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Cryptococcal meningitis

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https://www.readbyqxmd.com/read/29670625/immunology-of-cryptococcal-infections-developing-a-rational-approach-to-patient-therapy
#1
REVIEW
Waleed Elsegeiny, Kieren A Marr, Peter R Williamson
Cryptococcal meningoencephalitis is responsible for upwards of 15% of HIV-related deaths worldwide and is currently the most common cause of non-viral meningitis in the US, affecting both previously healthy and people with immune suppression caused by cancer chemotherapy, transplantation, and biologic therapies. Despite a continued 30-50% attributable mortality, recommended therapeutic strategies have remained largely unchanged since the 1950s. Recent murine models and human studies examining the role of the immune system in both susceptibility to the infection as well as host damage have begun to influence patient care decisions...
2018: Frontiers in Immunology
https://www.readbyqxmd.com/read/29668826/variability-in-innate-host-immune-responses-to-cryptococcosis
#2
Mariam Garelnabi, Robin C May
Cryptococcosis is an invasive fungal disease caused by Cryptococcus neoformans and the closely related species C. gattii. The severe form of the disease, cryptococcal meningitis (CM), is rapidly fatal without treatment. Although typically a disease of immunocompromised (especially HIV-positive) individuals, there is growing awareness of cryptococcal disease amongst non-immunocompromised patients. Whilst substantial progress has been made in understanding the pathogenicity of C. neoformans in HIV patients, prospective data on cryptococcosis outside the context of HIV remains lacking...
2018: Memórias do Instituto Oswaldo Cruz
https://www.readbyqxmd.com/read/29663539/cryptococcal-infections-over-a-15-year-period-at-a-tertiary-facility-impact-of-guideline-management
#3
Ian Gassiep, Joel Douglas, Theophilus I Emeto, Katherine Crawley, Elliott G Playford
BACKGROUND: Cryptococcosis is an invasive fungal infection caused primarily by Cryptococcus neoformans and Cryptococcus gattii species, presenting predominantly as meningoencephalitis. The aim of this study is to assess all cryptococcal infections managed at our facility from 2001-2015 to determine incidence, risk factors, and comparison of outcomes prior to and following introduction of the 2010 Infectious Disease Society of America (IDSA) guidelines. METHODS: Retrospective analysis of all patients diagnosed and treated for cryptococcal infection occurring between January 2001 and December 2015...
April 17, 2018: Mycoses
https://www.readbyqxmd.com/read/29662603/increased-mortality-among-hiv-infected-patients-with-cryptococcal-antigenemia-in-guinea-bissau
#4
Ditte Thomsen, Cecilie Juul Hviid, Bo Langhoff Hønge, Candida Medina, David Da Silva Té, Faustino Gomes Correira, Lars Østergaard, Christian Erikstrup, Christian Wejse, Alex Lund Laursen, Sanne Jespersen
Cryptococcal antigenemia may precede development of cryptococcal meningitis and death among patients with advanced HIV infection. Among 200 retrospectively and randomly selected ART-naïve patients with CD4 counts < 100 cells/μl from Guinea-Bissau, 20 (10%) had a positive cryptococcal antigen test. Self-reported headache and fever were predictors of a positive test, while cryptococcal antigenemia was a strong predictor of death within the first year of follow-up, MRR 2.22 (95% CI: 1.15-4.30). Screening for cryptococcal antigenemia should be implemented for patients with advanced HIV in Guinea-Bissau...
2018: Pan African Medical Journal
https://www.readbyqxmd.com/read/29658309/individuals-with-hiv-1-subtype-c-infection-and-cryptococcal-meningitis-exhibit-viral-genetic-intermixing-of-hiv-1-between-plasma-and-cerebrospinal-fluid-and-a-high-prevalence-of-cxcr4-using-variants
#5
Katlego Sojane, Richard T Kangethe, Christina C Chang, Mahomed-Yunus Moosa, Sharon Ruth Lewin, Martyn A French, Thumbi Ndung'u
The genotypic properties of HIV-1 subtype C in individuals presenting with cryptococcal meningitis (CM) are not well established. Employing single-genome amplification as well as bulk PCR, cloning and sequencing strategies, we evaluated the genetic properties of HIV-1 subtype C env in 16 antiretroviral therapy naïve study participants with CM. Eleven of the 16 participants had matched blood plasma and cerebrospinal fluid (CSF) evaluated, with the rest having either a plasma or CSF sample evaluated. Before antiretroviral therapy initiation, matched plasma and cerebrospinal fluid-derived env sequences of all 11 participants displayed genetic intermixing between the two compartments...
