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Hansakon A, Angkasekwinai P. Murine Models of Cryptococcus Infection. Curr Protoc 2024; 4:e1001. [PMID: 38456766 DOI: 10.1002/cpz1.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Cryptococcus is recognized as one of the emerging fungal pathogens that have major impact on diverse populations worldwide. Because of the high mortality rate and limited antifungal therapy options, there is an urgent need to understand the impact of dynamic processes between fungal pathogens and hosts that influence cryptococcal pathogenesis and disease outcomes. With known common limitations in human studies, experimental murine cryptococcosis models that can recapitulate human disease provide a valuable tool for studying fungal virulence and the host interaction, leading to development of better treatment strategies. Infection with Cryptococcus in mice via intranasal inhalation is mostly used because it is noninvasive and considered to be the most common mode of infection, strongly correlating with cryptococcal disease in humans. The protocols described in this article provide the procedures of establishing a murine model of Cryptococcus infection by intranasal inhalation and assessing the host immune response and disease progression during Cryptococcus infection. © 2024 Wiley Periodicals LLC. Basic Protocol 1: Murine model of pulmonary cryptococcal infection via intranasal inhalation Basic Protocol 2: Assessment of the pulmonary immune response during Cryptococcus infection Support Protocol: Evaluation of pulmonary gene expression by real-time PCR Basic Protocol 3: Enumeration of survival rate and organ fungal burden.
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Affiliation(s)
- Adithap Hansakon
- Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Pornpimon Angkasekwinai
- Department of Medical Technology, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
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2
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Li X, Xu J, Lin X, Lin Q, Yu T, Chen L, Chen L, Huang X, Zhang X, Chen G, Xu L. Macrophages-derived exo-miR-4449 induced by Cryptococcus affects HUVEC permeability and promotes pyroptosis in BEAS-2B via the HIC1 pathway. Cytokine 2024; 173:156441. [PMID: 37995394 DOI: 10.1016/j.cyto.2023.156441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
Macrophages have recently been discovered to assume a significant role in the progression of cryptococcosis. However, the potential involvement of macrophage-derived exosomes in the pathogenesis of cryptococcosis remains uncertain. In this study, we investigated the changes of microRNAs in macrophage exosomes (exo-miRNAs) in cryptococcal infections and the role of markedly altered exo-miRNAs in the modulation of Human Umbilical Vein Endothelial Cells (HUVEC) permeability and ROS accumulation and pyroptosis in Human Bronchial Epithelioid Cells (BEAS-2B). Techniques such as microarray analysis and real-time quantitative PCR were used to detect different exo-miRNAs and to screen for the most highly expressed exo-miRNAs. Then its mimics were transfected into HUVEC to study its effect on the monolayer permeability of HUVEC. Finally, the relationship between this exo-miRNAs and the ROS accumulation and pyroptosis was verified by bioinformatics analysis. The results showed that five exo-miRNAs were overexpressed and two exo-miRNAs were reduced, among which, exo-miR-4449 was expressed at the highest level. Exo-miR-4449 could be internalized by HUVEC and enhanced its monolayer permeability. Moreover, exo-miR-4449 was found to promote ROS accumulation and pyroptosis in BEAS-2B through HIC1 pathway. Thus, exo-miR-4449 plays an important role in the pathogenesis of cryptococcosis and holds promise as a significant biomarker for treatment.
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Affiliation(s)
- Xiaohua Li
- Department of Pulmonary and Critical Care Medicine, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Fuzhou 350009, China.
| | - Junping Xu
- Department of Pulmonary and Critical Care Medicine, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Fuzhou 350009, China.
| | - Xin Lin
- Department of Pulmonary and Critical Care Medicine, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Fuzhou 350009, China.
| | - Qiong Lin
- Department of Pulmonary and Critical Care Medicine, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Fuzhou 350009, China.
| | - Tianxing Yu
- Department of Pulmonary and Critical Care Medicine, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Fuzhou 350009, China.
| | - Lin Chen
- Department of Pulmonary and Critical Care Medicine, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Fuzhou 350009, China.
| | - Lifang Chen
- Department of Pulmonary and Critical Care Medicine, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Fuzhou 350009, China.
| | - Xiaoqing Huang
- Department of Pulmonary and Critical Care Medicine, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Fuzhou 350009, China.
| | - Xueping Zhang
- Department of Pulmonary and Critical Care Medicine, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Fuzhou 350009, China.
| | - Geng Chen
- Nursing Department, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Fuzhou 350009, China.
| | - Liyu Xu
- Department of Pulmonary and Critical Care Medicine, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Fuzhou 350009, China.
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Ueno K, Miyazaki Y. Detrimental impact of the IL-33/ST2 axis in an animal infection model with Cryptococcus neoformans. Allergol Int 2023; 72:530-536. [PMID: 37482531 DOI: 10.1016/j.alit.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023] Open
Abstract
Cryptococcus neoformans and Cryptococcus gattii are pathogenic fungi that infect the human respiratory system and cause life-threatening pulmonary cryptococcosis. The immunopathology of cryptococcosis is completely different from that of other fungal allergies. In murine cryptococcal infection models, cryptococcal cells are usually injected via nasal or intratracheal routes. After the infection, the alveolar epithelial cells are impaired and release IL-33, an IL-1 family cytokine that functions as an alarmin. This cytokine detrimentally amplifies allergic responses, and also induces a protective immune response against parasitic infection. In the pulmonary cryptococcosis model, type-II alveolar epithelial cells are the major source of IL-33, and the alveolar epithelial cells, ILC2, and Th2 cells express the IL-33 receptor (ST2). In IL-33- or ST2-deficient mice, allergy-like immune responses are attenuated after the C. neoformans infection. The numbers of ILC2 and Th2 cells and the levels of type 2 cytokines, including IL-4, IL-5, and IL-13, are decreased in the mouse lungs in both models. In association with these changes, total blood IgE, bronchus mucus production, and the number of eosinophils are decreased. Conversely, lung neutrophils and M1-type macrophages are increased. These are protective immune subsets suppressing cryptococcal growth. As a result, the lung fungal burden of IL-33- and ST2-deficient mice is decreased post-infection, and both deficient mice show significantly improved mortality. This pathogenesis varies depending on the cryptococcal and murine strains used in the animal experiments. Here, we overview and discuss the itmmunopathology of the IL-33/ST2 axis in a murine lethal cryptococcal infection model.
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Affiliation(s)
- Keigo Ueno
- Department of Fungal Infection, National Institute of Infectious Diseases, Tokyo, Japan.
| | - Yoshitsugu Miyazaki
- Department of Fungal Infection, National Institute of Infectious Diseases, Tokyo, Japan
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Carvalho JHDS, Nascimento JKC, Silva KGV, Silveira Neto S, Macedo ATD, Lima França H, Ferreira LDR, Silva RDS, Sa JC, Ramos DG, Marques DDAV, Furst C, Santos DA, Santos JRA, Holanda RA. Yeast-amoeba interaction influences murine cryptococcosis. Microbes Infect 2023; 25:105153. [PMID: 37244475 DOI: 10.1016/j.micinf.2023.105153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
The virulence of Cryptococcus spp. is modulated in the natural environment through interaction with abiotic and biotic factors, and this can occasionally have implications for the progression of cryptococcosis in mammals. Hence, we evaluated whether the prior interaction of highly virulent Cryptococcus gattii strain R265 with Acanthamoeba castellanii influenced the progression of cryptococcosis. The influence of the capsule on endocytosis was evaluated using amoeba and yeast morphometrics. Mice were intratracheally infected with yeast re-isolated from the amoeba (Interaction), yeast without prior contact with the amoeba (Non-Interaction), or sterile phosphate-buffered saline (SHAM). Morbidity signs and symptoms were monitored during the survival curve, while cytokine and fungal burden measurements and histopathological analysis were performed on the 10th day post infection. Morbidity and mortality parameters in experimental cryptococcosis were influenced by the prior interaction of yeast with amoeba, which led to phenotypic changes in the cryptococcal cells, polysaccharide secretion, and their tolerance to oxidative stress. Our results suggest that a prior yeast-amoeba interaction modulates yeast virulence, which is associated with a greater tolerance to oxidative stress related to the exo-polysaccharide content and influences the progression of cryptococcal infection.
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Affiliation(s)
| | | | | | - Sebastiao Silveira Neto
- Laboratório de Biologia Molecular de Microrganismos Patogênicos, Universidade CEUMA, São Luís, Maranhão, Brazil
| | | | - Hermeson Lima França
- Laboratório de Biologia Molecular de Microrganismos Patogênicos, Universidade CEUMA, São Luís, Maranhão, Brazil
| | - Larissa Dos Reis Ferreira
- Laboratório de Biologia Molecular de Microrganismos Patogênicos, Universidade CEUMA, São Luís, Maranhão, Brazil
| | - Rayssa de Sousa Silva
- Laboratório de Biologia Molecular de Microrganismos Patogênicos, Universidade CEUMA, São Luís, Maranhão, Brazil
| | - Joicy Cortez Sa
- Laboratório de Imunologia, Universidade CEUMA, São Luís, Maranhão, Brazil
| | - Diego Gomes Ramos
- Laboratório Integrado de Biotecnologia Aplicada, Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Cinthia Furst
- Departamento de Patologia, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Daniel Assis Santos
- Departamento de Microbiologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Rodrigo Assuncao Holanda
- Laboratório de Biologia Molecular de Microrganismos Patogênicos, Universidade CEUMA, São Luís, Maranhão, Brazil.
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Fang YF, Cao XH, Yao LY, Cao Q. Pulmonary cryptococcosis after immunomodulator treatment in patients with Crohn’s disease: Three case reports. World J Gastroenterol 2023; 29:758-765. [PMID: 36742174 PMCID: PMC9896616 DOI: 10.3748/wjg.v29.i4.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Corticosteroids and anti-tumor necrosis factor α mAbs are widely used to treat Crohn's disease (CD). However, one disadvantage of this treatment is impairment of normal immune function, leading to an increased risk of infection. Cryptococcus infection is an opportunistic infection that occurs mainly in immunocompromised patients and poses a significant diagnostic challenge in patients with CD.
CASE SUMMARY Here, we report three cases of pulmonary cryptococcosis in patients with CD after receiving immunomodulatory treatment. The patients presented with no or mild respiratory symptoms. Chest computed tomography scans revealed pulmonary nodules in the unilateral or bilateral lobes. Diagnoses were made using pathological examination and metagenomic sequencing. The patients were treated with fluconazole 400 mg once daily for 1 to 6 mo, and symptoms were resolved. Literature searches were conducted in PubMed, Web of Science, and Embase to retrieve previously reported cases and summarize patient characteristics.
