas Institute of Infectious Diseases, Av. Dr. Arnaldo 165, São Paulo, SP, CEP 05411-000, Brazil
| | - José Ernesto Vidal
- Department of Neurology, Emílio Ribas Institute of Infectious Diseases, Av. Dr. Arnaldo 165, São Paulo, SP, CEP 05411-000, Brazil.,Department of Infectious Diseases, Hospital das Clinicas, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 470, São Paulo, SP, CEP 01246-904, Brazil
| | - Fredi Alexander Diaz-Quijano
- Department of Epidemiology, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, CEP 01246-904, Brazil
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Firacative C, Meyer W, Castañeda E. Cryptococcus neoformans and Cryptococcus gattii Species Complexes in Latin America: A Map of Molecular Types, Genotypic Diversity, and Antifungal Susceptibility as Reported by the Latin American Cryptococcal Study Group. J Fungi (Basel) 2021; 7:jof7040282. [PMID: 33918572 PMCID: PMC8069395 DOI: 10.3390/jof7040282] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/20/2021] [Accepted: 04/01/2021] [Indexed: 02/07/2023] Open
Abstract
Cryptococcosis, a potentially fatal mycosis, is caused by members of the Cryptococcus neoformans and Cryptococcus gattii species complexes. In Latin America, cryptococcal meningitis is still an important health threat with a significant clinical burden. Analysis of publicly available molecular data from 5686 clinical, environmental, and veterinary cryptococcal isolates from member countries of the Latin American Cryptococcal Study Group showed that, as worldwide, C. neoformans molecular type VNI is the most common cause of cryptococcosis (76.01%) in HIV-infected people, followed by C. gattii molecular type VGII (12.37%), affecting mostly otherwise healthy hosts. These two molecular types also predominate in the environment (68.60% for VNI and 20.70% for VGII). Among the scarce number of veterinary cases, VGII is the predominant molecular type (73.68%). Multilocus sequence typing analysis showed that, in Latin America, the C. neoformans population is less diverse than the C. gattii population (D of 0.7104 vs. 0.9755). Analysis of antifungal susceptibility data showed the presence of non-wild-type VNI, VGI, VGII, and VGIII isolates in the region. Overall, the data presented herein summarize the progress that has been made towards the molecular epidemiology of cryptococcal isolates in Latin America, contributing to the characterization of the genetic diversity and antifungal susceptibility of these globally spreading pathogenic yeasts.
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Affiliation(s)
- Carolina Firacative
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota 111221, Colombia
- Correspondence: ; Tel.: +57-1-297-0200 (ext. 3404)
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, Centre for Infectious Diseases and Microbiology, Research and Education Network Westmead Hospital, Faculty of Medicine and Health, Sydney Medical School-Westmead Clinical School, Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, The University of Sydney, Sydney 2145, Australia;
| | - Elizabeth Castañeda
- Grupo de Microbiología, Instituto Nacional de Salud, Bogota 111321, Colombia;
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Tongue lesion due to Cryptococcus neoformans as the first finding in an HIV-positive patient. Rev Iberoam Micol 2020; 38:19-22. [PMID: 33388240 DOI: 10.1016/j.riam.2020.10.003] [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: 02/07/2020] [Revised: 09/14/2020] [Accepted: 10/14/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cryptococcosis is a severe universally distributed mycosis which mainly affects immunocompromised hosts. This mycosis is caused by yeasts of two species complex of the genus Cryptococcus: Cryptococcus neoformans and Cryptococcus gattii. Meningeal cryptococcosis is the most frequent clinical presentation of this disseminated mycosis. The oral mucosa involvement is extremely unusual. CASE REPORT We present a case of cryptococcosis with an unusual clinical form. The patient was assisted because she had an ulcerated lesion on the lingual mucosa. Encapsulated yeasts compatible with Cryptococcus were found in microscopic exams of wet preparations from lingual ulcer clinical samples obtained for cytodiagnosis and mycological studies. Cryptococcus neoformans (C. neoformans var. grubii VNI) was isolated in culture. This patient did not know her condition of HIV seropositive before the appearance of the tongue lesion. CONCLUSIONS The involvement of the oral mucosa is uncommon in this fungal infection, but is important to include it in the differential diagnosis in HIV positive patients.