April 15, 2018: AIDS Research and Human Retroviruses
https://www.readbyqxmd.com/read/29619316/pulmonary-cryptococcal-infection-presenting-with-multiple-lung-nodules
#6
Thilini L Basnayake, Aijye Lim, Bart J Currie
Pulmonary infections from the environmental fungus Cryptococcus gattii ( C. gattii ) are notable for cryptococcomas, which are usually solitary and can be very large. As with infections with Cryptococcus neoformans (C. neoformans) patients can have concomitant cryptococcal meningitis; however, unlike for C. neoformans, infections with C. gattii often occur in immunocompetent patients. The highest published incidence of C. gattii infection has been in the Indigenous Australian population of Arnhem Land in the tropical north of the country...
2018: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/29604972/cryptococcal-meningitis-in-aids
#7
Andrej Spec, William G Powderly
Cryptococcal meningitis remains a significant cause of morbidity and mortality amongst patients living with human immunodeficiency virus (HIV). The prevalence in the developed world has decreased as HIV is being diagnosed earlier, but is still significant, and the prevalence in resource-limited settings is exceedingly high. The presenting symptoms usually include a headache, fever, and, less often, cranial nerve abnormalities. Space-occupying lesions do occur, but are rare. Once diagnosed, patients should be treated with a combination of amphotericin and flucytosine, with step-down therapy to fluconazole for a minimum of a year, or until the CD4 count is above 100 cells/μL, whichever is longer...
2018: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/29601494/the-burden-of-serious-fungal-infections-in-cameroon
#8
Christine E Mandengue, David W Denning
Fungal infections are frequent in Cameroon, and invasive fungal infections are sometimes detected, usually in HIV-infected patients. For these reasons, we have estimated the burden of fungal infections. Using published literature and population estimates for the at-risk group, we used deterministic modelling to derive national incidence and prevalence estimates for the most serious fungal diseases. HIV infection is common and an estimated 120,000 have CD4 counts <200 × 10⁶/mL and commonly present with opportunistic infection...
March 30, 2018: Journal of Fungi (Basel, Switzerland)
https://www.readbyqxmd.com/read/29596441/quantifying-donor-to-donor-variation-in-macrophage-responses-to-the-human-fungal-pathogen-cryptococcus-neoformans
#9
Mariam Garelnabi, Leanne M Taylor-Smith, Ewa Bielska, Rebecca A Hall, Daniel Stones, Robin C May
Cryptococcosis remains the leading cause of fungal meningitis worldwide, caused primarily by the pathogen Cryptococcus neoformans. Symptomatic cryptococcal infections typically affect immunocompromised patients. However, environmental exposure to cryptococcal spores is ubiquitous and most healthy individuals are thought to harbor infections from early childhood onwards that are either resolved, or become latent. Since macrophages are a key host cell for cryptococcal infection, we sought to quantify the extent of individual variation in this early phagocyte response within a small cohort of healthy volunteers with no reported immunocompromising conditions...
2018: PloS One
https://www.readbyqxmd.com/read/29593675/cryptococcal-antigen-screening-in-asymptomatic-hiv-infected-antiretroviral-na%C3%A3-ve-patients-in-cameroon-and-evaluation-of-the-new-semi-quantitative-biosynex-cryptops-test
#10
Elvis Temfack, Charles Kouanfack, Leonella Mossiang, Angela Loyse, Marie C Fonkoua, Síle F Molloy, Sinata Koulla-Shiro, Eric Delaporte, Françoise Dromer, Thomas Harrison, Olivier Lortholary
Background: Cryptococcal meningitis (CM) is a major cause of AIDS-related mortality in Africa. Detection of serum cryptococcal antigen (CrAg) predicts development of CM in antiretroviral (ART) naïve HIV-infected patients with severe immune depression. Systematic pre-ART CrAg screening and pre-emptive oral fluconazole is thus recommended. We postulated that a semi-quantitative CrAg screening approach could offer clinically relevant advantages. Methods: ART-naïve asymptomatic adult outpatients with <100 CD4 cells/mm3 presenting to the Yaoundé Central Hospital, Cameroon were screened for CrAg using the IMMY lateral flow assay (LFA)...