CONCLUSION The incidence of cryptococcus infection has increased along with immunomodulator use. Clinical vigilance is required for early identification and standardized treatment.
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Affiliation(s)
- Yan-Fei Fang
- Department of Gastroenterology, Inflammatory Bowel Disease Center, Sir Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Xiang-Han Cao
- Department of Gastroenterology, Inflammatory Bowel Disease Center, Sir Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Ling-Ya Yao
- Department of Gastroenterology, Inflammatory Bowel Disease Center, Sir Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Qian Cao
- Department of Gastroenterology, Inflammatory Bowel Disease Center, Sir Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Chen JY, Li TT, Hao YQ, Tang HP. [Pulmonary cryptococcosis coexisting with lung cancer confirmed by pathological examinations: report of 3 cases and literature review]. Zhonghua Jie He He Hu Xi Za Zhi 2022; 45:1009-1014. [PMID: 36207957 DOI: 10.3760/cma.j.cn112147-20220312-00197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To describe the clinical characteristics of pulmonary cryptococcosis(PC)coexisting with lung cancer. Methods: We reported 3 cases of PC coexisting with lung cancer confirmed by pathology in Qingdao Municipal Hospital from January 2017 to December 2021.We reviewed the literature with"pulmonary cryptococcosis" and "lung cancer" as the keywords to search Wanfang database, China HowNet and PubMed database. Results: The patients consisted of 2 males and 1 female. Two patients were diagnosed with nodular type of PC and one with diffuse mixed type of PC. One patient had underlying cardiovascular diseases and the other two had no medical history. The clinical manifestations varied including fever, cough, sputum, and no specific symptoms. All the patients received surgery and postoperative medical therapy, and all 3 patients were pathologically confirmed with adenocarcinoma. A total of 18 cases were retrieved from related literatures. To our knowledge, one of our cases was the first one with diffuse mixed type of PC coexisting with lung cancer. Conclusions: Coexistence of pulmonary cryptococcosis and lung cancer is rare and the clinical symptoms are nonspecific. When PC coexists with lung cancer, it is extremely easy to be misdiagnosed. Therefore, PC should be considered in the differential diagnosis of pulmonary nodules and multiple imaging changes.
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Affiliation(s)
- J Y Chen
- Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao 266071, China
| | - T T Li
- Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao 266071, China
| | - Y Q Hao
- Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao 266071, China
| | - H P Tang
- Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao 266071, China
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Affiliation(s)
- Lisa Akintilo
- New York University Grossman School of Medicine, New York, NY
| | - Alisa Femia
- New York University Grossman School of Medicine, New York, NY
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8
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Abstract
Although we have recognized cryptococcosis as a disease entity for well over 100 years, there are many details about its pathogenesis which remain unknown. A major barrier to better understanding is the very broad range of clinical and pathological forms cryptococcal infections can take. One such form has been historically called the cryptococcal granuloma, or the cryptococcoma. These words have been used to describe essentially any mass lesion associated with infection, due to their presumed similarity to the quintessential granuloma, the tubercle in tuberculosis. Although clear distinctions between tuberculosis and cryptococcal disease have been discovered, cellular and molecular studies still confirm some important parallels between these 2 diseases and what we now call granulomatous inflammation. In this review, we shall sketch out some of the history behind the term “granuloma” as it pertains to cryptococcal disease, explore our current understanding of the biology of granuloma formation, and try to place that understanding in the context of the myriad pathological presentations of this infection. Finally, we shall summarize the role of the granuloma in cryptococcal latency and present opportunities for future investigations.
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Affiliation(s)
- Laura C. Ristow
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
| | - J. Muse Davis
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
- * E-mail:
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Johnson AL, Lewis AD. Two cases of cryptococcus gattii infection in the rhesus macaque (Macaca Mulatta). J Med Primatol 2021; 50:67-70. [PMID: 33305391 PMCID: PMC8006908 DOI: 10.1111/jmp.12497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022]
Abstract
Cryptococcus gattii was diagnosed in two female indoor-housed rhesus macaques. Gross and histopathologic findings included an isolated pulmonary cryptococcoma in a non-SIV-infected macaque and disseminated disease centered on the lungs of an SIV-infected macaque. Fungal yeast were positive with special stains, and the diagnoses were confirmed with a lateral flow assay and PCR.
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Affiliation(s)
- Amanda L. Johnson
- Pathology Services Unit, Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Anne D. Lewis
- Pathology Services Unit, Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
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Bardhi R, Lawrence K, Bedford LM, Deirawan H, Moossavi M. Disseminated cryptococcosis presenting with cutaneous involvement in an immunocompromised patient. Dermatol Online J 2020; 26:13030/qt8fv322pr. [PMID: 33423425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 06/12/2023] Open
Abstract
Cryptococcosis is a fungal infection that typically affects immunocompromised patients. It most commonly affects the lungs and may then disseminate to the central nervous system, bone, skin, and adrenal glands. Herein, we describe a 69-year-old man who presented with skin lesions as the initial manifestation of disseminated cryptococcosis. Initial workup led to an assumption that the patient was immunocompetent. Later in the clinical course, idiopathic depletion of CD4 T cells was discovered. This case highlights that disseminated cryptococcosis may present with cutaneous symptoms even when there is no evidence of pulmonary or central nervous system involvement and may be the first sign of an underlying cellular immune dysfunction.
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Affiliation(s)
| | - Kelsey Lawrence
- Department of Dermatology, Wayne State University, Detroit, MI.
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Lee E, Jang Y, Choi IH. Pleural Cryptococcosis in a Patient with AIDS. J Korean Med Sci 2020; 35:e392. [PMID: 33200595 PMCID: PMC7669458 DOI: 10.3346/jkms.2020.35.e392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/22/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Eunjung Lee
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.
| | - Youngeun Jang
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - In Ho Choi
- Department of Pathology, Soonchunhyang University Seoul Hospital, Seoul, Korea
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12
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Jung KW, Lee KT, Bahn YS. A Signature-Tagged Mutagenesis (STM)-based murine-infectivity assay for Cryptococcus neoformans. J Microbiol 2020; 58:823-831. [PMID: 32989639 DOI: 10.1007/s12275-020-0341-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/12/2020] [Indexed: 11/26/2022]
Abstract
Signature-tagged mutagenesis (STM) is a high-throughput genetic technique that can be used to investigate the function of genes by constructing a large number of mutant strains with unique DNA identification tags, pooling them, and screening them for a particular phenotypic trait. STM was first designed for the identification of genes that contribute to the virulence or infectivity of a pathogen in its host. Recently, this method has also been applied for the identification of mutants with specific phenotypes, such as antifungal drug resistance and proliferation. In the present study, we describe an STM method for the identification of genes contributing to the infectivity of Cryptococcus neoformans using a mutant library, in which each strain was tagged with a unique DNA sequence.
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Affiliation(s)
- Kwang-Woo Jung
- Radiation Research Division, Korea Atomic Energy Research Institute, Jeongeup o56212, Republic of Korea
| | - Kyung-Tae Lee
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, 03722, Republic of Korea
| | - Yong-Sun Bahn
- Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, 03722, Republic of Korea.
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Epstein DJ, Thompson LDR, Saleem A, Kao CS, Epstein JI. Fungal prostatitis due to endemic mycoses and Cryptococcus: A multicenter case series. Prostate 2020; 80:1006-1011. [PMID: 32572997 DOI: 10.1002/pros.24034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/05/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Fungal prostatitis is exceedingly rare with mostly case reports. METHODS Electronic medical records at three medical centers were searched for cases of fungal prostatitis due to endemic mycoses and Cryptococcus over the preceding 10 years. RESULTS Seven cases were identified from 105 600 prostate biopsies within the Southern California Permanente Medical Group for an incidence of 0.0066%. An additional eight cases were identified from two other health care systems. Excluding four patients without available clinical data, 11 patients were reviewed, most of whom underwent biopsy due to elevated prostate-specific antigen. Four were asymptomatic and the remainder had nonspecific signs or symptoms. All biopsies revealed granulomatous inflammation and fungal organisms. Seven patients had coccidioidomycosis, three patients had cryptococcosis (confirmed in two cases and suspected by organism morphology in the other), and one patient had likely histoplasmosis based on organism morphology. Prolonged antifungal treatment was standard; outcomes were favorable. CONCLUSION Fungal prostatitis due to endemic mycoses and Cryptococcus is uncommon and associated with favorable outcomes but generally involves prolonged therapy.
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Affiliation(s)
- David J Epstein
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Lester D R Thompson
- Department of Pathology, Southern California Permanente Medical Group, Pasadena, California
| | - Atif Saleem
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Chia-Sui Kao
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Jonathan I Epstein
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Xu J, Neal LM, Ganguly A, Kolbe JL, Hargarten JC, Elsegeiny W, Hollingsworth C, He X, Ivey M, Lopez R, Zhao J, Segal B, Williamson PR, Olszewski MA. Chemokine receptor CXCR3 is required for lethal brain pathology but not pathogen clearance during cryptococcal meningoencephalitis. Sci Adv 2020; 6:eaba2502. [PMID: 32596454 PMCID: PMC7299622 DOI: 10.1126/sciadv.aba2502] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 05/04/2020] [Indexed: 05/22/2023]
Abstract
Cryptococcal meningoencephalitis (CM) is the major cause of infection-related neurological death, typically seen in immunocompromised patients. However, T cell-driven inflammatory response has been increasingly implicated in lethal central nervous system (CNS) immunopathology in human patients and murine models. Here, we report marked up-regulation of the chemokine receptor CXCR3 axis in human patients and mice with CM. CXCR3 deletion in mice improves survival, diminishes neurological deficits, and limits neuronal damage without suppressing fungal clearance. CD4+ T cell accumulation and TH1 skewing are reduced in the CNS but not spleens of infected CXCR3-/- mice. Adoptive transfer of WT, but not CXCR3-/- CD4+ T cells, into CXCR3-/- mice phenocopies the pathology of infected WT mice. Collectively, we found that CXCR3+CD4+ T cells drive lethal CNS pathology but are not required for fungal clearance during CM. The CXCR3 pathway shows potential as a therapeutic target or for biomarker discovery to limit CNS inflammatory damages.
