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cryptococcal antigene

Souleymane Sawadogo, Boniface Makumbi, Anne Purfield, Christophine Ndjavera, Gram Mutandi, Andrew Maher, Francina Kaindjee-Tjituka, Jonathan E Kaplan, Benjamin J Park, David W Lowrance
BACKGROUND: Cryptococcal meningitis is common and associated with high mortality among HIV infected persons. The World Health Organization recommends that routine Cryptococcal antigen (CrAg) screening in ART-naïve adults with a CD4+ count <100 cells/μL followed by pre-emptive antifungal therapy for CrAg-positive patients be considered where CrAg prevalence is ≥3%. The prevalence of CrAg among HIV adults in Namibia is unknown. We estimated CrAg prevalence among HIV-infected adults receiving care in Namibia for the purpose of informing routine screening strategies...
2016: PloS One
S Marques, R Carmo, I Ferreira, M Bustorff, S Sampaio, M Pestana
BACKGROUND: In solid organ transplant patients, 8% of invasive fungal infections are attributed to Cryptococcus. The aim of this study was to determine the frequency, risk factors, clinical characteristics, and outcome of kidney transplant recipients (TR) infected with Cryptococcus. CASE SERIES: Between 2007 and 2014, a total of 500 kidney transplantations were performed at São João Hospital, in Porto, Portugal. Six infections by C. neoformans were reported, an incidence of 1...
September 2016: Transplantation Proceedings
John F Fisher, Paula A Valencia-Rey, William B Davis
Background.  There are no prospective data regarding the management of pulmonary cryptococcosis in the immunocompetent patient. Clinical guidelines recommend oral fluconazole for patients with mild to moderate symptoms and amphotericin B plus flucytosine followed by fluconazole for severe disease. It is unclear whether patients who have histological evidence of Cryptococcus neoformans but negative cultures will even respond to drug treatment. We evaluated and managed a patient whose presentation and course raised important questions regarding the significance of negative cultures, antifungal choices, duration of therapy, and resolution of clinical, serologic, and radiographic findings...
September 2016: Open Forum Infectious Diseases
José E Vidal, Carolina Toniolo, Adriana Paulino, Arnaldo Colombo, Marilena Dos Anjos Martins, Cristina da Silva Meira, Vera Lucia Pereira-Chioccola, Claudia Figueiredo-Mello, Tiago Barros, Jequelie Duarte, Fernanda Fonseca, Mirella Alves, Clara Mendes, Taiana Ribero, Marcia Dos Santos Lazera, Radha Rajasingham, David R Boulware
OBJECTIVE: To determine the prevalence of asymptomatic cryptococcal antigen (CRAG) using lateral flow assay (LFA) in hospitalized HIV-infected patients with CD4 counts < 200 cells/μL. METHODS: Hospitalized HIV-infected patients were prospectively recruited at Instituto de Infectologia Emilio Ribas, a tertiary referral hospital to HIV-infected patients serving the São Paulo State, Brazil. All patients were >18 years old without prior cryptococcal meningitis, without clinical suspicion of cryptococcal meningitis, regardless of antiretroviral (ART)-status, and with CD4 counts <200 cells/μL...
October 3, 2016: Tropical Medicine & International Health: TM & IH
Nina Singh, Costi D Sifri, Fernanda P Silveira, Rachel Miller, Kevin S Gregg, Shirish Huprikar, Erika D Lease, Andrea Zimmer, J Stephen Dummer, Cedric W Spak, Christine Koval, David B Banach, Miloni Shroff, Jade Le, Darin Ostrander, Robin Avery, Albert Eid, Raymund R Razonable, Jose Montero, Emily Blumberg, Ahlaam Alynbiawi, Michele I Morris, Henry B Randall, George Alangaden, Jeffrey Tessier, Thomas V Cacciarelli, Marilyn M Wagener, Hsin Yun Sun
Characteristics of cirrhosis-associated cryptococcosis first diagnosed after death are not fully known. In a multicenter study, data generated as standard of care was systematically collected in 113 consecutive patients with cirrhosis and cryptococcosis followed for 80 patient-years. The diagnosis of cryptococcosis was first established after death in 15.9% (18/113) of the patients. Compared to cases diagnosed while alive, these patients had higher MELD score (33 vs. 22, P = .029) and higher rate of cryptococcemia (75...
September 6, 2016: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
Sonja E Leonhard, Daan Fritz, Diederik van de Beek, Matthijs C Brouwer
BACKGROUND: Cryptococcal meningitis is an uncommon but severe complication of sarcoidosis. METHODS: We present 2 patients with cryptococcal meningitis complicating sarcoidosis and compared findings with 38 cases reported in the literature. RESULTS: When analyzing our patients and 38 cases reported in the literature, we found that median age of sarcoidosis patients with cryptococcal meningitis was 39 years (range 30-48); 27 of 33 reported cases (82%) had a history of sarcoidosis...
