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cryptococcal antigene

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
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
Elizabeth Nalintya, David B Meya, Sarah Lofgren, Kathy Huppler Hullsiek, David R Boulware, Radha Rajasingham
BACKGROUND: Cryptococcus is a leading cause of AIDS-related mortality. Cryptococcal antigen (CrAg) is detectable in blood before meningitis onset, and predicts death. CrAg screening amongst those with advanced HIV, and treatment of those CrAg+ with fluconazole has demonstrated survival benefit. However, implementation and widespread uptake have been slow outside of clinical trials. METHODS: We designed a CrAg screening program for routine care that incorporated intensive education and training of clinic staff...
March 2, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
José E Vidal, Carolina Toniolo, Adriana Paulino, Arnaldo L Colombo, Marilena Dos Anjos Martins, Cristina da Silva Meira, Renata Guise Soares Azevedo, Vera Lucia Pereira-Chioccola, Hélio Rodrigues Gomes, Marcia Dos Santos Lazera, Augusto C Penalva de Oliveira, David R Boulware
Cryptococcal meningitis is the most common cause of opportunistic meningitis in HIV-infected patients in Brazil and causes unacceptable high mortality rates. In this study, HIV-infected patients with a first episode of culture-proven cryptococcal meningitis in cerebrospinal fluid (CSF) were prospectively included in order to evaluate sensitivity of cryptococcal antigen (CrAg) lateral flow assay (LFA) in serum, CSF, whole blood (fingerstick), and fresh urine. In addition, HIV-infected patients with other neurological confirmed diseases were included in order to evaluate the specificity of CrAg LFA in serum...
2018: Revista do Instituto de Medicina Tropical de São Paulo
Carolina Firacative, A Elisabeth Gressler, Kristin Schubert, Bianca Schulze, Uwe Müller, Frank Brombacher, Martin von Bergen, Gottfried Alber
Cryptococcosis, caused by Cryptococcus neoformans, has been demonstrated to be controlled by T helper (Th)1 cells while Th2 cells are associated with fungal growth and dissemination. Although cryptococcal immunoreactive protein antigens were previously identified, their association with Th1 or Th2 immune responses was not provided. In mice, Th1-dependent IFN-γ induces the production of IgG2a, whereas the Th2 cytokine IL-4 stimulates the expression of IgG1 rendering each isotype an indicator of the underlying Th cell response...
February 8, 2018: Scientific Reports
Richard Kwizera, Andrew Akampurira, Tadeo K Kandole, Maria S Nabaggala, Darlisha A Williams, Andrew Kambugu, David B Meya, Joshua Rhein, David R Boulware
Cerebrospinal fluid (CSF) culture can determine a quantitative viability of Cryptococcus yeasts; however, culture has a long turnaround-time. The TC20 automated cell counter (Bio-Rad) is a benchtop instrument used to count cells in 30 seconds. In vitro studies suggest trypan blue staining can distinguish between viable and dead cryptococcal yeasts. We hypothesized that trypan blue staining with automated cell counting may provide rapid quantification of viable CSF Cryptococcus yeasts. In sum, 96 HIV-infected participants with cryptococcal meningitis were enrolled and provided 194 CSF specimens in Kampala, Uganda...
October 9, 2017: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
David B Meya, Samuel Okurut, Godfrey Zziwa, Stephen Cose, Paul R Bohjanen, Harriet Mayanja-Kizza, Moses Joloba, David R Boulware, Carol Yukari Manabe, Sharon Wahl, Edward N Janoff
A third of adults with AIDS and cryptococcal meningitis (CM) develop immune reconstitution inflammatory syndrome (IRIS) after initiating antiretroviral therapy (ART), which is thought to result from exaggerated inflammatory antigen-specific T cell responses. The contribution of monocytes to the immunopathogenesis of cryptococcal IRIS remains unclear. We compared monocyte subset frequencies and immune responses in HIV-infected Ugandans at time of CM diagnosis (IRIS-Baseline) for those who later developed CM-IRIS, controls who did not develop CM-IRIS (Control-Baseline) at CM-IRIS (IRIS-Event), and for controls at a time point matched for ART duration (Control-Event) to understand the association of monocyte distribution and immune responses with cryptococcal IRIS...