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Affiliation(s)
- Jintao Xu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
- Research Service, Ann Arbor VA Healthcare System, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Lori M. Neal
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
- Research Service, Ann Arbor VA Healthcare System, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Anutosh Ganguly
- Research Service, Ann Arbor VA Healthcare System, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Jessica L. Kolbe
- Research Service, Ann Arbor VA Healthcare System, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Jessica C. Hargarten
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Waleed Elsegeiny
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Christopher Hollingsworth
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Xiumiao He
- School of Marine Sciences and Biotechnology, Guangxi University for Nationalities, Nanning, Guangxi, China
| | - Mike Ivey
- Research Service, Ann Arbor VA Healthcare System, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Rafael Lopez
- Research Service, Ann Arbor VA Healthcare System, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Jessica Zhao
- Research Service, Ann Arbor VA Healthcare System, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Benjamin Segal
- Department of Neurology and Neurological Institute, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, OH, USA
| | - Peter R. Williamson
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Michal A. Olszewski
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
- Research Service, Ann Arbor VA Healthcare System, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
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Seoane PI, Taylor-Smith LM, Stirling D, Bell LCK, Noursadeghi M, Bailey D, May RC. Viral infection triggers interferon-induced expulsion of live Cryptococcus neoformans by macrophages. PLoS Pathog 2020; 16:e1008240. [PMID: 32106253 PMCID: PMC7046190 DOI: 10.1371/journal.ppat.1008240] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022] Open
Abstract
Cryptococcus neoformans is an opportunistic human pathogen, which causes serious disease in immunocompromised hosts. Infection with this pathogen is particularly relevant in HIV+ patients, where it leads to around 200,000 deaths per annum. A key feature of cryptococcal pathogenesis is the ability of the fungus to survive and replicate within the phagosome of macrophages, as well as its ability to be expelled from host cells via a novel non-lytic mechanism known as vomocytosis. Here we show that cryptococcal vomocytosis from macrophages is strongly enhanced by viral coinfection, without altering phagocytosis or intracellular proliferation of the fungus. This effect occurs with distinct, unrelated human viral pathogens and is recapitulated when macrophages are stimulated with the anti-viral cytokines interferon alpha or beta (IFNα or IFNβ). Importantly, the effect is abrogated when type-I interferon signalling is blocked, thus underscoring the importance of type-I interferons in this phenomenon. Lastly, our data help resolve previous, contradictory animal studies on the impact of type I interferons on cryptococcal pathogenesis and suggest that secondary viral stimuli may alter patterns of cryptococcal dissemination in the host.
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Affiliation(s)
- Paula I. Seoane
- Institute of Microbiology & Infection and School of Biosciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Leanne M. Taylor-Smith
- Institute of Microbiology & Infection and School of Biosciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - David Stirling
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Lucy C. K. Bell
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, United Kingdom
| | | | - Robin C. May
- Institute of Microbiology & Infection and School of Biosciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- * E-mail:
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16
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Dos Santos VM. Pulmonary Cryptococcosis. Arch Iran Med 2019; 22:629-630. [PMID: 31679366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/07/2019] [Indexed: 06/10/2023]
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17
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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: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Taniwaki M, Yamasaki M, Ishikawa N, Kawamoto K, Hattori N. Pulmonary cryptococcosis mimicking lung cancer. Lancet Infect Dis 2019; 19:1033. [PMID: 31478508 DOI: 10.1016/s1473-3099(19)30278-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Masaya Taniwaki
- Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, Japan.
| | - Masahiro Yamasaki
- Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, Japan
| | - Nobuhisa Ishikawa
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Minami-ku, Hiroshima, Japan
| | - Kazuma Kawamoto
- Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
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19
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Walsh NM, Botts MR, McDermott AJ, Ortiz SC, Wüthrich M, Klein B, Hull CM. Infectious particle identity determines dissemination and disease outcome for the inhaled human fungal pathogen Cryptococcus. PLoS Pathog 2019; 15:e1007777. [PMID: 31247052 PMCID: PMC6597114 DOI: 10.1371/journal.ppat.1007777] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/22/2019] [Indexed: 01/01/2023] Open
Abstract
The majority of invasive human fungal pathogens gain access to their human hosts via the inhalation of spores from the environment into the lung, but relatively little is known about this infectious process. Among human fungal pathogens the most frequent cause of inhaled fatal fungal disease is Cryptococcus, which can disseminate from the lungs to other tissues, including the brain, where it causes meningoencephalitis. To determine the mechanisms by which distinct infectious particles of Cryptococcus cause disseminated disease, we evaluated two developmental cell types (spores and yeast) in mouse models of infection. We discovered that while both yeast and spores from several strains cause fatal disease, there was a consistently higher fungal burden in the brains of spore-infected mice. To determine the basis for this difference, we compared the pathogenesis of avirulent yeast strains with their spore progeny derived from sexual crosses. Strikingly, we discovered that spores produced by avirulent yeast caused uniformly fatal disease in the murine inhalation model of infection. We determined that this difference in outcome is associated with the preferential dissemination of spores to the lymph system. Specifically, mice infected with spores harbored Cryptococcus in their lung draining lymph nodes as early as one day after infection, whereas mice infected with yeast did not. Furthermore, phagocyte depletion experiments revealed this dissemination to the lymph nodes to be dependent on CD11c+ phagocytes, indicating a critical role for host immune cells in preferential spore trafficking. Taken together, these data support a model in which spores capitalize on phagocytosis by immune cells to escape the lung and gain access to other tissues, such as the central nervous system, to cause fatal disease. These previously unrealized insights into early interactions between pathogenic fungal spores and lung phagocytes provide new opportunities for understanding cryptococcosis and other spore-mediated fungal diseases.
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Affiliation(s)
- Naomi M. Walsh
- Department of Biomolecular Chemistry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Michael R. Botts
- Department of Biomolecular Chemistry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Andrew J. McDermott
- Department of Biomolecular Chemistry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Sébastien C. Ortiz
- Department of Biomolecular Chemistry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Marcel Wüthrich
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Bruce Klein
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Christina M. Hull
- Department of Biomolecular Chemistry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail:
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20
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Li Y, Li H, Sui M, Li M, Wang J, Meng Y, Sun T, Liang Q, Suo C, Gao X, Li C, Li Z, Du W, Zhang B, Sai S, Zhang Z, Ye J, Wang H, Yue S, Li J, Zhong M, Chen C, Qi S, Lu L, Li D, Ding C. Fungal acetylome comparative analysis identifies an essential role of acetylation in human fungal pathogen virulence. Commun Biol 2019; 2:154. [PMID: 31069264 PMCID: PMC6494858 DOI: 10.1038/s42003-019-0419-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/08/2019] [Indexed: 11/09/2022] Open
Abstract
Lysine acetylation is critical in regulating important biological processes in many organisms, yet little is known about acetylome evolution and its contribution to phenotypic diversity. Here, we compare the acetylomes of baker's yeast and the three deadliest human fungal pathogens, Cryptococcus neoformans, Candida albicans, and Aspergillus fumigatus. Using mass spectrometry enriched for acetylated peptides together with public data from Saccharomyces cerevisiae, we show that fungal acetylomes are characterized by dramatic evolutionary dynamics and limited conservation in core biological processes. Notably, the levels of protein acetylation in pathogenic fungi correlate with their pathogenicity. Using gene knockouts and pathogenicity assays in mice, we identify deacetylases with critical roles in virulence and protein translation elongation. Finally, through mutational analysis of deactylation motifs we find evidence of positive selection at specific acetylation motifs in fungal pathogens. These results shed new light on the pathogenicity regulation mechanisms underlying the evolution of fungal acetylomes.
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Affiliation(s)
- Yanjian Li
- College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Hailong Li
- College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Mingfei Sui
- Software College, Northeastern University, Shenyang, China
| | - Minghui Li
- College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Jiamei Wang
- College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Yang Meng
- College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Tianshu Sun
- Department of Scientific Research, Central Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
- Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Qiaojing Liang
- College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Chenhao Suo
- College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Xindi Gao
- College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Chao Li
- College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Zhuoran Li
- College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Wei Du
- College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Baihua Zhang
- SINO-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China
| | - Sixiang Sai
- School of Medicine, Binzhou Medical University, Yantai, China
| | | | - Jing Ye
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Center for Microbiology, College of Life Sciences, Nanjing Normal University, Nanjing, China
| | - Hongchen Wang
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Center for Microbiology, College of Life Sciences, Nanjing Normal University, Nanjing, China
| | - Shang Yue
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Center for Microbiology, College of Life Sciences, Nanjing Normal University, Nanjing, China
| | - Jiayi Li
- College of Life and Health Sciences, Northeastern University, Shenyang, China
- Neural Plasticity and Repair Unit, Wallenberg Neuroscience Center, Lund University, Lund, Sweden
| | - Manli Zhong
- College of Life and Health Sciences, Northeastern University, Shenyang, China
| | - Changbin Chen
- Unit of Pathogenic Fungal Infection & Host Immunity, CAS Key Laboratory of Molecular Virology & Immunology, Institute Pasteur of Shanghai, Chinese Academy of Science, Shanghai, China
| | - Shouliang Qi
- SINO-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China
| | - Ling Lu
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Center for Microbiology, College of Life Sciences, Nanjing Normal University, Nanjing, China
| | - Dancheng Li
- Software College, Northeastern University, Shenyang, China
| | - Chen Ding
- College of Life and Health Sciences, Northeastern University, Shenyang, China
- Key Laboratory of Data Analytics and Optimization for Smart Industry, Northeastern University, Shenyang, China
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21
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Heung LJ, Hohl TM. Inflammatory monocytes are detrimental to the host immune response during acute infection with Cryptococcus neoformans. PLoS Pathog 2019; 15:e1007627. [PMID: 30897162 PMCID: PMC6428256 DOI: 10.1371/journal.ppat.1007627] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/07/2019] [Indexed: 12/30/2022] Open
Abstract
Cryptococcus neoformans is a leading cause of invasive fungal infections among immunocompromised patients. However, the cellular constituents of the innate immune response that promote clearance versus progression of infection upon respiratory acquisition of C. neoformans remain poorly defined. In this study, we found that during acute C. neoformans infection, CCR2+ Ly6Chi inflammatory monocytes (IM) rapidly infiltrate the lungs and mediate fungal trafficking to lung-draining lymph nodes. Interestingly, this influx of IM is detrimental to the host, since ablating IM or impairing their recruitment to the lungs improves murine survival and reduces fungal proliferation and dissemination. Using a novel conditional gene deletion strategy, we determined that MHC class II expression by IM did not mediate their deleterious impact on the host. Furthermore, although ablation of IM reduced the number of lymphocytes, innate lymphoid cells, and eosinophils in the lungs, the effects of IM were not dependent on these cells. We ascertained that IM in the lungs upregulated transcripts associated with alternatively activated (M2) macrophages in response to C. neoformans, consistent with the model that IM assume a cellular phenotype that is permissive for fungal growth. We also determined that conditional knockout of the prototypical M2 marker arginase 1 in IM and deletion of the M2-associated transcription factor STAT6 were not sufficient to reverse the harmful effects of IM. Overall, our findings indicate that C. neoformans can subvert the fungicidal potential of IM to enable the progression of infection through a mechanism that is not dependent on lymphocyte priming, eosinophil recruitment, or downstream M2 macrophage polarization pathways. These results give us new insight into the plasticity of IM function during fungal infections and the level of control that C. neoformans can exert on host immune responses. Cryptococcus neoformans is a fungus that is prevalent throughout the environment and can cause a fatal infection of the central nervous system when inhaled into the lungs by patients with impaired immune systems. Our understanding of the immune responses that either help clear C. neoformans from the lungs or permit development of disease remains limited. In this study, we used a mouse model of lethal C. neoformans infection to determine that inflammatory monocytes, immune cells that are often among the first responders to infections, actually facilitate the progression of infection rather than clearance. These findings establish a foundation for future work to target the immune response of inflammatory monocytes as a strategy to improve the outcomes of patients that develop C. neoformans infections.