2018: Frontiers in Microbiology
https://www.readbyqxmd.com/read/29592982/pulmonary-alveolar-proteinosis-following-cryptococcal-meningitis-a-possible-cause
#11
Sarah Demir, Nader Chebib, Francoise Thivolet-Bejui, Vincent Cottin
Autoimmune pulmonary alveolar proteinosis (PAP) is a rare interstitial lung disease characterised by the presence of granulocyte macrophage colony-stimulating factor (GM-CSF) autoantibodies. A man with no history of infection developed cryptococcal meningitis and a right parahilar cryptococcal mass. Antifungal treatment led to infection control, although there was presence of neurological sequelae. After 3 years, thoracic CT revealed bilateral ground glass opacities and a crazy paving pattern. Transparietal needle biopsy showed proteinaceous alveolar deposits, confirming the diagnosis of PAP...
March 28, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29583086/dual-infection-of-the-central-nervous-system-caused-by-cryptococcus-and-toxoplasma-in-a-patient-with-aids-a-case-report-and-literature-review
#12
Jose Armando Gonzales Zamora
Dual infection of the central nervous system secondary to Cryptococcus and Toxoplasma is very uncommon, even in the setting of acquired immunodeficiency syndrome (AIDS). We report the case of a 52-year-old patient who was admitted with multiple cranial nerve deficits. Magnetic resonance imaging showed supratentorial and infratentorial enhancing lesions. He was newly diagnosed with HIV infection with a CD4 count of 59 cells/uL and HIV viral load of 299,619 copies/mL. Diagnosis of Cryptococcus meningitis was made by Cryptococcal antigen in cerebrospinal fluid (CSF)...
March 27, 2018: Acta Clinica Belgica
https://www.readbyqxmd.com/read/29579432/clinical-features-vary-by-the-aetiology-of-meningitis-in-hiv-seropositive-patients-a-four-year-study-from-a-tertiary-hospital-in-india
#13
Amalakanti Sridhar, Gajula Krishna Sagar
Meningitis is a serious infection of the nervous system associated with high mortality in Human Immunodeficiency Virus (HIV) seropositive individuals. Asian clinical studies describing meningitis in people living with HIV are scarce. We describe the clinical features of meningitis in 116 HIV seropositive patients from a tertiary hospital in India as a cross-sectional observational study. The mean age of the patients in our study was 35±9 years with 70.6% of them being men. Eighty-five percent of the patients had an altered sensorium during the illness...
April 2018: Indian Journal of Tuberculosis
https://www.readbyqxmd.com/read/29562712/estimation-of-the-burden-of-serious-human-fungal-infections-in-malaysia
#14
Rukumani Devi Velayuthan, Chandramathi Samudi, Harvinder Kaur Lakhbeer Singh, Kee Peng Ng, Esaki M Shankar, David W Denning
Fungal infections (mycoses) are likely to occur more frequently as ever-increasingly sophisticated healthcare systems create greater risk factors. There is a paucity of systematic data on the incidence and prevalence of human fungal infections in Malaysia. We conducted a comprehensive study to estimate the burden of serious fungal infections in Malaysia. Our study showed that recurrent vaginal candidiasis (>4 episodes/year) was the most common of all cases with a diagnosis of candidiasis ( n = 501,138). Oesophageal candidiasis ( n = 5850) was most predominant among individuals with HIV infection...
March 19, 2018: Journal of Fungi (Basel, Switzerland)
https://www.readbyqxmd.com/read/29560802/triple-therapy-versus-amphotericin-b-plus-flucytosine-for-the-treatment-of-non-hiv-and-non-transplant-associated-cryptococcal-meningitis-retrospective-cohort-study
#15
Li Xu, Jia Liu, Qilong Zhang, Min Li, Jingchi Liao, Weifeng Kuang, Cansheng Zhu, Huan Yi, Fuhua Peng
Objectives Amphotericin B plus flucytosine is the most widely used induction therapy regimen for non-HIV-infected and non-transplant patients; however, the therapeutic outcomes are unsatisfactory, especially when two antifungal drugs are at sub-therapeutic doses. Methods In this study of induction therapy, all non-HIV-infected, non-transplant patients with a first episode of cryptococcal meningitis were divided into two groups. In group I, the patients received amphotericin B plus 5-flucytosine. In group II, in addition to amphotericin B and 5-flucytosine, the patients also received fluconazole...
