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Nematollahi S, Dioverti-Prono V. Cryptococcal infection in haematologic malignancies and haematopoietic stem cell transplantation. Mycoses 2020; 63:1033-1046. [PMID: 32740974 DOI: 10.1111/myc.13153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/18/2022]
Abstract
This review summarises both the recent and relevant studies about cryptococcal infections in haematologic malignancies and haematopoietic stem cell transplantation. Although uncommon in this patient population, this infection carries a high mortality, especially if left untreated. Given the limited data, we draw some conclusions with respect to management from the solid organ transplantation and HIV-infected literature. Herein, we discuss cryptococcosis with a particular attention to its background, epidemiology, risk factors, clinical presentation, diagnosis, treatment and prevention in this group.
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Affiliation(s)
- Saman Nematollahi
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Veronica Dioverti-Prono
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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2
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Okamoto K, Proia LA, Demarais PL. Disseminated Cryptococcal Disease in a Patient with Chronic Lymphocytic Leukemia on Ibrutinib. Case Rep Infect Dis 2016; 2016:4642831. [PMID: 27703818 PMCID: PMC5039271 DOI: 10.1155/2016/4642831] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/28/2016] [Indexed: 01/08/2023] Open
Abstract
Cryptococcus is a unique environmental fungus that can cause disease most often in immunocompromised individuals with defective cell-mediated immunity. Chronic lymphocytic leukemia (CLL) is not known to be a risk factor for cryptococcal disease although cases have been described mainly in patients treated with agents that suppress cell-mediated immunity. Ibrutinib is a new biologic agent used for treatment of CLL, mantle cell lymphoma, and Waldenstrom's macroglobulinemia. It acts by inhibiting Bruton's tyrosine kinase, a kinase downstream of the B-cell receptor critical for B-cell survival and proliferation. Ibrutinib use has not been associated previously with cryptococcal disease. However, recent evidence suggested that treatments aimed at blocking the function of Bruton's tyrosine kinase could pose a higher risk for cryptococcal infection in a mice model. Here, we report the first case of disseminated cryptococcal disease in a patient with CLL treated with ibrutinib. When evaluating possible infection in CLL patients receiving ibrutinib, cryptococcal disease, which could be life threatening if overlooked, could be considered.
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Affiliation(s)
- Koh Okamoto
- Division of Infectious Diseases, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
- Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Laurie A. Proia
- Division of Infectious Diseases, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Patricia L. Demarais
- Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
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3
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Schmalzle SA, Buchwald UK, Gilliam BL, Riedel DJ. Cryptococcus neoformans infection in malignancy. Mycoses 2016; 59:542-52. [PMID: 26932366 DOI: 10.1111/myc.12496] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/10/2016] [Accepted: 02/04/2016] [Indexed: 12/25/2022]
Abstract
Cryptococcosis is an opportunistic invasive fungal infection that is well described and easily recognised when it occurs as meningitis in HIV-infected persons. Malignancy and its treatment may also confer a higher risk of infection with Cryptococcus neoformans, but this association has not been as well described. A case of cryptococcosis in a cancer patient is presented, and all cases of coincident C. neoformans infection and malignancy in adults published in the literature in English between 1970 and 2014 are reviewed. Data from these cases were aggregated in order to describe the demographics, type of malignancy, site of infection, clinical manifestations, treatment and outcomes of cryptococcosis in patients with cancer. Haematologic malignancies accounted for 82% of cases, with lymphomas over-represented compared to US population data (66% vs. 53% respectively). Cryptococcosis was reported rarely in patients with solid tumours. Haematologic malignancy patients were more likely to have central nervous system (P < 0.001) or disseminated disease (P < 0.001), receive Amphotericin B as part of initial therapy (P = 0.023), and had higher reported mortality rates than those with solid tumours (P = 0.222). Providers should have heightened awareness of the possibility of cryptococcosis in patients with haematologic malignancy presenting with infection.
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Affiliation(s)
- Sarah A Schmalzle
- University of Maryland School of Medicine Division of Infectious Diseases, Institute of Human Virology, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA
| | - Ulrike K Buchwald
- University of Maryland School of Medicine Division of Infectious Diseases, Institute of Human Virology, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA
| | - Bruce L Gilliam
- University of Maryland School of Medicine Division of Infectious Diseases, Institute of Human Virology, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA
| | - David J Riedel
- University of Maryland School of Medicine Division of Infectious Diseases, Institute of Human Virology, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA
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Farmakiotis D, Liakos A, Miller MB, Krane JF, Baden LR, Hammond SP. An Avid Imitator. J Clin Med Res 2016; 8:257-9. [PMID: 26858802 PMCID: PMC4737040 DOI: 10.14740/jocmr2458w] [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] [Accepted: 01/06/2016] [Indexed: 12/03/2022] Open
Abstract
We present a case of disseminated cryptococcal disease, coexisting with and mimicking lymphoma. Determination of serum cryptococcal antigen should be considered for lymphopenic patients with hematologic malignancies, presenting with unexplained fever, and/or lymphadenopathy and/or pulmonary findings. Patients with hematologic malignancies treated with chemotherapy regimens are susceptible to diverse opportunistic infections. Therefore, in this patient population, it is often necessary to obtain a definitive pathologic diagnosis, to diagnose uncommon syndromes and guide management.