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Affiliation(s)
- Lena J. Heung
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- * E-mail: (LJH); (TMH)
| | - Tobias M. Hohl
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- * E-mail: (LJH); (TMH)
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22
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Sim BNH, Hui LY, Krishnan D, Joseph JP. Idiopathic CD4 lymphopenia in a case of disseminated cryptococcosis with brain, vertebral spine and reproductive organ involvement. Clin Med (Lond) 2019; 19:133-134. [PMID: 30872296 PMCID: PMC6454367 DOI: 10.7861/clinmedicine.19-2-133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cryptococcosis is an opportunistic fungal infection commonly seen in HIV cases. We present a case of disseminated cryptococcosis with multiple non-continuous infective foci in a non-HIV, non-transplant case.
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Affiliation(s)
| | - Lau Yue Hui
- Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
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23
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Twede JV, Peters KM. Primary cutaneous cryptococcosis in an immunocompetent Iraq War veteran. Cutis 2018; 102:E30-E31. [PMID: 30566563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- James V Twede
- Department of Dermatology, Evans Army Community Hospital, Fort Carson, Colorado, USA
| | - Kristopher M Peters
- Department of Dermatology, Madigan Army Medical Center, Tacoma, Washington, USA
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24
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Ni LF, Wang H, Li H, Zhang ZG, Liu XM. [Clinical analysis of pulmonary cryptococcosis in non-human immunodeficiency virus infection patients]. Beijing Da Xue Xue Bao Yi Xue Ban 2018; 50:855-860. [PMID: 30337748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To improve the understanding of the clinical features of pulmonary cryptococcosis in non-human immunodeficiency virus (non-HIV) infection patients and reduce delay in diagnosis, or misdiagnosis. METHODS The clinical features, imaging characteristics, laboratory examinations, treatment and prognosis of 34 cases of pulmonary cryptococcosis were retrospectively analyzed. The data were collected from Peking University First Hospital from June 1997 to June 2016. RESULTS There were 34 cases diagnosed with pulmonary cryptococcosis, including 22 males and 12 females, aged from 20 to 75 years [average: (50.1±15.0) years]. There were 16 cases with host factors and (or) underlying diseases named immunocompromised group. In the study, 67.6% patients had clinical symptoms while 32.4% patients had no symptoms. The most common symptoms included cough, fever, chest pain, shortness of breath, and hemoptysis in sequence. Common chest imaging findings were patchy infiltrates, consolidation, single or multiple nodular or masses shadows. Among the 20 cases with cryptococcal capsular polysaccharide antigen detection, 19 were positive. Eleven cases underwent routine cerebrospinal fluid examination, and 3 cases complicated with central nervous system cryptococcal infection. At first visit, 24 cases were misdiagnosed, among which, 11 cases were misdiagnosed as lung cancer. The diagnosis of 15 cases was proved by percutaneous lung biopsy and 11 were confirmed by surgery, while 8 were diagnosed clinically. Then 11 cases were treated by surgical resection, and in median 4 years' followp, there was 1 case of recurrence. And 23 cases were treated with antifungal therapy, and in median 8 years' follow-up, 3 cases lost to the follow-up and 1 case of recurrence. Compared with normal immune group, immunocompromised patients had higher ages (P=0.017), more crackles (P=0.006) and more percentage of increase of peripheral white blood cells or neutrophils (P=0.003), but no significant difference in symptoms, imaging characteristics or hospitalization time. CONCLUSION There were no specific clinical symptoms and signs for pulmonary cryptococcosis in non-HIV patients. Diagnosis of pulmonary cryptococcosis depends on pathology. Percutaneous lung biopsy was mostly recommended for clinical highly suspected patients. Cryptoeoccal capsular polysaccharide antigen detection had a high sensitivity for the clinical diagnosis. Antifungal drug therapy was the major treatment, and the prognosis of the most patients was good.
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Affiliation(s)
- L F Ni
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
| | - H Wang
- Department of Radiology, Peking University First Hospital, Beijing 100034, China
| | - H Li
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
| | - Z G Zhang
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
| | - X M Liu
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
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25
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Paiva ALC, de Aguiar GB, Lovato RM, Zanetti AVD, Panagopoulos AT, Veiga JCE. Cryptococcoma mimicking a brain tumor in an immunocompetent patient: case report of an extremely rare presentation. SAO PAULO MED J 2018; 136:492-496. [PMID: 29116307 PMCID: PMC9907762 DOI: 10.1590/1516-3180.2017.0046210417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 04/21/2017] [Indexed: 12/27/2022] Open
Abstract
CONTEXT Central nervous system (CNS) infectious diseases have high prevalence in developing countries and their proper diagnosis and treatment are very important for public health planning. Cryptococcus neoformans is a fungus that may cause several CNS manifestations, especially in immunocompromised patients. Cryptococcal meningitis is the most common type of involvement. Mass-effect lesions are uncommon: they are described as cryptococcomas and their prevalence is even lower among immunocompetent patients. The aim here was to report an extremely rare case of cryptococcoma causing a mass effect and mimicking a brain tumor in an immunocompetent patient. The literature on CNS cryptococcal infections was reviewed with emphasis on cryptococcomas. Clinical, surgical and radiological data on a female patient with this rare presentation of cryptococcoma mimicking a brain tumor are described. CASE REPORT A 54-year-old female patient presented to the emergency department with a rapid-onset progressive history of confusion and completely dependency for basic activities. Neuroimaging showed a left occipital lesion and neurosurgical treatment was proposed. From histopathological evaluation, a diagnosis of cryptococcoma was established. She received clinical support with antifungals, but despite optimal clinical treatment, her condition evolved to death. CONCLUSIONS Cryptococcal infections have several forms of presentation and, in immunocompetent patients, their manifestation may be even more different. Cryptococcoma is an extremely rare presentation in which proper surgical and clinical treatment should be instituted as quickly as possible, but even so, there is a high mortality rate.
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Affiliation(s)
- Aline Lariessy Campos Paiva
- MD. Resident, Discipline of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil.
| | - Guilherme Brasileiro de Aguiar
- MSc. Attending Neurosurgeon, Discipline of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil.
| | - Renan Maximilian Lovato
- MD. Resident, Discipline of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil.
| | - Arthus Vilar Deolindo Zanetti
- MD. Resident, Discipline of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil.
| | - Alexandros Theodoros Panagopoulos
- PhD. Attending Neurosurgeon, Discipline of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil.
| | - José Carlos Esteves Veiga
- PhD. Full Professor and Head, Discipline of Neurosurgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil.
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26
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Fu MS, Coelho C, De Leon-Rodriguez CM, Rossi DCP, Camacho E, Jung EH, Kulkarni M, Casadevall A. Cryptococcus neoformans urease affects the outcome of intracellular pathogenesis by modulating phagolysosomal pH. PLoS Pathog 2018; 14:e1007144. [PMID: 29906292 PMCID: PMC6021110 DOI: 10.1371/journal.ppat.1007144] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/27/2018] [Accepted: 06/05/2018] [Indexed: 01/22/2023] Open
Abstract
Cryptococcus neoformans is a facultative intracellular pathogen and its interaction with macrophages is a key event determining the outcome of infection. Urease is a major virulence factor in C. neoformans but its role during macrophage interaction has not been characterized. Consequently, we analyzed the effect of urease on fungal-macrophage interaction using wild-type, urease-deficient and urease-complemented strains of C. neoformans. The frequency of non-lytic exocytosis events was reduced in the absence of urease. Urease-positive C. neoformans manifested reduced and delayed intracellular replication with fewer macrophages displaying phagolysosomal membrane permeabilization. The production of urease was associated with increased phagolysosomal pH, which in turn reduced growth of urease-positive C. neoformans inside macrophages. Interestingly, the ure1 mutant strain grew slower in fungal growth medium which was buffered to neutral pH (pH 7.4). Mice inoculated with macrophages carrying urease-deficient C. neoformans had lower fungal burden in the brain than mice infected with macrophages carrying wild-type strain. In contrast, the absence of urease did not affect survival of yeast when interacting with amoebae. Because of the inability of the urease deletion mutant to grow on urea as a sole nitrogen source, we hypothesize urease plays a nutritional role involved in nitrogen acquisition in the environment. Taken together, our data demonstrate that urease affects fitness within the mammalian phagosome, promoting non-lytic exocytosis while delaying intracellular replication and thus reducing phagolysosomal membrane damage, events that could facilitate cryptococcal dissemination when transported inside macrophages. This system provides an example where an enzyme involved in nutrient acquisition modulates virulence during mammalian infection.
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Affiliation(s)
- Man Shun Fu
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Carolina Coelho
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Carlos M. De Leon-Rodriguez
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Diego C. P. Rossi
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Emma Camacho
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Eric H. Jung
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Madhura Kulkarni
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, United States of America
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27
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Esher SK, Ost KS, Kohlbrenner MA, Pianalto KM, Telzrow CL, Campuzano A, Nichols CB, Munro C, Wormley FL, Alspaugh JA. Defects in intracellular trafficking of fungal cell wall synthases lead to aberrant host immune recognition. PLoS Pathog 2018; 14:e1007126. [PMID: 29864141 PMCID: PMC6002136 DOI: 10.1371/journal.ppat.1007126] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 06/14/2018] [Accepted: 05/29/2018] [Indexed: 11/19/2022] Open
Abstract
The human fungal pathogen, Cryptococcus neoformans, dramatically alters its cell wall, both in size and composition, upon entering the host. This cell wall remodeling is essential for host immune avoidance by this pathogen. In a genetic screen for mutants with changes in their cell wall, we identified a novel protein, Mar1, that controls cell wall organization and immune evasion. Through phenotypic studies of a loss-of-function strain, we have demonstrated that the mar1Δ mutant has an aberrant cell surface and a defect in polysaccharide capsule attachment, resulting in attenuated virulence. Furthermore, the mar1Δ mutant displays increased staining for exposed cell wall chitin and chitosan when the cells are grown in host-like tissue culture conditions. However, HPLC analysis of whole cell walls and RT-PCR analysis of cell wall synthase genes demonstrated that this increased chitin exposure is likely due to decreased levels of glucans and mannans in the outer cell wall layers. We observed that the Mar1 protein differentially localizes to cellular membranes in a condition dependent manner, and we have further shown that the mar1Δ mutant displays defects in intracellular trafficking, resulting in a mislocalization of the β-glucan synthase catalytic subunit, Fks1. These cell surface changes influence the host-pathogen interaction, resulting in increased macrophage activation to microbial challenge in vitro. We established that several host innate immune signaling proteins are required for the observed macrophage activation, including the Card9 and MyD88 adaptor proteins, as well as the Dectin-1 and TLR2 pattern recognition receptors. These studies explore novel mechanisms by which a microbial pathogen regulates its cell surface in response to the host, as well as how dysregulation of this adaptive response leads to defective immune avoidance.