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HIV-Associated Cryptococcal Meningitis Patients Treated with Amphotericin B Deoxycholate Plus Flucytosine under Routine Care Conditions in a Referral Center in São Paulo, Brazil. Mycopathologia 2020; 186:93-102. [PMID: 33258083 DOI: 10.1007/s11046-020-00512-2] [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: 09/22/2020] [Accepted: 11/19/2020] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cryptococcal meningitis remains a common cause of mortality in low- and middle-income countries, where amphotericin B deoxycholate (amphotericin) plus fluconazole is the most common treatment. Flucytosine is almost uniformly absent as is outcome data on flucytosine use in routine care. The main goal of this study was identified the cumulative mortality at 2, 4, and 10 weeks after hospital admission. METHODS We conducted a retrospective, observational cohort study among HIV-infected adults with cryptococcal meningitis receiving amphotericin plus flucytosine as induction therapy in Brazil. We assessed cumulative mortality at 2, 4, and 10 weeks and the cumulative proportion discontinuating amphotericin or flucytosine due to toxicity at 2 weeks. We performed multiple logistic regression to identify variables associated with in-hospital mortality. RESULTS In total, 77 individuals (n = 66 men) were included with median baseline CD4 of 29 (IQR, 9-68) cells/mcL. Twenty (26%) had at least one concurrent neurological disease diagnosed. Sixty (78%) patients received at least 14 days of amphotericin plus flucytosine. Cumulative mortality was 5% (4/77) at 2 weeks, 8% (6/77) at 4 weeks, and 19% (15/77) at 10 weeks. Cumulative proportion of patients that discontinuated amphotericin or flucytosine due to toxicity was 20% (16/77) at 2 weeks. In addition, in-hospital mortality was associated with receiving ≤ 10 days of induction therapy (odds ratio = 4.5, 95% CI 1.2-17.1, P = 0.028) or positive cerebrospinal fluid fungal culture after 2 weeks (odds ratio = 3.8, 95% CI 1.1-13.5, P = 0.035). CONCLUSION In this "real-world" study, amphotericin plus flucytosine shows low early mortality of patients with HIV-associated cryptococcal meningitis. Early discontinuation due to adverse events was moderate. More effective and safe antifungals are needed in order to improve the outcome of cryptococcal meningitis.
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Messina F, Romero M, Benchetrit A, Marin E, Arechavala A, Depardo R, Negroni R, Santiso G. Clinical and microbiological characteristics of paracoccidioidomycosis in patients with AIDS in Buenos Aires, Argentina. Med Mycol 2020; 58:22-29. [PMID: 30874811 DOI: 10.1093/mmy/myz021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/10/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022] Open
Abstract
Paracoccidioidomycosis (Pm) is a systemic disease, endemic in the American continent. There are two different clinical forms, the infant-juvenile or subacute form (PmS) and the chronic adult form (PmC). The human immunodeficiency virus (HIV) associated paracoccidioidomycosis (PmHIV) shares characteristics with both of the previously mentioned forms. The objective of this work was to describe the epidemiological, clinical and laboratory features of the PmHIV and to compare them with the ones of PmS and the PmC. A retrospective analysis of 119 patients with paracoccidioidomycosis was performed. Ninety four suffered the chronic form, 11 the subacute one and 14 were coinfected with HIV. Patients with PmHIV presented a CD4+ T lymphocytes median of 70.5 cells/μl, 71.4% had fever, 64.3% had a miliary pattern on the chest radiography, 64.3% had hepatosplenomegaly, 64.3% had mucosal lesions and 50% had skin lesions. One patient died during his hospitalization. The clinical presentation of Pm in patients with HIV resembled the subacute form with fever, hepatomegaly and skin lesions. However, they also tended to present mucosal lesions, positive serology for Pm and pulmonary parenchyma lesions as usually seen in PmC (9/14 PmHIV patients had overlapping features, while 4/14 PmHIV patients clinically resembled PmS and 1/14 PmC). The incidence of Pm has not changed with the burden of AIDS as it has happened with other fungal infections but it appears clinically different from the classic clinical forms of the disease.