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Affiliation(s)
- Dimitrios Farmakiotis
- Division of Infectious Diseases, Brigham and Women's Hospital and Dana-Farber Cancer Institute Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alexis Liakos
- Division of Infectious Diseases, Brigham and Women's Hospital and Dana-Farber Cancer Institute Harvard Medical School, Boston, MA, USA
| | - Michael B Miller
- Department of Pathology, Brigham and Women's Hospital and Dana-Farber Cancer Institute Harvard Medical School, Boston, MA, USA
| | - Jeffrey F Krane
- Department of Pathology, Brigham and Women's Hospital and Dana-Farber Cancer Institute Harvard Medical School, Boston, MA, USA
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham and Women's Hospital and Dana-Farber Cancer Institute Harvard Medical School, Boston, MA, USA
| | - Sarah P Hammond
- Division of Infectious Diseases, Brigham and Women's Hospital and Dana-Farber Cancer Institute Harvard Medical School, Boston, MA, USA
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Neves RP, Lima Neto RGD, Leite MC, Silva VKAD, Santos FDAGD, Macêdo DPC. Cryptococcus laurentii fungaemia in a cervical cancer patient. Braz J Infect Dis 2015; 19:660-3. [PMID: 26361842 PMCID: PMC9425362 DOI: 10.1016/j.bjid.2015.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/19/2015] [Accepted: 06/23/2015] [Indexed: 11/30/2022] Open
Abstract
Infections caused by emerging Cryptococcus non-neoformans species are being reported with increasingly frequency. Here, we present a case of fungaemia by Cryptococcus laurentii in a woman receiving aggressive immunosuppressive therapy for cervical neoplasia. Three venous blood samples were aseptically collected on consecutive days and C. laurentii was isolated and identified through phenotypic and molecular methods. After central venous catheter removal and appropriate antifungal therapy, the patient showed significant improvement and blood culture became negative. Thus, patients following immunosuppressive therapies and using invasive medical devices are at risk of C. laurentii blood infections.
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Affiliation(s)
- Rejane Pereira Neves
- Departamento de Micologia, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | | | - Melyna Chaves Leite
- Departamento de Micologia, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
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Bowen DA, Rabe KG, Schwager SM, Slager SL, Call TG, Viswanatha DS, Zent CS. Infectious lymphadenitis in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma: a rare, but important, complication. Leuk Lymphoma 2014; 56:311-4. [PMID: 24738974 DOI: 10.3109/10428194.2014.914202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The differential diagnosis of rapidly progressive or symptomatic lymphadenopathy in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) includes infectious lymphadenitis. We studied 286 (9%) of 3040 patients with CLL seen between 2003 and 2012 at Mayo Clinic Rochester who had 356 diagnostic lymph node biopsies to evaluate rapidly progressive or symptomatic lymphadenopathy. Most (85.4%) biopsies showed progressive CLL, 8.9% a second lymphoid malignancy, 3.9% infectious lymphadenitis, 1.1% reactive adenitis and 0.6% non-hematological malignancies. Of the 12 patients (14 biopsies) with infectious lymphadenitis, five patients had never been treated for their CLL, and seven had a specific microbiological diagnosis (herpes simplex n=3, Cryptococcus neoformans n=1, Mycobacterium n=1, coagulase negative Staphylococcus n=2). We conclude that infectious lymphadenitis is a rare complication of CLL with clinical characteristics similar to progressive CLL and transformation to a more aggressive lymphoma. Early recognition and antimicrobial therapy treatment of infectious lymphadenitis can be highly effective in these patients.
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Abstract
Cryptococcal meningitis causes morbidity and mortality worldwide. The burden of disease is greatest in middle- and low-income countries with a high incidence of human immunodeficiency virus (HIV) infection. Patients taking immunosuppressive drugs and some immunocompetent hosts are also at risk. Treatment of cryptococcal meningitis consists of three phases: induction, consolidation, and maintenance. Effective induction therapy requires potent fungicidal drugs (amphotericin B and flucytosine), which are often unavailable in low-resource, high-endemicity settings. As a consequence, mortality is unacceptably high. Wider access to effective treatment is urgently required to improve outcomes. For human immunodeficiency virus-infected patients, judicious management of asymptomatic cryptococcal antigenemia and appropriately timed introduction of antiretroviral therapy are important.
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Affiliation(s)
- Derek J Sloan
- Tropical and infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Victoria Parris
- Tropical and infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
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