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Affiliation(s)
- Shannon K. Esher
- Departments of Molecular Genetics and Microbiology/Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Kyla S. Ost
- Departments of Molecular Genetics and Microbiology/Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Maria A. Kohlbrenner
- Departments of Molecular Genetics and Microbiology/Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Kaila M. Pianalto
- Departments of Molecular Genetics and Microbiology/Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Calla L. Telzrow
- Departments of Molecular Genetics and Microbiology/Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Althea Campuzano
- Department of Biology, University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Connie B. Nichols
- Departments of Molecular Genetics and Microbiology/Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Carol Munro
- MRC Centre for Medical Mycology, University of Aberdeen, Institute of Medical Sciences, Foresterhill, Aberdeen, United Kingdom
| | - Floyd L. Wormley
- Department of Biology, University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - J. Andrew Alspaugh
- Departments of Molecular Genetics and Microbiology/Medicine, Duke University School of Medicine, Durham, NC, United States of America
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Li LX, Rautengarten C, Heazlewood JL, Doering TL. Xylose donor transport is critical for fungal virulence. PLoS Pathog 2018; 14:e1006765. [PMID: 29346417 PMCID: PMC5773217 DOI: 10.1371/journal.ppat.1006765] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/22/2017] [Indexed: 12/22/2022] Open
Abstract
Cryptococcus neoformans, an AIDS-defining opportunistic pathogen, is the leading cause of fungal meningitis worldwide and is responsible for hundreds of thousands of deaths annually. Cryptococcal glycans are required for fungal survival in the host and for pathogenesis. Most glycans are made in the secretory pathway, although the activated precursors for their synthesis, nucleotide sugars, are made primarily in the cytosol. Nucleotide sugar transporters are membrane proteins that solve this topological problem, by exchanging nucleotide sugars for the corresponding nucleoside phosphates. The major virulence factor of C. neoformans is an anti-phagocytic polysaccharide capsule that is displayed on the cell surface; capsule polysaccharides are also shed from the cell and impede the host immune response. Xylose, a neutral monosaccharide that is absent from model yeast, is a significant capsule component. Here we show that Uxt1 and Uxt2 are both transporters specific for the xylose donor, UDP-xylose, although they exhibit distinct subcellular localization, expression patterns, and kinetic parameters. Both proteins also transport the galactofuranose donor, UDP-galactofuranose. We further show that Uxt1 and Uxt2 are required for xylose incorporation into capsule and protein; they are also necessary for C. neoformans to cause disease in mice, although surprisingly not for fungal viability in the context of infection. These findings provide a starting point for deciphering the substrate specificity of an important class of transporters, elucidate a synthetic pathway that may be productively targeted for therapy, and contribute to our understanding of fundamental glycobiology.
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Affiliation(s)
- Lucy X. Li
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | | | | | - Tamara L. Doering
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
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29
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Specht CA, Lee CK, Huang H, Hester MM, Liu J, Luckie BA, Torres Santana MA, Mirza Z, Khoshkenar P, Abraham A, Shen ZT, Lodge JK, Akalin A, Homan J, Ostroff GR, Levitz SM. Vaccination with Recombinant Cryptococcus Proteins in Glucan Particles Protects Mice against Cryptococcosis in a Manner Dependent upon Mouse Strain and Cryptococcal Species. mBio 2017; 8:e01872-17. [PMID: 29184017 PMCID: PMC5705919 DOI: 10.1128/mbio.01872-17] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 01/02/2023] Open
Abstract
Development of a vaccine to protect against cryptococcosis is a priority given the enormous global burden of disease in at-risk individuals. Using glucan particles (GPs) as a delivery system, we previously demonstrated that mice vaccinated with crude Cryptococcus-derived alkaline extracts were protected against lethal challenge with Cryptococcus neoformans and Cryptococcus gattii The goal of the present study was to identify protective protein antigens that could be used in a subunit vaccine. Using biased and unbiased approaches, six candidate antigens (Cda1, Cda2, Cda3, Fpd1, MP88, and Sod1) were selected, recombinantly expressed in Escherichia coli, purified, and loaded into GPs. Three mouse strains (C57BL/6, BALB/c, and DR4) were then vaccinated with the antigen-laden GPs, following which they received a pulmonary challenge with virulent C. neoformans and C. gattii strains. Four candidate vaccines (GP-Cda1, GP-Cda2, GP-Cda3, and GP-Sod1) afforded a significant survival advantage in at least one mouse model; some vaccine combinations provided added protection over that seen with either antigen alone. Vaccine-mediated protection against C. neoformans did not necessarily predict protection against C. gattii Vaccinated mice developed pulmonary inflammatory responses that effectively contained the infection; many surviving mice developed sterilizing immunity. Predicted T helper cell epitopes differed between mouse strains and in the degree to which they matched epitopes predicted in humans. Thus, we have discovered cryptococcal proteins that make promising candidate vaccine antigens. Protection varied depending on the mouse strain and cryptococcal species, suggesting that a successful human subunit vaccine will need to contain multiple antigens, including ones that are species specific.IMPORTANCE The encapsulated fungi Cryptococcus neoformans and Cryptococcus gattii are responsible for nearly 200,000 deaths annually, mostly in immunocompromised individuals. An effective vaccine could substantially reduce the burden of cryptococcosis. However, a major gap in cryptococcal vaccine development has been the discovery of protective antigens to use in vaccines. Here, six cryptococcal proteins with potential as vaccine antigens were expressed recombinantly and purified. Mice were then vaccinated with glucan particle preparations containing each antigen. Of the six candidate vaccines, four protected mice from a lethal cryptococcal challenge. However, the degree of protection varied as a function of mouse strain and cryptococcal species. These preclinical studies identify cryptococcal proteins that could serve as candidate vaccine antigens and provide a proof of principle regarding the feasibility of protein antigen-based vaccines to protect against cryptococcosis.
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MESH Headings
- Animals
- Antigens, Fungal/administration & dosage
- Antigens, Fungal/genetics
- Antigens, Fungal/immunology
- Cloning, Molecular
- Cryptococcosis/pathology
- Cryptococcosis/prevention & control
- Cryptococcus gattii/immunology
- Cryptococcus neoformans/immunology
- Disease Models, Animal
- Drug Carriers/administration & dosage
- Escherichia coli/genetics
- Escherichia coli/metabolism
- Fungal Proteins/administration & dosage
- Fungal Proteins/genetics
- Fungal Proteins/immunology
- Fungal Vaccines/administration & dosage
- Fungal Vaccines/genetics
- Fungal Vaccines/immunology
- Gene Expression
- Glucans/administration & dosage
- Lung/pathology
- Lung Diseases, Fungal/prevention & control
- Mice
- Recombinant Proteins/administration & dosage
- Recombinant Proteins/genetics
- Recombinant Proteins/immunology
- Survival Analysis
- Treatment Outcome
- Vaccines, Subunit/administration & dosage
- Vaccines, Subunit/genetics
- Vaccines, Subunit/immunology
- Vaccines, Synthetic/administration & dosage
- Vaccines, Synthetic/genetics
- Vaccines, Synthetic/immunology
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Affiliation(s)
- Charles A Specht
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Chrono K Lee
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Haibin Huang
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Maureen M Hester
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jianhua Liu
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bridget A Luckie
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Melanie A Torres Santana
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Zeynep Mirza
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Payam Khoshkenar
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ambily Abraham
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Zu T Shen
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jennifer K Lodge
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ali Akalin
- Department of Pathology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Gary R Ostroff
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Stuart M Levitz
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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30
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Lu J, Palavecino EL, Salih ZT. Pulmonary cryptococcosis diagnosed on a lung fine-needle aspiration. Diagn Cytopathol 2017; 46:160-161. [PMID: 29063707 DOI: 10.1002/dc.23842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/28/2017] [Accepted: 10/04/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Jing Lu
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Elizabeth L Palavecino
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Ziyan T Salih
- Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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31
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Raj S, Nazemidashtarjandi S, Kim J, Joffe L, Zhang X, Singh A, Mor V, Desmarini D, Djordjevic J, Raleigh DP, Rodrigues ML, London E, Del Poeta M, Farnoud AM. Changes in glucosylceramide structure affect virulence and membrane biophysical properties of Cryptococcus neoformans. Biochim Biophys Acta Biomembr 2017; 1859:2224-2233. [PMID: 28865794 DOI: 10.1016/j.bbamem.2017.08.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/03/2017] [Accepted: 08/27/2017] [Indexed: 11/19/2022]
Abstract
Fungal glucosylceramide (GlcCer) is a plasma membrane sphingolipid in which the sphingosine backbone is unsaturated in carbon position 8 (C8) and methylated in carbon position 9 (C9). Studies in the fungal pathogen, Cryptococcus neoformans, have shown that loss of GlcCer synthase activity results in complete loss of virulence in the mouse model. However, whether the loss of virulence is due to the lack of the enzyme or to the loss of the sphingolipid is not known. In this study, we used genetic engineering to alter the chemical structure of fungal GlcCer and studied its effect on fungal growth and pathogenicity. Here we show that unsaturation in C8 and methylation in C9 is required for virulence in the mouse model without affecting fungal growth in vitro or common virulence factors. However, changes in GlcCer structure led to a dramatic susceptibility to membrane stressors resulting in increased cell membrane permeability and rendering the fungal mutant unable to grow within host macrophages. Biophysical studies using synthetic vesicles containing GlcCer revealed that the saturated and unmethylated sphingolipid formed vesicles with higher lipid order that were more likely to phase separate into ordered domains. Taken together, these studies show for the first time that a specific structure of GlcCer is a major regulator of membrane permeability required for fungal pathogenicity.
