Characterization of Clinical and CT Manifestations of Pulmonary Cryptococcosis with Consolidation

Yang, Ding; Yu, Lei; Luo, Jianhua; Shen, Jianmin; Wang, Dongguo; Pingding, Kuang; Fu, Gangzhe

doi:10.34172/aim.2021.73

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…Pulmonary cryptococcosis should be considered in the differential diagnosis of solitary or multiple pulmonary nodules in patients with COVID-19 [ 17 ]. While air bronchograms within nodules or masses with a predominant distribution in the lower lung lobes and peripheral area are more frequently present in immunocompetent patients [ 55 , 56 , 57 ]. Cavitations within nodules or masses are more frequently present in immunocompromised patients than in immunocompetent patients [ 55 , 56 ].…”

Section: Diagnosismentioning

confidence: 99%

COVID-19 Associated with Cryptococcosis: A New Challenge during the Pandemic

Chan

Lai

et al. 2022

JoF

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Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a great threat to global health. In addition to SARS-CoV-2 itself, clinicians should be alert to the possible occurrence of co-infection or secondary infection among patients with COVID-19. The possible co-pathogens include bacteria, viruses, and fungi, but COVID-19-associated cryptococcosis is rarely reported. This review provided updated and comprehensive information about this rare clinical entity of COVID-19-associated cryptococcosis. Through an updated literature search till 23 August 2022, we identified a total of 18 culture-confirmed case reports with detailed information. Half (n = 9) of them were elderly. Fifteen (83.3%) of them had severe COVID-19 and ever received systemic corticosteroid. Disseminated infection with cryptococcemia was the most common type of cryptococcosis, followed by pulmonary and meningitis. Except one case of C. laurentii, all other cases are by C. neoformans. Liposomal amphotericin B and fluconazole were the most commonly used antifungal agents. The overall mortality was 61.1% (11/18) and four of them did not receive antifungal agents before death. Improving the poor outcome requires a physician’s high suspicion, early diagnosis, and prompt treatment.

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Section: Diagnosismentioning

confidence: 99%

COVID-19 Associated with Cryptococcosis: A New Challenge during the Pandemic

Chan

Lai

et al. 2022

JoF

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“…Fig. 1 Flow diagram of the study selection process full texts, including 248 immunocompromised and 276 immunocompetent patients, were assessed for eligibility and included in our meta-analysis [16][17][18][19][20][21][22][23][24].…”

Section: Characteristics Of the Studies And Quality Assessmentsmentioning

confidence: 99%

Comparison of the clinical manifestations and chest CT findings of pulmonary cryptococcosis in immunocompetent and immunocompromised patients: a systematic review and meta-analysis

Xiong¹,

Lü²,

Chen

et al. 2022

BMC Pulm Med

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Objective The purpose of our study was to perform a meta-analysis and systematic review to compare differences in clinical manifestations and chest computed tomography (CT) findings between immunocompetent and immunocompromised pulmonary cryptococcosis (PC) patients. Methods An extensive search for relevant studies was performed using the PubMed, EMBASE, Cochrane Library, and Web of Sciences databases from inception to September 30, 2021. We included studies that compared the clinical manifestations and chest CT findings between immunocompetent and immunocompromised PC patients. Study bias and quality assessment were performed using the Newcastle–Ottawa Scale (NOS). Results Nine studies involving 248 immunocompromised and 276 immunocompetent PC patients were included in our analysis. The NOS score of each eligible study was above 5, indicating moderate bias. The proportion of elderly patients (> = 60 years old) in the immunosuppressed group was significantly higher than that in the immunocompetent group (OR = 2.90, 95% CI (1.31–6.43), Z = 2.63, p = 0.01). Fever (OR = 7.10, 95% CI (3.84–13.12), Z = 6.25, p < 0.000) and headache (OR = 6.92, 95% CI (2.95–16.26), Z = 4.44, p < 0.000) were more common in immunosuppressed patients. According to thin-section CT findings, lesions were more frequently distributed in the upper lobe (OR = 1.90, 95% CI (1.07–3.37), Z = 2.2, p = 0.028) in immunocompromised individuals. The proportions of patients with cavity sign (OR = 5.11, 95% CI (2.96–8.83), Z = 5.86, p = 0.00), ground-glass attenuation (OR = 5.27, 95% CI (1.60–17.35), Z = 2.73, p = 0.01), and mediastinal lymph node enlargement (OR = 2.41, 95% CI (1.12–5.20), Z = 2.24, p = 0.03) were significantly higher in immunocompromised patients. Conclusion No significant differences in nonspecific respiratory symptoms were found between immunocompromised and immunocompetent PC patients. Nevertheless, fever and headache were more common in immunocompromised patients. Among the CT findings, cavity, ground-glass attenuation, and mediastinal lymph node enlargement were more common in immunocompromised individuals.