June 2, 2017: Journal of Fungi (Basel, Switzerland)
Matthew Stankowicz, Megan Banaszynski, Russell Crawford
Cryptococcal infections are responsible for significant morbidity and mortality in immunocompromised patients. Reports of these infections in patients on small molecular kinase inhibitors have not been widely reported in clinical trials. We describe one case of cryptococcal meningoencephalitis and one case of cryptococcal pneumonia in two patients who were receiving ibrutinib for chronic lymphocytic leukemia. Despite different sites of cryptococcal infection, both patients had similar presentations of acute illness...
January 1, 2018: Journal of Oncology Pharmacy Practice
Toyomitsu Sawai, Takumi Nakao, Satoru Koga, Shotaro Ide, Sumako Yoshioka, Nobuko Matsuo, Hiroshi Mukae
BACKGROUND: Tuberculosis and cryptococcosis co-infection usually occurs in immunosuppressed patients with impaired cell-mediated immunity. However, there are few reports about such co-infection in non-HIV patients without underlying diseases. Here, we report a case of miliary tuberculosis with co-existing pulmonary cryptococcosis in non-HIV patient without underlying diseases. CASE PRESENTATION: An 84-year-old Asian female presented to our hospital with complaints of a 1-week history of abdominal pain and appetite loss...
January 16, 2018: BMC Pulmonary Medicine
J M Koshy, S Mohan, D Deodhar, M John, A Oberoi, A Pannu
Background: Though cryptococcal meningitis (CM) is recognized as a disease of the immunocompromised, studies have implicated that it also affect immunocompetent patients. Methodology: This was a cross sectional study conducted in the Department of Medicine of a tertiary teaching institution in North India. All the patients diagnosed with CM on the basis of detection of cryptococcal antigen or the presence of capsulated budding yeast cells on India ink preparation, from April 2009 to March2015 were included in the study...
October 2017: Journal of the Association of Physicians of India
Edward Mpoza, Liliane Mukaremera, Didas Atwebembere Kundura, Andrew Akampurira, Tonny Luggya, Kiiza Kandole Tadeo, Katelyn A Pastick, Sarah C Bridge, Lillian Tugume, Reuben Kiggundu, Abdu K Musubire, Darlisha A Williams, Conrad Muzoora, Elizabeth Nalintya, Radha Rajasingham, Joshua Rhein, David R Boulware, David B Meya, Mahsa Abassi
BACKGROUND: HIV-associated cryptococcal meningitis is the leading cause of adult meningitis in Sub-Saharan Africa, accounting for 15%-20% of AIDS-attributable mortality. The development of point-of-care assays has greatly improved the screening and diagnosis of cryptococcal disease. We evaluated a point-of-care immunoassay, StrongStep (Liming Bio, Nanjing, Jiangsu, China) lateral flow assay (LFA), for cryptococcal antigen (CrAg) detection in cerebrospinal fluid (CSF) and plasma. METHODS: We retrospectively tested 143 CSF and 77 plasma samples collected from HIV-seropositive individuals with suspected meningitis from 2012-2016 in Uganda...
2018: PloS One
Hitesh Raheja, Ankur Sinha, Pavan Kumar Irukulla, Yizhak Kupfer
We report a case of acute cryptococcal meningitis (CM) masquerading as normal pressure hydrocephalus (NPH) in an immune-competent female. An 85-year-old human immunodeficiency virus-negative female presented to the emergency room for altered mental status and difficulty walking. She was increasingly lethargic, with urinary incontinence and gait instability. A previous computed tomography was reported to have ventricular dilatation out of proportion to the degree of cortical atrophy. Magnetic resonance scan of the brain revealed ventricular dilatation and subtle debris layering the occipital horns of the lateral ventricles...
October 2017: Journal of Global Infectious Diseases
Samuel Shribman, Alastair Noyce, Sharmilee Gnanapavan, Jonathan Lambourne, Thomas Harrison, Frederick Schon
We present two cases of cryptococcal meningitis in people subsequently diagnosed with idiopathic CD4+ lymphopenia. Both presented with new onset headaches without sinister features and were sent home on multiple occasions from emergency departments. Cryptococcal meningitis in HIV-negative patients poses major diagnostic and management problems; the associated mortality is 9%-27%. We suggest performing blood and cerebrospinal fluid cryptococcal antigen tests in all people with lymphocytic meningitis.