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Affiliation(s)
- F Messina
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
| | - M Romero
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
| | - A Benchetrit
- Ward 21. Infectious Diseases Hospital F.J. Muñiz, Buenos Aires, Argentina
| | - E Marin
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
| | - A Arechavala
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
| | - R Depardo
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
| | - R Negroni
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
| | - G Santiso
- Mycology Unit of the Infectious Diseases Hospital F.J. Muñiz, Reference Center of Mycology of Buenos Aires city, Argentina
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Gastrointestinal Cryptococcosis Associated with Intestinal Lymphangiectasia. Case Rep Med 2020; 2020:7870154. [PMID: 32373179 PMCID: PMC7191395 DOI: 10.1155/2020/7870154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/19/2020] [Accepted: 03/07/2020] [Indexed: 12/28/2022] Open
Abstract
Intestinal lymphangiectasia is a pathological dilation of enteric lymphatic vessels resulting in lymph leakage to the intestinal lumen. This chronic lymph leakage leads to a state of immunosuppression secondary to the loss of humoral and cellular components of the immune system and represents a potential risk factor for opportunistic infections. We report a case of protein-losing enteropathy in a seemingly immunocompetent patient. An intestinal histopathological study revealed the unusual association of lymphangiectasia and intestinal cryptococcosis. Although cryptococcal infection is common in immunocompromised patients, intestinal involvement is rarely reported. We found no reports on the association of intestinal cryptococcosis in patients with lymphangiectasia. This case report is the first to describe intestinal cryptococcosis associated with intestinal lymphangiectasia.
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Taverna CG, Bosco-Borgeat ME, Mazza M, Vivot ME, Davel G, Canteros CE. Frequency and geographical distribution of genotypes and mating types of Cryptococcus neoformans and Cryptococcus gattii species complexes in Argentina. Rev Argent Microbiol 2020; 52:183-188. [PMID: 31948732 DOI: 10.1016/j.ram.2019.07.005] [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: 12/10/2018] [Revised: 06/15/2019] [Accepted: 07/16/2019] [Indexed: 12/27/2022] Open
Abstract
The aim of this work was to know the frequency and geographical distribution of genotypes and mating types of Cryptococcus neoformans and Cryptococcus gattii species complexes isolated from human infections in Argentina during the period from April 2009 to April 2011. A multicenter study was conducted, in which 372 isolates were obtained from 61 laboratories throughout the country. Of those, 98.8% of the isolates belonged to the C. neoformans species complex and 1.1% to the C. gattii species complex. Genotype VNI (MATα) was the most frequently isolated (n=326, 87.6%), followed by VNII (MATα) (n=22, 5.9%), the recently described VNII-VNIV (aADα) hybrid (n=14, 3.8%), VNIV (MATα) (n=4, 1.1%), VNIII (αADa) hybrid (n=1, 0.3%), and VNIII (αADα) hybrid (n=1, 0.3%). The Argentine Central region showed the greatest number of cases and genotype diversity. Interestingly, a relative high frequency was observed in genotype VNII (MATα) in the Cuyo, Northeast and Northwest regions and, also in VNII-VNIV (aADα) hybrids in the Northwest region. C. gattii species complex was isolated at a low rate; 3 VGI (MATα) and 1 VGII (MATα) isolates were obtained from the Northwest and Central regions. In conclusion, this study shows that genotype frequencies seem to vary among regions in Argentina and reveals a relatively high frequency of rare hybrids in the Northwest region. Further regional clinical and environmental studies may help to elucidate if those variations in frequencies are associated with the existence of regional ecological niches or any other regional factors.
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Affiliation(s)
- Constanza Giselle Taverna
- Mycology Department, INEI (Instituto Nacional de Enfermedades Infecciosas) "Dr. C. G. Malbrán," ANLIS (Administración Nacional de Laboratorios e Institutos de Salud) Ciudad Autónoma de Buenos Aires, Argentina.
