Clinical Aspects of Immune Damage in Cryptococcosis

Anjum, Seher; Williamson, Peter R.

doi:10.1007/s12281-019-00345-7

Cited by 22 publications

(16 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…After 10 days of combination therapy, an LP was repeated yielding negative CSF cultures and a reduction in cryptococcal antigen titers on CSF (1:10 from 1:100); however, diplopia was still present. Because of diplopia and persistent headaches, in the setting of effective anti-fungal therapy and negative CSF fungal cultures, a post-infectious inflammatory response syndrome (PIIRS) was suspected (11), prompting testing for inflammatory cytokines which were found to be elevated (Table 2): CSF studies demonstrated elevated levels of IL6 (1,160 pg/ml) and TNF alpha (241 pg/ml), and continued negative fungal cultures, supportive of PIIRS.…”

Section: Case Presentationmentioning

confidence: 99%

Cryptococcal Meningitis and Post-Infectious Inflammatory Response Syndrome in a Patient With X-Linked Hyper IgM Syndrome: A Case Report and Review of the Literature

et al. 2021

View full text Add to dashboard Cite

The hyper IgM syndromes are a rare group of primary immunodeficiency. The X-linked Hyper IgM syndrome (HIGM), due to a gene defect in CD40L, is the commonest variant; it is characterized by an increased susceptibility to a narrow spectrum of opportunistic infection. A few cases of HIGM patients with Cryptococcal meningoencephalitis (CM) have been described in the literature. Herein we report the case of a young male diagnosed in infancy with HIGM who developed CM complicated by a post-infectious inflammatory response syndrome (PIIRS), despite regular immunoglobulin replacement therapy and appropriate antimicrobial prophylaxis. The patient was admitted because of a headache and CM was diagnosed through detection of Cryptococcus neoformans in the cerebrospinal fluid. Despite the antifungal therapy resulting to negative CSF culture, the patient exhibited persistent headaches and developed diplopia. An analysis of inflammatory cytokines on CSF, as well as the brain MRI, suggested a diagnosis of PIIRS. Therefore, a prolonged corticosteroids therapy was started obtaining a complete resolution of symptoms without any relapse.

show abstract

Section: Case Presentationmentioning

confidence: 99%

Cryptococcal Meningitis and Post-Infectious Inflammatory Response Syndrome in a Patient With X-Linked Hyper IgM Syndrome: A Case Report and Review of the Literature

et al. 2021

View full text Add to dashboard Cite

show abstract

“…This encapsulated yeast-like fungus was first isolated from peach juice in 1895, and then was subsequently found in milk, soil, and avian excrement, including pigeons, chickens, parrots, canaries, sparrows, and skylarks [ 2 ]. The association between Cryptococcus neoformans and nervous system infection was first described by von Hansmann in 1905 [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…The lateral flow assay (LFA) provides a rapid and highly specific method for measuring cryptococcal antigen titres and is particularly useful for detecting cryptococcal meningitis as it involves a simple plasma test and can be used in patients who have low antigen levels. As latex agglutination and latera flow assay cannot differentiate live from dead organisms the assessment of treatment response is limited [ 3 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Cryptococcosis and unexpected death

Byard

2021

Forensic Sci Med Pathol

View full text Add to dashboard Cite

Cryptococcosis is a fungal disease caused predominantly by Cryptococcus neoformans and Cryptococcus gatti. It is most often found in immunocompromised individuals and has quite protean and chronic manifestations affecting all body systems. The unexpected death of a 22-year-old man with cryptococcal meningoencephalitis demonstrates, however, that it may have a fulminant course in previously well individuals. Also present at autopsy was a toruloma of the upper lobe of the right lung. Delays in clinical diagnoses, confusion with tuberculosis and precipitate clinical deterioration may mean that cases will be encountered unexpectedly during medicolegal autopsies.

show abstract

“…The lateral flow assay (LFA, IMMY ® diagnostics, Norman, OK, USA) utilizes gold-conjugated monoclonal antibodies that target capsular polysaccharide glucuronoxylomannan (GXM), a primary cryptococcal antigen of four serotypes [ 39 ]. LFA is fast and able to quantify cryptococcal antigen (CrAg) titers with high sensitivity and specificity in CSF: 100% and 99.8%, respectively (reviewed in [ 40 ]). Cryptococcal antigenemia (CrAg+) in serum, CSF or other biofluids is often detected in asymptomatic CM patients who subsequently develop CM-IRIS [ 41 , 42 , 43 , 44 ].…”

Section: Conventional Risk Factors For Cm-irismentioning

confidence: 99%

Cryptococcal Immune Reconstitution Inflammatory Syndrome: From Blood and Cerebrospinal Fluid Biomarkers to Treatment Approaches

Brienze

André

Liso

et al. 2021

Life

View full text Add to dashboard Cite

Immune reconstitution inflammatory syndrome (IRIS) presents as an exaggerated immune reaction that occurs during dysregulated immune restoration in immunocompromised patients in late-stage human immunodeficiency virus (HIV) infection who have commenced antiretroviral treatments (ART). Virtually any opportunistic pathogen can provoke this type of immune restoration disorder. In this review, we focus on recent developments in the identification of risk factors for Cryptococcal IRIS and on advancements in our understanding of C-IRIS immunopathogenesis. We overview new findings in blood and cerebrospinal fluid which can potentially be useful in the prediction and diagnosis of cryptococcal meningitis IRIS (CM-IRIS). We assess current therapeutic regimens and novel treatment approaches to combat CM-IRIS. We discuss the utility of biomarkers for clinical monitoring and adjusting treatment modalities in acquired immunodeficiency syndrome (AIDS) patients co-infected with Cryptococcus who have initiated ART.

show abstract

Clinical Aspects of Immune Damage in Cryptococcosis

Cited by 22 publications

References 73 publications

Cryptococcal Meningitis and Post-Infectious Inflammatory Response Syndrome in a Patient With X-Linked Hyper IgM Syndrome: A Case Report and Review of the Literature

Cryptococcal Meningitis and Post-Infectious Inflammatory Response Syndrome in a Patient With X-Linked Hyper IgM Syndrome: A Case Report and Review of the Literature

Cryptococcosis and unexpected death

Cryptococcal Immune Reconstitution Inflammatory Syndrome: From Blood and Cerebrospinal Fluid Biomarkers to Treatment Approaches

Contact Info

Product

Resources

About