August 2016: Medicine (Baltimore)
Hiromitsu Noguchi, Masataro Hiruma, Keishi Maruo, Masayoshi Jono, Keishi Miyata, Hideaki Tanaka, Koichi Tanabe, Yoshitsugu Miyazaki, Hironobu Ihn
A 68-year-old male plasterer with no history of trauma presented to our clinic in March 2012 with a 16×14-mm ulcer that developed following a crushed small papule on the right anterior chest. In April 2012, the patient was referred to another hospital, where cutaneous cryptococcosis was diagnosed based on discharge culture results. The patient was treated with oral itraconazole at a dose of 150 mg/day for 10 weeks; however, the ulcer remained unchanged and he discontinued the treatment. In May 2014, when he revisited our clinic, the ulcer with crust had grown to 29×13 mm...
2016: Medical Mycology Journal
Simona Frunza-Stefan, Gyanendra Acharya, Viktoryia Kazlouskaya, Paunel Vukasinov, Yushan Chiou, Zeyar Thet
Immune reconstitution inflammatory syndrome (IRIS) is a condition associated with paradoxical worsening and/or new onset of an opportunistic infection in HIV patients following the initiation of anti-retroviral therapy or switching to more potent antiretroviral therapy (ART) regimen. Although IRIS associated with many opportunistic infections (OIs) has been well reported, syphilis has very rarely been mentioned in this regard. A 52-year-old male, diagnosed with AIDS six weeks ago, presented with the disseminated non-pruritic painless skin rash...
August 26, 2016: International Journal of STD & AIDS
David A Stevens, Yonglong Zhang, Malcolm A Finkelman, Pappagianis Demosthenes, Karl V Clemons, Martinez Marife
Diagnosing coccidioidal meningitis (CM) can be problematic owing to infrequency and/or delay of positivity of CSF culture or CSF antibody, particularly if primary coccidioidal infection is unrecognized. We tested 37 CSF specimens, 26 from confirmed CM and 11 from patients with suspected microbial meningitis without fungal diagnosis, for (1, 3)-beta glucan (BG). CM CSF specimens BG ranged from 18-3300 pg/ml, controls <3.9-103. Diagnostic performance was determined using 31 pg/ml cutoff (bottom of serum range per directions for commercial kit, though further serial dilutions of the standard indicated linearity to 3...
August 24, 2016: Journal of Clinical Microbiology
Admasu Tenna Mamuye, Ethan Bornstein, Obsie Temesgen, Henry M Blumberg, Russell R Kempker
In a cross-sectional study among hospitalized human immunodeficiency virus (HIV)-infected patients in Ethiopia, we sought to determine the rates and predictors of cryptococcal disease and evaluate the test performance of a recently introduced point-of-care test for Cryptococcus neoformans detection in various biological samples. We tested serum, urine, and fingerstick blood samples from each patient with a cryptococcal antigen lateral flow assay (CRAG LFA; Immuno Mycologic Inc., Norman, OK). Cerebrospinal fluid was collected at the discretion of the treating physician...
October 5, 2016: American Journal of Tropical Medicine and Hygiene
Kedar R Mahajan, Amity L Roberts, Mark T Curtis, Danielle Fortuna, Robin Dharia, Lori Sheehan
Cryptococcus neoformans can cause disseminated meningoencephalitis and evade immunosurveillance with expression of a major virulence factor, the polysaccharide capsule. Direct diagnostic assays often rely on the presence of the cryptococcal glucuronoxylomannan capsular antigen (CrAg) or visualization of the capsule. Strain specific phenotypic traits and environmental conditions influence differences in expression that can thereby compromise detection and timely diagnosis. Immunocompetent hosts may manifest clinical signs and symptoms indolently, often expanding the differential and delaying appropriate treatment and diagnosis...
2016: Case Reports in Neurological Medicine
Andrés F Henao-Martínez, Lilyana Gross, Bryan Mcnair, Bruce McCollister, Kristen DeSanto, Jose G Montoya, Leland Shapiro, J David Beckham
Cryptococcal meningitis carries a high mortality. Further understanding of immune suppression factors associated with neuroinvasive infection will improve risk stratification and enhance early diagnosis and treatment with antifungal therapy. The aim of the study was to corroborate established or find novel clinical predictors for cryptococcal meningitis. We performed a matched case-control study of Cryptococcus infection in immunocompromised patients with or without cryptococcal meningitis. Data of all patients with a diagnosis of cryptococcal disease were collected at University of Colorado Hospital between 2000 and 2015 (n = 51)...
August 8, 2016: Mycopathologia
Hashem Nasri, Sarah Kabbani, Melhim Bou Alwan, Yun F Wang, Paulina A Rebolledo, Colleen S Kraft, Minh L Nguyen, Albert M Anderson, Nadine Rouphael
Background.  Mortality for cryptococcal meningitis remains significant, in spite of available treatment. Resistance to first-line maintenance therapy, particularly fluconazole, has been reported. Methods.  A retrospective chart review was performed on immunocompromised patients with cryptococcal meningitis, who had susceptibility testing performed between January 2001 and December 2011, at 3 hospitals in Atlanta, Georgia. Results.  A total of 35 immunocompromised patients with cryptococcal meningitis were identified, 13 (37...