| | - María Eugenia Bosco-Borgeat
- Mycology Department, INEI (Instituto Nacional de Enfermedades Infecciosas) "Dr. C. G. Malbrán," ANLIS (Administración Nacional de Laboratorios e Institutos de Salud) Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariana Mazza
- Mycology Department, INEI (Instituto Nacional de Enfermedades Infecciosas) "Dr. C. G. Malbrán," ANLIS (Administración Nacional de Laboratorios e Institutos de Salud) Ciudad Autónoma de Buenos Aires, Argentina
| | - Matías Ezequiel Vivot
- Mycology Department, INEI (Instituto Nacional de Enfermedades Infecciosas) "Dr. C. G. Malbrán," ANLIS (Administración Nacional de Laboratorios e Institutos de Salud) Ciudad Autónoma de Buenos Aires, Argentina
| | - Graciela Davel
- Mycology Department, INEI (Instituto Nacional de Enfermedades Infecciosas) "Dr. C. G. Malbrán," ANLIS (Administración Nacional de Laboratorios e Institutos de Salud) Ciudad Autónoma de Buenos Aires, Argentina
| | - Cristina Elena Canteros
- Mycology Department, INEI (Instituto Nacional de Enfermedades Infecciosas) "Dr. C. G. Malbrán," ANLIS (Administración Nacional de Laboratorios e Institutos de Salud) Ciudad Autónoma de Buenos Aires, Argentina
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- Mycology Department, INEI (Instituto Nacional de Enfermedades Infecciosas) "Dr. C. G. Malbrán," ANLIS (Administración Nacional de Laboratorios e Institutos de Salud) Ciudad Autónoma de Buenos Aires, Argentina
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Burden of Serious Fungal Infections in Argentina. J Fungi (Basel) 2018; 4:jof4020051. [PMID: 29695056 PMCID: PMC6023532 DOI: 10.3390/jof4020051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/09/2018] [Accepted: 04/13/2018] [Indexed: 01/30/2023] Open
Abstract
The number of fungal infections at any given time in Argentina is not known. Here we estimate the burden of serious fungal infections in Argentina for the first time. Specific population statistics were searched from multiple sources, local literature was identified, and estimates made. Some additional data were sourced from the Ministry of Health, the Global Initiative for Asthma (GINA) program, and national haematology and transplant societies. Argentina has a population of 43.8 million, with 25% of this total being children under 15 years. The predicted candidemia annual incidence is 2193 cases, with 50% occurring in the ICU. At a 6% prevalence rate, an estimated 593,695 women suffer from recurrent vulvovaginal candidiasis. Invasive aspergillosis is relatively common because of high smoking and chronic obstructive pulmonary disease (COPD) rates, with 268 cases in immunocompromised patients and another 1938 in the 168,000 COPD patients admitted to hospital. Asthma is also common, affecting 14% of adults, and so allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) are major problems. An estimated 432 cases of cryptococcal meningitis (CM)—90% of them in AIDS patients—and 1177 cases of Pneumocystis pneumonia (PCP) occur each year. The estimated annual case number of disseminated histoplasmosis is 404 in AIDS patients, almost as frequent as CM. Paracoccidioidomycosis annual incidence is estimated at 219, and coccidioidomycosis at 16 cases. At least 881,023 people (>2.01%) in Argentina are affected by a serious fungal disease annually, with considerable morbidity and mortality.
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Firacative C, Lizarazo J, Illnait-Zaragozí MT, Castañeda E. The status of cryptococcosis in Latin America. Mem Inst Oswaldo Cruz 2018; 113:e170554. [PMID: 29641639 PMCID: PMC5888000 DOI: 10.1590/0074-02760170554] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/06/2018] [Indexed: 12/23/2022] Open
Abstract
Cryptococcosis is a life-threatening fungal infection caused by the encapsulated
yeasts Cryptococcus neoformans and C. gattii,
acquired from the environment. In Latin America, as occurring
worldwide, C. neoformans causes more than 90% of the cases of
cryptococcosis, affecting predominantly patients with HIV, while C.
gattii generally affects otherwise healthy individuals. In this
region, cryptococcal meningitis is the most common presentation, with
amphotericin B and fluconazole being the antifungal drugs of choice. Avian
droppings are the predominant environmental reservoir of C.
neoformans, while C. gattii is associated with
several arboreal species. Importantly, C. gattii has a high
prevalence in Latin America and has been proposed to be the likely origin of
some C. gattii populations in North America. Thus, in the
recent years, significant progress has been made with the study of the basic
biology and laboratory identification of cryptococcal strains, in understanding
their ecology, population genetics, host-pathogen interactions, and the clinical
epidemiology of this important mycosis in Latin America.
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Affiliation(s)
- Carolina Firacative
- Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jairo Lizarazo
- Internal Medicine Department, Hospital Universitario Erasmo Meoz, Universidad de Pamplona, Cúcuta, Colombia
| | - María Teresa Illnait-Zaragozí
- Diagnosis and Reference Centre, Bacteriology-Mycology Department Research, Tropical Medicine Institute Pedro Kourí, Havana, Cuba
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