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Affiliation(s)
- Shriya Raj
- Department of Mycology, Institut Pasteur, Paris, France
| | | | - Jihyun Kim
- Department of Chemistry and Biochemistry, Stony Brook University, Stony Brook, NY, USA
| | - Luna Joffe
- Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro (UFRJ), Brazil
| | - Xiaoxue Zhang
- Department of Chemistry and Biochemistry, Stony Brook University, Stony Brook, NY, USA
| | - Ashutosh Singh
- Department of Molecular Genetics and Microbiology, Stony Brook University, Stony Brook, NY, USA
| | - Visesato Mor
- Department of Molecular Genetics and Microbiology, Stony Brook University, Stony Brook, NY, USA
| | - Desmarini Desmarini
- Fungal Pathogenesis Laboratory, Centre for Infectious Diseases and Microbiology, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Julianne Djordjevic
- Fungal Pathogenesis Laboratory, Centre for Infectious Diseases and Microbiology, The Westmead Institute for Medical Research, Westmead, NSW, Australia; Westmead Clinical School, University of Sydney at Westmead Hospital, Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia
| | - Daniel P Raleigh
- Department of Chemistry and Biochemistry, Stony Brook University, Stony Brook, NY, USA
| | - Marcio L Rodrigues
- Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Centro de Desenvolvimento Tecnológico em Saúde (CDTS) da Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Erwin London
- Department of Chemistry and Biochemistry, Stony Brook University, Stony Brook, NY, USA
| | - Maurizio Del Poeta
- Department of Molecular Genetics and Microbiology, Stony Brook University, Stony Brook, NY, USA; Veterans Administration Medical Center, Northport, NY, USA; Division of Infectious Diseases, Stony Brook University, Stony Brook, NY, USA.
| | - Amir M Farnoud
- Department of Chemical and Biomolecular Engineering, Ohio University, Athens, OH, USA.
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32
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Walsh TL, Bhanot N, Murillo MA, Uchin JM, Min Z. Creeping Skin Lesions: Primary Cutaneous Cryptococcosis. Am J Med 2017; 130:666-668. [PMID: 28223065 DOI: 10.1016/j.amjmed.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/07/2017] [Accepted: 02/08/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Thomas L Walsh
- Division of Infectious Diseases, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa.
| | - Nitin Bhanot
- Division of Infectious Diseases, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa
| | - Monika A Murillo
- Division of Infectious Diseases, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa
| | - Jeffrey M Uchin
- Department of Pathology, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa
| | - Zaw Min
- Division of Infectious Diseases, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pa
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33
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Smith FL, Mercurio MG, Poligone B. Primary cutaneous cryptococcosis presenting as an extensive eroded plaque. Cutis 2017; 99:E16-E18. [PMID: 28398425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Franki Lambert Smith
- Department of Dermatology, Rochester General Hospital Research Institute, New York, USA
| | - Mary Gail Mercurio
- Department of Dermatology, Rochester General Hospital Research Institute, New York, USA
| | - Brian Poligone
- Department of Dermatology, Rochester General Hospital Research Institute, New York, USA
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34
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Qu J, Wang X, Liu Y, Lv X. RAPIDLY PROGRESSIVE PULMONARY CRYPTOCOCCOSIS WITH CAVITATION IN AN IMMUNOCOMPETENT WOMAN: A CASE REPORT AND LITERATURE REVIEW. Southeast Asian J Trop Med Public Health 2017; 48:179-183. [PMID: 29644837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pulmonary cryptococcosis with pulmonary cavitation is rare, especially in immunocompetent cryptococcosis patients. We describe here a case of rapidly progressive pulmonary with cavitation in an immunocompetent woman. A 29-year-old woman had a routine chest X-ray as part of a routine examination. The chest X-ray showed pulmonary nodules. She was diagnosed as having bacterial pneumonia even though she had no symptoms and was treated with ampicillin orally. A chest X-ray was repeated 12 days later as follow-up which showed an increase in the nodules. She continued to be asymptomatic and had a normal lung examination. Her complete blood count revealed a normal white blood cell count and her anti-human immunodeficiency virus test was normal, as were her immunoglobulin levels and CD4 counts. She had a computed tomography (CT) scan of the lungs that showed two pulmonary nodules, one with cavitation. She then underwent a CT guided needle biopsy of the cavitary lesion which revealed pulmonary cryptococcosis. A serum latex cryptococcal antigen test revealed a titer of 1:32. She was treated with fluconazole 400 mg IV daily for 7 days, followed by oral fluconazole 200 mg daily for a year. The cavitary lesion gradually disappeared and the nodules decreased in size. A follow-up CT 1 year later was normal. Although rare, cryptococcosis of the lungs with pulmonary cavitation can occur in otherwise healthy patients, requiring long term treatment to improve.
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35
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Ding Y, Li P, He Q, Wei H, Wu T, Xia D, Tan M, Shi Y, Su X. The CD4 + T-lymphocyte count is an important predictor for the prognosis of cryptococcosis. Eur J Clin Microbiol Infect Dis 2016; 36:897-904. [PMID: 28035481 PMCID: PMC5395594 DOI: 10.1007/s10096-016-2880-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/14/2016] [Indexed: 12/01/2022]
Abstract
There is great heterogeneity of immunity among patients with cryptococcosis, and severe immunodeficiency can lead to negative clinical outcomes. Underlying disease is a poor surrogate for immune status and inferior in predicting an individual’s prognosis. This study was intended to determine whether T-lymphocyte subgroups would be more suitable indicators regarding the severity of infection and clinical outcomes of such patients. We retrieved clinical data on 101 patients with cryptococcosis and compared the validity of multiple parameters (underlying disease and T-lymphocyte subgroups) in predicting the severity of infection and clinical outcome in these patients. For patients with CD4+ T-lymphocyte counts lower than 400/μL, the odds ratio of disseminated cryptococcosis was 23.3 (P = 0.005). There was a moderate negative correlation between CD4+ T-cell count and Apache II score (−0.609, P < 0.001). Mortality among patients with low levels of CD4+ T lymphocytes was significantly higher than among those with normal levels (23.8% vs 5.3%, P = 0.016). However, the difference was not significant if the patients were grouped by underlying disease (P = 0.067). The CD4+ T-lymphocyte count in peripheral blood is a simple and more accurate biomarker for predicting severity of infection and clinical outcome in patients with cryptococcosis.
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Affiliation(s)
- Y Ding
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China, 210002
| | - P Li
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China, 210002
| | - Q He
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Southern Medical University, Nanjing, China, 210002
| | - H Wei
- Department of Infectious Disease, Nanjing Second Hospital, Nanjing, China, 210002
| | - T Wu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China, 210002
| | - D Xia
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China, 210002
| | - M Tan
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China, 210002
| | - Y Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China, 210002
| | - X Su
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China, 210002.
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36
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Hile G, Wilson ML. Verrucous plaque on the leg. Cutis 2016; 98:294-319. [PMID: 28040811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Grace Hile
- Division of Dermatology, Southern Illinois University School of Medicine, Springfield, USA
| | - Morgan L Wilson
- Division of Dermatology, Southern Illinois University School of Medicine, Springfield, USA
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37
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Arras SDM, Chua SMH, Wizrah MSI, Faint JA, Yap AS, Fraser JA. Targeted Genome Editing via CRISPR in the Pathogen Cryptococcus neoformans. PLoS One 2016; 11:e0164322. [PMID: 27711143 PMCID: PMC5053423 DOI: 10.1371/journal.pone.0164322] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/22/2016] [Indexed: 12/21/2022] Open
Abstract
Low rates of homologous integration have hindered molecular genetic studies in Cryptococcus neoformans over the past 20 years, and new tools that facilitate genome manipulation in this important pathogen are greatly needed. To this end, we have investigated the use of a Class 2 CRISPR system in C. neoformans (formerly C. neoformans var. grubii). We first expressed a derivative of the Streptococcus pyogenes Cas9 nuclease in C. neoformans, and showed that it has no effect on growth, production of virulence factors in vitro, or virulence in a murine inhalation model. In proof of principle experiments, we tested the CAS9 construct in combination with multiple self-cleaving guide RNAs targeting the well-characterized phosphoribosylaminoamidazole carboxylase-encoding ADE2 gene. Utilizing combinations of transient and stable expression of our constructs, we revealed that functionality of our CRISPR constructs in C. neoformans is dependent upon the CAS9 construct being stably integrated into the genome, whilst transient expression of the guide RNA is sufficient to enhance rates of homologous recombination in the CAS9 genetic background. Given that the presence of the CRISPR nuclease does not influence virulence in a murine inhalation model, we have successfully demonstrated that this system is compatible with studies of C. neoformans pathogenesis and represents a powerful tool that can be exploited by researchers in the field.
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Affiliation(s)
- Samantha D. M. Arras
- Australian Infectious Diseases Research Centre, St Lucia, Queensland, Australia
- School of Chemistry & Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Sheena M. H. Chua
- Australian Infectious Diseases Research Centre, St Lucia, Queensland, Australia
- School of Chemistry & Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Maha S. I. Wizrah
- Australian Infectious Diseases Research Centre, St Lucia, Queensland, Australia
- School of Chemistry & Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Joshua A. Faint
- Australian Infectious Diseases Research Centre, St Lucia, Queensland, Australia
- School of Chemistry & Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Amy S. Yap
- Australian Infectious Diseases Research Centre, St Lucia, Queensland, Australia
- School of Chemistry & Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
| | - James A. Fraser
- Australian Infectious Diseases Research Centre, St Lucia, Queensland, Australia
- School of Chemistry & Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
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38
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Vázquez-Osorio I, García-Rodiño S, Rodríguez-Rodríguez M, Labandeira J, Suárez-Peñaranda JM, Sánchez-Aguilar MD, Vázquez-Veiga H. Criptococosis cutánea primaria en paciente inmunocompetente. Dermatol Online J 2016; 22:13030/qt69q6k8z8. [PMID: 27617525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 06/06/2023] Open
Abstract
La criptococosis cutánea es una micosis propia de pacientes inmunodeprimidos, sobre todo aquellos con infección por el virusde la inmunodeficiencia humana (VIH). Sin embargo, existen casos infrecuentes de criptococosis cutánea en pacientes inmunocompetentes, que suelen simular otras dermatosis, lo que retrasa su diagnóstico y tratamiento. Presentamos el caso de un varón pluripatológico de 79 años, con úlceras dolorosas en dorso de mano derecha que no respondían a tratamientos tópicos. A través del estudio histopatológico y micológico se alcanzó el diagnóstico de criptococosis cutánea primaria, lográndose la remisión de las lesiones tras 6 meses de tratamiento con fluconazol.