April 2016: Open Forum Infectious Diseases
Juergen Prattes, Sven Heldt, Susanne Eigl, Martin Hoenigl
Diagnostic tools for invasive fungal infections have continuously improved within the last decades. Nowadays, cultural methods, antigen testing, and molecular tests, such as polymerase chain reaction, are widely used. These methods, however, are accompanied with different limitations as various availability, various turnaround time or high costs. A new generation of point-of-care test has shown promising results in various studies and may overcome some of these limitations. We therefore reviewed the literature for the most promising new point-of-care tests for invasive aspergillosis (Aspergillus-specific lateral-flow device test, Aspergillus proximity ligation antigen assay), cryptococcosis (cryptococcal lateral-flow assay), and for histoplasmosis (loop-mediated isothermal amplification assay)...
2016: Current Fungal Infection Reports
Justin F Rosenberg, Martin Haulena, Linda M N Hoang, Muhammad Morshed, Erin Zabek, Stephen A Raverty
Cryptococcosis has been reported in marine mammals in the northeastern Pacific with increasing frequency in the last 15 yr. Although a variety of cetaceans have been diagnosed with cryptococcosis, Cryptococcus gattii has not been reported in pinnipeds. We document C. gattii VGIIa in a harbor seal ( Phoca vitulina ) pup and in an unrelated adult. Both animals were presented to Vancouver Aquarium's Marine Mammal Rescue Centre (VAMMRC) with generalized weakness, dehydration, respiratory compromise, minimally responsive mentation, and suboptimal body condition...
July 2016: Journal of Wildlife Diseases
Sunita Kumari, Rajesh Kumar Verma, Dharmendra Prasad Singh, Ramakant Yadav
INTRODUCTION: The cases of cryptococcal meningitis and other forms of cryptococcosis have increased in recent time and the present scenario of the condition with significant morbidity and mortality is actually posing a serious threat to the community, so an early and prompt diagnosis is necessary to prevent serious complications and thus improving the overall disease outcome. AIM: Comparison of diagnostic efficacy of nested Polymerase Chain Reaction (PCR) with Latex Agglutination Test (LAT) in the Cerebro Spinal Fluid (CSF) samples of the cases of meningitis in HIV positive and negative cases...
April 2016: Journal of Clinical and Diagnostic Research: JCDR
Rita O Oladele, Alani S Akanmu, Augustina O Nwosu, Folasade T Ogunsola, Malcolm D Richardson, David W Denning
Background.  Cryptococcal meningitis has a high mortality in human immunodeficiency virus (HIV)-infected persons in Africa. This is preventable with early screening and preemptive therapy. We evaluated the prevalence of cryptococcal disease by antigen testing, possible associated factors, and outcomes in HIV-infected patients being managed in a tertiary hospital in Lagos, Nigeria. Methods.  Sera were collected from 214 consenting HIV-infected participants with CD4(+) counts <250 cells/mm(3), irrespective of their antiretroviral therapy (ART) status, between November 2014 and May 2015...
March 2016: Open Forum Infectious Diseases
Ploenchan Chetchotisakd, Siriluck Anunnatsiri, Arnone Nithichanon, Ganjana Lertmemongkolchai
Disseminated nontuberculous mycobacterial (NTM) infection is the most common feature in patients positive for anti-interferon-gamma autoantibodies (IFN-γ Ab). Cryptococcus co-infects these patients. A retrospective, matched case-control study was conducted at Srinagarind Hospital between 1992 and 2013. We reviewed the charts of non-HIV-infected patients with cryptococcosis with disseminated NTM (case) and matched 2 HIV-infected patients (control) with cryptococcosis for each case. There were 16 cases and 32 controls...
May 9, 2016: Japanese Journal of Infectious Diseases
Allan Sørensen, Sanne Jespersen, Terese L Katzenstein, Candida Medina, David da Silva Té, Faustino Gomes Correira, Cecilie Juul Hviid, Alex Lund Laursen, Christian Wejse
BACKGROUND: Better understanding of HIV-2 infection is likely to affect the patient care in areas where HIV-2 is prevalent. In this study, we aimed to characterize the clinical presentations among HIV-1, HIV-2 and HIV-1/2 dual seropositive patients. METHODS: In a cross-sectional study, newly diagnosed HIV patients attending the HIV outpatient clinic at Hospital Nacional Simão Mendes in Guinea-Bissau were enrolled. Demographical and clinical data were collected and compared between HIV-1, HIV-2 and HIV-1/2 dual seropositive patients...
August 2016: Infectious Diseases
Elizabeth Nalintya, Reuben Kiggundu, David Meya
Over the last decade, an upsurge in both the frequency and severity of fungal infections due to the HIV/AIDS epidemic and the use of immunosuppressive therapy has occurred. Even diagnostic methods like culture and microscopy, which have low sensitivity and longer turn-around-times are not widely available, leading to delays in timely antifungal therapy and detrimental patient outcomes. The evolution of cryptococcal antigen (CrAg) testing to develop inexpensive and more sensitive methods to detect cryptococcal antigen is significant...
2016: Current Fungal Infection Reports
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