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“…The majority of patients with PC typically present with non-specific symptoms such as cough and expectoration, accompanied by ambiguous imaging manifestations. Consequently, the disease can easily be confused with and misdiagnosed as other pulmonary conditions, including pulmonary aspergillosis (PA), TB, lung cancer, and bacterial pneumonia ( 11 , 12 ). For instance, it has been reported that approximately 51.9% of South African miners tested for PC were mistakenly diagnosed with TB ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Serum sphingolipids aid in diagnosing adult HIV-negative patients with pulmonary cryptococcosis: a clinical cohort study

Yau,

Chan,

et al. 2023

J Thorac Dis

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Background Pulmonary cryptococcosis (PC) contributes to the ongoing global disease burden in human immunodeficiency virus (HIV)-negative populations. Since some PC patients are misdiagnosed under existing diagnostic guidelines, new diagnostic markers are needed to improve diagnostic accuracy and therapeutic efficacy and reduce disease risk. Methods Our previously established sphingolipidomic approach was employed to explore the use of serum sphingolipids (SPLs) in diagnosing HIV-negative patients with PC. A clinical cohort of PC, pulmonary aspergillosis (PA), and tuberculosis (TB) patients and healthy controls was assessed to identify SPL biomarkers. Results A total of 47 PC, 27 PA, and 18 TB patients and 40 controls were enrolled. PC and TB patients had similar clinical features, laboratory test results and radiological features, excluding plural effusion. The serum ceramide [Cer (d18:1/18:0)] level showed a significant increase in PC patients compared to controls and PA and TB patients (P<0.05). Cer (d18:1/18:0) was identified as a specific diagnostic biomarker for PC. The optimal cut-off value of greater than 18.00 nM showed a diagnostic sensitivity of 76.60% and a specificity of 95.00% and better distinguished PC patients from PA and TB patients. Furthermore, the serum Cer (d18:1/18:0) level gradually decreased after 3 and 6 months of treatment, suggesting the prediction potential for therapeutic efficacy of this biomarker. In addition, Cer (d18:1/18:0) analysis presented a higher sensitivity than the cryptococcal antigen (CrAg) assay. Conclusions This is the first study to report the use of the SPL Cer (d18:1/18:0) as a serum biomarker for diagnosing Cryptococcus spp. infection in HIV-negative patients.

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Characterization of Clinical and CT Manifestations of Pulmonary Cryptococcosis with Consolidation

Cited by 4 publications

References 15 publications

COVID-19 Associated with Cryptococcosis: A New Challenge during the Pandemic

COVID-19 Associated with Cryptococcosis: A New Challenge during the Pandemic

Comparison of the clinical manifestations and chest CT findings of pulmonary cryptococcosis in immunocompetent and immunocompromised patients: a systematic review and meta-analysis

Serum sphingolipids aid in diagnosing adult HIV-negative patients with pulmonary cryptococcosis: a clinical cohort study

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