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Vallabhaneni S, Haselow D, Lloyd S, Lockhart S, Moulton-Meissner H, Lester L, Wheeler G, Gladden L, Garner K, Derado G, Park B, Harris JR. Cluster of Cryptococcus neoformans Infections in Intensive Care Unit, Arkansas, USA, 2013. Emerg Infect Dis 2016; 21:1719-24. [PMID: 26403080 PMCID: PMC4593437 DOI: 10.3201/eid2110.150249] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Use of short-term steroids was a risk factor for infection. We investigated an unusual cluster of 6 patients with Cryptococcus neoformans infection at a community hospital in Arkansas during April–December 2013, to determine source of infection. Four patients had bloodstream infection and 2 had respiratory infection; 3 infections occurred within a 10-day period. Five patients had been admitted to the intensive care unit (ICU) with diagnoses other than cryptococcosis; none had HIV infection, and 1 patient had a history of organ transplantation. We then conducted a retrospective cohort study of all patients admitted to the ICU during April–December 2013 to determine risk factors for cryptococcosis. Four patients with C. neoformans infection had received a short course of steroids; this short-term use was associated with increased risk for cryptococcosis (rate ratio 19.1; 95% CI 2.1–170.0; p<0.01). Although long-term use of steroids is a known risk factor for cryptococcosis, the relationship between short-term steroid use and disease warrants further study
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Pawar S, Ganakumar V, Jha S, Ragesh R, Ray A, Kakkar A, Sharma MC, Sharma SK. Pulmonary Cryptococcoma Masquerading as Lung Cancer. J Assoc Physicians India 2016; 64:66-68. [PMID: 27735154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We report a case of pulmonary cryptococcoma, in an adult with recently detected diabetes, mimicking as lung cancer. A 45-year-old gentleman with past history of pulmonary tuberculosis presented with fever, cough with expectoration, pleuritic chest pain and hemoptysis. Chest radiograph and computed tomography revealed right lower lobe mass which significantly enhanced on contrast administration. Ultrasound guided biopsy was done which on histopathological examination showed non-necrotizing granulomas with narrow-based budding yeast cells suggestive of cryptococcosis. Detailed work-up for dissemination of infection was negative. A dramatic response to anti-fungal treatment was observed and the patient is doing fine on follow-up.
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Affiliation(s)
| | | | | | | | | | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi
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de Oliveira EVL, de Almeida MTG, Turatti A, Gomes CM, Roselino AM. Paracoccidioidomycosis and cryptococcosis with localized skin manifestations: report of two cases in the elderly. An Bras Dermatol 2016; 91:243-4. [PMID: 27192530 PMCID: PMC4861578 DOI: 10.1590/abd1806-4841.20164061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 09/29/2015] [Indexed: 11/29/2022] Open
Abstract
Distinct cases of Paracoccidioidomycosis and Cryptococcosis with atypical and localized skin manifestation on the upper limbs of two elderly patients are reported. In the 2nd one, he presented asymptomatic pulmonary cancer; the blood tests for fungal infection were negative, and the etiologic agents were seen in skin biopsy samples. This report emphasizes the importance of the differential diagnosis of infectious diseases in elderly patients.
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Affiliation(s)
| | | | - Aline Turatti
- Universidade de São Paulo (USP) – Ribeirão
Preto (SP), Brazil
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Béogo R, Andonaba JB, Bamba S, Konségré V, Diallo B, Traoré A. [Cryptococcosis: a potential aetiology of facial ulceration]. J Mycol Med 2016; 24:e185-8. [PMID: 25442912 DOI: 10.1016/j.mycmed.2014.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/12/2014] [Accepted: 03/31/2014] [Indexed: 11/19/2022]
Abstract
UNLABELLED Cutaneous cryptococcosis is an uncommon aetiology of chronic facial ulceration but which may be associated to a potentially lethal focus of cryptococcosis. OBSERVATION A 35-year-old AIDS patient under antiretroviral therapy, presented with a chronic facial ulceration. Histopathological examination of a biopsy of the facial ulceration showed an inflammatory granuloma and masses of yeasts. Mycological culture of the cerebrospinal fluid revealed Cryptococcus neoformans. The diagnosis of AIDS-related cutaneous cryptococcosis of the face and cryptococcal meningitis was concluded. DISCUSSION Cryptococcosis should be thought as a potential aetiology of a chronic facial ulceration in an AIDS patient. Screening of other foci of the cryptococcosis such as that of the central nervous system is mandatory. Mycological examinations are of great interest for the diagnosis in rare resources setting.
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Affiliation(s)
- R Béogo
- Service de stomatologie et de chirurgie maxillo-faciale, CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso.
| | - J-B Andonaba
- Service de dermatologie et de vénérologie, CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso
| | - S Bamba
- Laboratoire de parasitologie et de mycologie, CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso
| | - V Konségré
- Laboratoire de cytologie et d'anatomie pathologique, CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso
| | - B Diallo
- Service de dermatologie et de vénérologie, CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso
| | - A Traoré
- Service de dermatologie et de vénérologie, CHU Yalgado, Ouédraogo, Burkina Faso
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Kikuchi N, Hiraiwa T, Ishikawa M, Mori T, Igari S, Hanami Y, Miura T, Ohtsuka M, Yamamoto T. Cutaneous Cryptococcosis Mimicking Pyoderma Gangrenosum: A Report of Four Cases. Acta Derm Venereol 2016; 96:116-7. [PMID: 26039271 DOI: 10.2340/00015555-2153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nobuyuki Kikuchi
- Department of Dermatology, Fukushima Medical University, Hikarigaoka 1, Fukushima 960-1295, Japan.
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Wang J, Zeng Y, Luo W, Xie X, Li S. The Role of Cryptococcus in the Immune System of Pulmonary Cryptococcosis Patients. PLoS One 2015; 10:e0144427. [PMID: 26637129 PMCID: PMC4670196 DOI: 10.1371/journal.pone.0144427] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/18/2015] [Indexed: 12/12/2022] Open
Abstract
Objectives To investigate the role of Cryptococcus in the immune system of immunocompetent patients with pulmonary cryptococcosis (PC) by analysing the dynamic changes of patients’ immune status before and after antifungal therapy. Methods The level of the serum interferon-γ (IFN-γ) and interleukin (IL)-2, -4, -10 and -12 was measured before and after 6-months of treatment. Peripheral blood samples were obtained from 30 immunocompetent PC patients and 30 age- and gender-matched healthy controls. Peripheral blood mononuclear cells (PBMCs) were isolated and incubated with recombinant human IL-12 (rhIL-12) for 48 h. Then the concentrations of IFN-γ and IL-4 in the supernatant were analysed. Results Baseline serum IFN-γ level was significantly lower in the PC patients as compared with the control group (P < 0.001). The serum IL-2 and IFN-γ of PC patients were significantly increased after appropriate treatments (P < 0.05 and P < 0.001 when compared to their baseline levels). The productions of IFN-γ in the culture supernatant of PBMCs showed no significant difference between the control and PC patients both before and after antifungal treatments. RhIL-12 is a potent stimulus for IFN-γ production. Culture PBMCs collected from PC patients before treatments had a smaller increase of IFN-γ production in the present of rhIL-12 than the control (P < 0.01); PBMCs from PC patients completing 6-months of treatment showed a comparable increase of IFN-γ production by rhIL-12 stimulation to the control group. Conclusions In apparently immunocompetent patients with PC, a normalization of serum IFN-γ was achieved after recovery from infection. This suggests that Cryptococcus infection per se can suppress the immune system and its elimination contributes to the reestablishment of an immune equilibrium.
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Affiliation(s)
- Jinlin Wang
- Department of Respiratory, The State Key Laboratory of Respiratory Disease, China Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
| | - Yunxiang Zeng
- Department of Respiratory, The State Key Laboratory of Respiratory Disease, China Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
| | - Weizhan Luo
- Department of Respiratory, The State Key Laboratory of Respiratory Disease, China Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
| | - Xiaohong Xie
- Department of Respiratory, The State Key Laboratory of Respiratory Disease, China Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
| | - Shiyue Li
- Department of Respiratory, The State Key Laboratory of Respiratory Disease, China Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
- * E-mail:
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Du L, Yang Y, Gu J, Chen J, Liao W, Zhu Y. Systemic Review of Published Reports on Primary Cutaneous Cryptococcosis in Immunocompetent Patients. Mycopathologia 2015; 180:19-25. [PMID: 25736173 DOI: 10.1007/s11046-015-9880-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 02/25/2015] [Indexed: 12/19/2022]
Abstract
Primary cutaneous cryptococcosis (PCC) has been confirmed as a distinct clinical entity with secondary cutaneous cryptococcosis from systematic infection since 2003. Although it has been confirmed as a distinct clinical entity, little has progressed on PCC in immunocompetent hosts compared to their immunocompromised counterpart. We reviewed the literature on cases of PCC in immunocompetent patients from 2004 to 2014, and 21 cases from 16 reports were identified. Males are more likely to develop PCC infections, with a ratio of 17:4 male to female. These patients were found to be almost all senior population except for patients from Asia. Asymptomatic or moderate itching manifesting in a painful nodule is the most common presentation, although there is no typical clinical manifestation recorded. Upper limbs are the most common site of infection, accounting for 71.4 % of all patients. Of the 12 identified isolates, 6 strains are identified as C. neoformans, 5 as C. gattii, and 1 as C.laurentii. Fluconazole was used in 10 cases; however, only 80 % of the 10 cases could confirm that fluconazole was effective in clearing the infections. Interestingly although not approved as a treatment option, Itraconazole was effective in the seven cases it was used to treat cryptococcosis, with a dosage range of 100-400 mg/d and duration from 3 to 6 months. Even though the prognosis of these patients was generally good, more data are need to determine which antifungal azole is the better treatment option and whether primary skin infections could disseminate to systematic infection.
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Affiliation(s)
- Lin Du
- Department of Dermatology and Mycology Center, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
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Reddy BY, Shaigany S, Schulman L, Grossman ME. Resident Rounds Part III: Case Report: Fatal Cryptococcal Panniculitis in a Lung Transplant Recipient. J Drugs Dermatol 2015; 14:519-522. [PMID: 25942673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cryptococcal panniculitis is a rare entity previously reported in only 13 solid organ transplant (SOT) recipients. Cutaneous cryptococcosis in SOT recipients warrants extensive systemic workup and treatment as if central nervous system (CNS) disease is present. It should be included in the differential diagnosis of panniculitis in the immunocompromised host, as early diagnosis and treatment are critical. We report a fatal case of cryptococcal panniculitis in a 44-year-old lung transplant recipient.