December 9, 2017: Practical Neurology
Mahboobeh Hajiabdolbaghi, Saeed Kalantari, Mahin Jamshidi-Makiani, Esfandiar Shojaei, Ladan Abbasian, Mehrnaz Rasoulinezhad, Katayoun Tayeri
Background and Objectives: Cryptococcal meningitis is one of the main opportunistic infections associated with human immunodeficiency virus (HIV) infection. Despite the present and increasingly availability of specific treatment for cryptococcosis, the mortality rate of this infection is still high, particularly in patients with advanced immunsupression and advanced cryptococcal diseases. Materials and Methods: This Prospective Cohort study was conducted at Imam Khomeini hospital in Tehran, Iran...
April 2017: Iranian Journal of Microbiology
Charles A Specht, Chrono K Lee, Haibin Huang, Maureen M Hester, Jianhua Liu, Bridget A Luckie, Melanie A Torres Santana, Zeynep Mirza, Payam Khoshkenar, Ambily Abraham, Zu T Shen, Jennifer K Lodge, Ali Akalin, Jane Homan, Gary R Ostroff, Stuart M Levitz
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...
November 28, 2017: MBio
Alicia Arechavala, Ricardo Negroni, Fernando Messina, Mercedes Romero, Emmanuel Marín, Roxana Depardo, Laura Walker, Gabriela Santiso
BACKGROUND: Cryptococcosis is still a life-threatening mycosis that continues to be of serious concern in Latin American countries, especially among HIV+positive population. However, there is not any reliable information about the prevalence of this disease in this region. AIMS: The aim of this study is to report data of 2041 patients with cryptococcosis that were attended at the Infectious Diseases Hospital F. J. Muñiz over a 30 year-period. METHODS: Information about demographic and clinical data, survival time and the applied treatment, was taken from the Mycology Unit database...
November 9, 2017: Revista Iberoamericana de Micología
Sujal I Shah, Hai Bui, Nelson Velasco, Shilpa Rungta
BACKGROUND Cryptococcus is the third most common invasive fungal organism in immunocompromised patients, including transplant patients, and usually involves the central nervous system and lungs, with a median time to infection of 25 months. We report a case of Cryptococcus of the prostate gland, found as an incidental finding on prostate biopsy for prostate adenocarcinoma, four months following cardiac transplantation. CASE REPORT A 62-year-old male African-American who had a cardiac transplant four months previously, underwent a six-core prostate biopsy for a two-year history of increasing prostate-specific antigen (PSA) levels, and a recent history of non-specific urinary tract symptoms...
November 6, 2017: American Journal of Case Reports
Jiwoon Choi, Se Hoon Kim
Cryptococcus neoformans is the most common microorganism found in cerebrospinal fluid (CSF) cytology and causes life-threatening infections in immunocompromised hosts. Although its cytomorphologic features in conventional smear cytology have been well described, those in liquid-based cytology have rarely been. A 73-year-old woman with diffuse large B-cell lymphoma presented with mental confusion and a spiking fever. To rule out infectious conditions, CSF examination was performed. A cytology slide that was prepared using the ThinPrep method showed numerous spherical yeast-form organisms with diameters of 4-11 μm and thick capsules...
October 26, 2017: Journal of Pathology and Translational Medicine
Ariya Chindamporn, Arunaloke Chakrabarti, Ruoyu Li, Pei-Lun Sun, Ban-Hock Tan, Mitzi Chua, Retno Wahyuningsih, Atul Patel, Zhengyin Liu, Yee-Chun Chen, Methee Chayakulkeeree
An online survey of mycology laboratories in seven Asian countries was conducted to assess the status, competence, and services available. Country representatives from the Asia Fungal Working Group (AFWG) contacted as many laboratories performing mycology diagnosis as possible in their respective countries, requesting that the laboratory heads complete the online survey. In total, 241 laboratories responded, including 71 in China, 104 in India, 11 in Indonesia, 26 in the Philippines, four in Singapore, 18 in Taiwan, and seven in Thailand...
September 20, 2017: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
Jintao Xu, Adam Flaczyk, Lori M Neal, Zhenzong Fa, Daphne Cheng, Mike Ivey, Bethany B Moore, Jeffrey L Curtis, John J Osterholzer, Michal A Olszewski
Macrophage receptor with collagenous structure (MARCO) contributes to fungal containment during the early/innate phase of cryptococcal infection; however, its role in adaptive antifungal immunity remains unknown. Using a murine model of cryptococcosis, we compared host adaptive immune responses in wild-type and MARCO(-/-) mice throughout an extended time course post-infection. Unlike in early infection, MARCO deficiency resulted in improved pulmonary fungal clearance and diminished cryptococcal dissemination during the efferent phase...
2017: Frontiers in Immunology
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