March 21, 2018: Neurological Research
https://www.readbyqxmd.com/read/29539274/antifungal-combinations-for-treatment-of-cryptococcal-meningitis-in-africa
#16
RANDOMIZED CONTROLLED TRIAL
Síle F Molloy, Cecilia Kanyama, Robert S Heyderman, Angela Loyse, Charles Kouanfack, Duncan Chanda, Sayoki Mfinanga, Elvis Temfack, Shabir Lakhi, Sokoine Lesikari, Adrienne K Chan, Neil Stone, Newton Kalata, Natasha Karunaharan, Kate Gaskell, Mary Peirse, Jayne Ellis, Chimwemwe Chawinga, Sandrine Lontsi, Jean-Gilbert Ndong, Philip Bright, Duncan Lupiya, Tao Chen, John Bradley, Jack Adams, Charles van der Horst, Joep J van Oosterhout, Victor Sini, Yacouba N Mapoure, Peter Mwaba, Tihana Bicanic, David G Lalloo, Duolao Wang, Mina C Hosseinipour, Olivier Lortholary, Shabbar Jaffar, Thomas S Harrison
BACKGROUND: Cryptococcal meningitis accounts for more than 100,000 human immunodeficiency virus (HIV)-related deaths per year. We tested two treatment strategies that could be more sustainable in Africa than the standard of 2 weeks of amphotericin B plus flucytosine and more effective than the widely used fluconazole monotherapy. METHODS: We randomly assigned HIV-infected adults with cryptococcal meningitis to receive an oral regimen (fluconazole [1200 mg per day] plus flucytosine [100 mg per kilogram of body weight per day] for 2 weeks), 1 week of amphotericin B (1 mg per kilogram per day), or 2 weeks of amphotericin B (1 mg per kilogram per day)...
March 15, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29515938/suppressed-without-a-cause-a-case-of-idiopathic-immune-deficiency
#17
Muhammad Talha Ayub, Munnam S Jafar, Muhammad Khalid, Muhammad A Baig, Benjamin Mba
We report a case of a 45-year-old male who presented with a headache, fever, vomiting, somnolence, and difficulty walking for 10 days. His cerebrospinal fluid studies revealed cryptococcal meningitis. Chest and abdominal computed tomography (CT) scans showed splenomegaly along with mediastinal, retroperitoneal and inguinal lymphadenopathy. CD4 count turned out to be 208 μL-1 . Human immunodeficiency virus (HIV) testing, serum protein electrophoresis, serum light chains and quantitative immunoglobulins were non-diagnostic and CD4 lymphopenia was attributed to acute infection...
January 1, 2018: Curēus
https://www.readbyqxmd.com/read/29514236/cd4-cell-count-threshold-for-cryptococcal-antigen-screening-of-hiv-infected-individuals-a-systematic-review-and-meta-analysis
#18
Nathan Ford, Zara Shubber, Joseph N Jarvis, Tom Chiller, Greg Greene, Chantal Migone, Marco Vitoria, Meg Doherty, Graeme Meintjes
Background: Current guidelines recommend screening all people living with human immunodeficiency virus (PLHIV) who have a CD4 count ≤100 cells/µL for cryptococcal antigen (CrAg) to identify those patients who could benefit from preemptive fluconazole treatment prior to the onset of meningitis. We conducted a systematic review to assess the prevalence of CrAg positivity at different CD4 cell counts. Methods: We searched 4 databases and abstracts from 3 conferences up to 1 September 2017 for studies reporting prevalence of CrAg positivity according to CD4 cell count strata...
March 4, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29514232/managing-advanced-hiv-disease-in-a-public-health-approach
#19
Nathan Ford, Graeme Meintjes, Alexandra Calmy, Helen Bygrave, Chantal Migone, Marco Vitoria, Martina Penazzato, Lara Vojnov, Meg Doherty
In 2017, the World Health Organization (WHO) published guidelines for the management of advanced human immunodeficiency virus (HIV) disease within a public health approach. Recent data suggest that more than a third of people starting antiretroviral therapy (ART) do so with advanced HIV disease, and an increasing number of patients re-present to care at an advanced stage of HIV disease following a period of disengagement from care. These guidelines recommend a standardized package of care for adults, adolescents, and children, based on the leading causes of morbidity and mortality: tuberculosis, severe bacterial infections, cryptococcal meningitis, toxoplasmosis, and Pneumocystis jirovecii pneumonia...
March 4, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29513785/the-war-on-cryptococcosis-a-review-of-the-antifungal-arsenal
#20
Ahmad Mourad, John R Perfect
Cryptococcal meningitis is the most common central nervous system infection in the world today. It occurs primarily, but not exclusively, in immunocompromised individuals and despite substantial improvement in management of clinical events like AIDS, the numbers of cases of cryptococcosis remain very high. Unfortunately, despite several antifungal agents available for treatment, morbidity and mortality rates remain high with this fungal infection. In this Review, we will describe the treatments and strategies for success, identify the failures, and provide insights into the future developments / improvements for management...
2018: Memórias do Instituto Oswaldo Cruz
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