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Davis MJ, Eastman AJ, Qiu Y, Gregorka B, Kozel TR, Osterholzer JJ, Curtis JL, Swanson JA, Olszewski MA. Cryptococcus neoformans-induced macrophage lysosome damage crucially contributes to fungal virulence. J Immunol 2015; 194:2219-31. [PMID: 25637026 PMCID: PMC4379045 DOI: 10.4049/jimmunol.1402376] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Upon ingestion by macrophages, Cryptococcus neoformans can survive and replicate intracellularly unless the macrophages become classically activated. The mechanism enabling intracellular replication is not fully understood; neither are the mechanisms that allow classical activation to counteract replication. C. neoformans-induced lysosome damage was observed in infected murine bone marrow-derived macrophages, increased with time, and required yeast viability. To demonstrate lysosome damage in the infected host, we developed a novel flow cytometric method for measuring lysosome damage. Increased lysosome damage was found in C. neoformans-containing lung cells compared with C. neoformans-free cells. Among C. neoformans-containing myeloid cells, recently recruited cells displayed lower damage than resident cells, consistent with the protective role of recruited macrophages. The magnitude of lysosome damage correlated with increased C. neoformans replication. Experimental induction of lysosome damage increased C. neoformans replication. Activation of macrophages with IFN-γ abolished macrophage lysosome damage and enabled increased killing of C. neoformans. We conclude that induction of lysosome damage is an important C. neoformans survival strategy and that classical activation of host macrophages counters replication by preventing damage. Thus, therapeutic strategies that decrease lysosomal damage, or increase resistance to such damage, could be valuable in treating cryptococcal infections.
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Affiliation(s)
- Michael J Davis
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI 48109
| | - Alison J Eastman
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI 48109; Graduate Program in Immunology, University of Michigan, Ann Arbor, MI 48109
| | - Yafeng Qiu
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI 48109; VA Ann Arbor Healthcare System, Ann Arbor, MI 48105
| | - Brian Gregorka
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI 48109; and
| | - Thomas R Kozel
- Department of Microbiology and Immunology, University of Nevada School of Medicine, Reno, NV 89557
| | - John J Osterholzer
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI 48109; VA Ann Arbor Healthcare System, Ann Arbor, MI 48105
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI 48109; Graduate Program in Immunology, University of Michigan, Ann Arbor, MI 48109; VA Ann Arbor Healthcare System, Ann Arbor, MI 48105
| | - Joel A Swanson
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI 48109; and
| | - Michal A Olszewski
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI 48109; Graduate Program in Immunology, University of Michigan, Ann Arbor, MI 48109; VA Ann Arbor Healthcare System, Ann Arbor, MI 48105;
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de Brito Ximenes P, Beltrão EIC, Macêdo DPC, Buonafina MDS, de Lima-Neto RG, Neves RP. Targeting the Cryptococcus neoformans var. grubii cell wall using lectins: study of the carbohydrate-binding domain. Molecules 2015; 20:3776-82. [PMID: 25723851 PMCID: PMC6272190 DOI: 10.3390/molecules20033776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/09/2015] [Accepted: 01/16/2015] [Indexed: 01/21/2023] Open
Abstract
Cryptococcus neoformans var. grubii is considered to be the major cause of cryptococcosis in immunosuppressed patients. Understanding cell wall glycoproteins using lectins is of medical interest and can contribute to specific therapy. The aim of this study was to evaluate the carbohydrates on the cell wall of Cryptococcus neoformans var. grubii clinical isolates, using a fluorescein isothiocyanate-lectin binding protocol. Thirty yeast strains stocked in the culture collection were cultivated for 2 days at 30 °C with shaking. Cells were obtained by centrifugation, washed in phosphate-buffered saline, and a suspension of 107 cells/mL was obtained. To determine the binding profile of lectins, concanavalin A (Con A), wheat germ agglutinin (WGA), Ulex europaeus agglutinin I (UEA-I), and peanut agglutinin (PNA) conjugated to fluorescein were used. All the tested clinical isolates of Cryptococcus neoformans var. grubii were intensely stained by WGA, moderately stained by Con A, and weakly stained by PNA and UEA-I. Thus, Cryptococcus can be detected in clinical specimens such as blood and cerebrospinal fluid using the fluorescent lectin WGA, which may be considered as an option for detection in cases of suspected cryptococcosis with low laboratory sensitivity. Future applications may be developed using this basic tool.
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Affiliation(s)
- Pamella de Brito Ximenes
- Department of Mycology, Universidade Federal de Pernambuco (UFPE), Av. Prof. Nelson Chaves, s/n°-Cidade Universitária, Recife 50670-420, Brazil.
| | - Eduardo Isidoro Carneiro Beltrão
- Department of Biochemistry, Universidade Federal de Pernambuco (UFPE), Av. Prof. Nelson Chaves, s/n°-Cidade Universitária, Recife 50670-420, Brazil.
| | - Danielle Patrícia Cerqueira Macêdo
- Department of Pharmaceutical Sciences, Universidade Federal de Pernambuco (UFPE), Av. Prof. Nelson Chaves, s/n°-Cidade Universitária, Recife 50670-420, Brazil.
| | - Maria Daniela Silva Buonafina
- Department of Mycology, Universidade Federal de Pernambuco (UFPE), Av. Prof. Nelson Chaves, s/n°-Cidade Universitária, Recife 50670-420, Brazil.
| | - Reginaldo Gonçalves de Lima-Neto
- Department of Tropical Medicine, Universidade Federal de Pernambuco (UFPE), Av. Prof. Nelson Chaves, s/n°-Cidade Universitária, Recife 50670-420, Brazil.
| | - Rejane Pereira Neves
- Department of Mycology, Universidade Federal de Pernambuco (UFPE), Av. Prof. Nelson Chaves, s/n°-Cidade Universitária, Recife 50670-420, Brazil.
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Santos JRA, Holanda RA, Frases S, Bravim M, Araujo GDS, Santos PC, Costa MC, Ribeiro MJA, Ferreira GF, Baltazar LM, Miranda AS, Oliveira DB, Santos CMA, Fontes ACL, Gouveia LF, Resende-Stoianoff MA, Abrahão JS, Teixeira AL, Paixão TA, Souza DG, Santos DA. Fluconazole alters the polysaccharide capsule of Cryptococcus gattii and leads to distinct behaviors in murine Cryptococcosis. PLoS One 2014; 9:e112669. [PMID: 25392951 PMCID: PMC4231059 DOI: 10.1371/journal.pone.0112669] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 10/10/2014] [Indexed: 11/30/2022] Open
Abstract
Cryptococcus gattii is an emergent human pathogen. Fluconazole is commonly used for treatment of cryptococcosis, but the emergence of less susceptible strains to this azole is a global problem and also the data regarding fluconazole-resistant cryptococcosis are scarce. We evaluate the influence of fluconazole on murine cryptococcosis and whether this azole alters the polysaccharide (PS) from cryptococcal cells. L27/01 strain of C. gattii was cultivated in high fluconazole concentrations and developed decreased drug susceptibility. This phenotype was named L27/01F, that was less virulent than L27/01 in mice. The physical, structural and electrophoretic properties of the PS capsule of L27/01F were altered by fluconazole. L27/01F presented lower antiphagocytic properties and reduced survival inside macrophages. The L27/01F did not affect the central nervous system, while the effect in brain caused by L27/01 strain began after only 12 hours. Mice infected with L27/01F presented lower production of the pro-inflammatory cytokines, with increased cellular recruitment in the lungs and severe pulmonary disease. The behavioral alterations were affected by L27/01, but no effects were detected after infection with L27/01F. Our results suggest that stress to fluconazole alters the capsule of C. gattii and influences the clinical manifestations of cryptococcosis.
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Affiliation(s)
- Julliana Ribeiro Alves Santos
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Rodrigo Assunção Holanda
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Susana Frases
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratório de Biotecnologia (LABIO), Instituto Nacional de Metrologia, Normalização e Qualidade Industrial (INMETRO), Rio de Janeiro, Brazil
| | - Mayara Bravim
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Glauber de S. Araujo
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratório de Biotecnologia (LABIO), Instituto Nacional de Metrologia, Normalização e Qualidade Industrial (INMETRO), Rio de Janeiro, Brazil
| | - Patrícia Campi Santos
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Marliete Carvalho Costa
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Maira Juliana Andrade Ribeiro
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Gabriella Freitas Ferreira
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Ludmila Matos Baltazar
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Aline Silva Miranda
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Danilo Bretas Oliveira
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Carolina Maria Araújo Santos
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Alide Caroline Lima Fontes
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Ludmila Ferreira Gouveia
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | | | - Jonatas Santos Abrahão
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Antônio Lúcio Teixeira
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Tatiane Alves Paixão
- Departamento de Patologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Danielle G. Souza
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Daniel Assis Santos
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
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Wang L, Shi Y, Ding Y, Wang Q, Su X. [Pulmonary cryptococcosis: a retrospective analysis of 65 cases]. Zhonghua Jie He He Hu Xi Za Zhi 2014; 37:764-768. [PMID: 25537413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To improve understanding of the clinical manifestations and imaging features of pulmonary cryptococcosis. METHODS The clinical features, imaging characteristics, laboratory examinations, treatment and prognosis of 65 cases of pulmonary cryptococcosis were retrospectively analyzed. The data were collected from Nanjing General Hospital , Suqian Municipal People's Hospital and People's Liberation Army 81 Hospital from January 2001 to March 2013. RESULTS There were 65 proven cases diagnosed with pulmonary cryptococcosis, including 44 males and 21 females, aged from 12 to 73 years [average (44 ± 13) years]. The most common clinical symptoms included cough (n = 32), expectoration(n = 20) , fever (n = 16), and chest pain (n = 14), while some patients(n = 18) had no symptoms. Common chest imaging findings included single or multiple masses or nodules (n = 36), patchy infiltrates (n = 19, and mixed lesions (n = 10). Among the 21 cases with cryptococcal capsular polysaccharide antigen detection, 14 were positive. The antigen titre ( ≥ 1: 8 for positivity) was positively correlated with disease severity and lesion extent. The diagnosis of 45 cases was proven by percutaneous lung biopsy and 3 were diagnosed by bronchoscopic biopsy, while 17 were confirmed by surgery. Among 65 patients, 53 underwent Acute Physiology and Chronic Health EvaluationII (APACHEII) scoring, and 45 had a score of less than 10. Among them, 38 cases acquired complete or partial recovery, 4 were progressive and 3 died. Eight cases had a score of 10 or more, of whom 3 acquired complete or partial recovery, 1 was progressive and 4 died. CONCLUSIONS The most common clinical manifestations of pulmonary cryptococcosis were cough and expectoration and the most common chest imaging features were masses or nodular shadows. Percutaneous lung biopsy was a commonly used method to diagnose this disease. Cryptococcal capsular polysaccharide antigen detection was helpful for the diagnosis and management with a relatively high sensitivity. Antifungal drug therapy was the major treatment and a few patients may need surgery. The prognosis was better in patients with mild disease.
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Affiliation(s)
- Lifang Wang
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China
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