Cryptococcal antigen detection from the urine of AIDS patients

Chapin-Robertson, Kimberle; Bechtel, Cynthia; Waycott, Sandra; Kontnick, C M; Edberg, Stephen C.

doi:10.1016/0732-8893(93)90096-p

Cited by 19 publications

(11 citation statements)

References 14 publications

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“…GXM has been found in urine in some experimental models of GXM clearance [33] but not in others [31,32]. GXM also is found in the urine of patients with cryptococcosis; however, titers are usually low [32,48]. Eng et al [32] calculated that levels of GXM in the urine of patients with cryptococcosis are too low to account for renal elimination of cryptococcal antigen from serum.…”

Section: Discussionmentioning

confidence: 97%

In Vivo Clearance of Glucuronoxylomannan, the Major Capsular Polysaccharide ofCryptococcus neoformans:A Critical Role for Tissue Macrophages

Grinsell

Weinhold²,

Cutler

et al. 2001

J INFECT DIS

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Cryptococcus neoformans produces a life-threatening meningitis in patients who are immunocompromised by AIDS. A striking feature of cryptococcosis in AIDS is high serum levels of the major capsular polysaccharide, glucuronoxylomannan (GXM). Soluble GXM has numerous biologic activities that may contribute to the pathogenesis of infection. The objective of the study was to further understand in vivo processing of GXM. Mice were injected intravenously with GXM, and the tissue distribution was determined. A macrophage suicide technique that used liposome-encapsulated dichloromethylene diphosphonate determined the role of macrophages. GXM was cleared from serum with a half-life of 24-48 h but was retained for an indefinite period in tissues rich in cells of the mononuclear phagocyte system. Ablation of macrophages decreased GXM in the liver and spleen and increased serum GXM. The results identify a key role for macrophages in the clearance of GXM from serum and identify macrophages as a long-term reservoir for storage.

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Section: Discussionmentioning

confidence: 97%

In Vivo Clearance of Glucuronoxylomannan, the Major Capsular Polysaccharide ofCryptococcus neoformans:A Critical Role for Tissue Macrophages

Grinsell

Weinhold²,

Cutler

et al. 2001

J INFECT DIS

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“…These observations were based on small studies mainly in HIV positive patients (and, by inference, with C. neoformans infection) (321)(322)(323). The utility of CRAG testing of BAL fluid and urine in C. gattii infection is untested.…”

Section: Microbiological Diagnosismentioning

confidence: 99%

Cryptococcus gattii Infections

2014

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SUMMARY Understanding of the taxonomy and phylogeny of Cryptococcus gattii has been advanced by modern molecular techniques. C. gattii probably diverged from Cryptococcus neoformans between 16 million and 160 million years ago, depending on the dating methods applied, and maintains diversity by recombining in nature. South America is the likely source of the virulent C. gattii VGII molecular types that have emerged in North America. C. gattii shares major virulence determinants with C. neoformans , although genomic and transcriptomic studies revealed that despite similar genomes, the VGIIa and VGIIb subtypes employ very different transcriptional circuits and manifest differences in virulence phenotypes. Preliminary evidence suggests that C. gattii VGII causes severe lung disease and death without dissemination, whereas C. neoformans disseminates readily to the central nervous system (CNS) and causes death from meningoencephalitis. Overall, currently available data indicate that the C. gattii VGI, VGII, and VGIII molecular types more commonly affect nonimmunocompromised hosts, in contrast to VGIV. New, rapid, cheap diagnostic tests and imaging modalities are assisting early diagnosis and enabling better outcomes of cerebral cryptococcosis. Complications of CNS infection include increased intracranial pressure, severe neurological sequelae, and development of immune reconstitution syndrome, although the mortality rate is low. C. gattii VGII isolates may exhibit higher fluconazole MICs than other genotypes. Optimal therapeutic regimens are yet to be determined; in most cases, initial therapy with amphotericin B and 5-flucytosine is recommended.

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“…In AIDS patients, positive cryptococcal antigen detection from urine is strongly associated with disseminated mycosis [17]. Culture-proven cryptococcuria is relatively uncommon, and isolated cryptococcuria is more rarely reported on the literatures.…”

Section: Discussionmentioning

confidence: 99%

“…Case 1 became culture-negative for C. neoformans in urine after 10 days without any antifungal drugs, however, urine was still positive for cryptococcal antigen. It may be due to low sensitivity of cultures [19] or cryptococcal antigen could be detected as a form of degraded cell debris or soluble antigen liberated from primary infectious sites such as cryptococcal peritonitis [17]. In disseminated cryptococcosis, cryptococcal antigen can exist for a long time in CSF, blood, and urine despite of appropriate antifungal therapy [19].…”

Section: Discussionmentioning

confidence: 99%

Two Cases of Cryptococcuria Developed as Isolated Cryptococcuria and Disseminated Cryptococcosis

Bae

Namgoong

et al. 2011

Korean J Clin Microbiol

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Cryptococcus is an opportunistic pathogen that mainly affects immunocompromised hosts and, less frequently, immunocompetent hosts. It causes serious morbidity and mortality due to systemic infections such as meningoencephalitis and pulmonary infection. Urinary involvement of Cryptococcus is sometimes reported among cases of disseminated cryptococcosis in AIDS patients, but no such reports have been published in Korea. We report two cases of cryptococcuria that developed in a 71-year old female with diabetes and liver cirrhosis and in a 50-year old male who received a liver transplant due to HBV-associated hepatic failure. The female patient had received prednisolone for 12 days before we detected C. neoformans in urine culture. Even though no antifungal therapy was indicated for cryptococcuria, following urine culture became negative, but still positive for cryptococcal antigen on hospital day 25. Her blood, CSF culture, and antigen tests were negative, and therefore she was diagnosed with isolated cryptococcuria. The male patient had received prednisolone and tacrolimus for 10 days before sputum and urine cultures became positive for C. neoformans. He had ill defined nodules and pleural effusion in both lungs on chest CT. His cryptococcuria was sustained for over 2 months, despite receiving amphotericin B treatment. His cryptococcuria seemed to be a symptom of disseminated cryptococcosis. (Korean J Clin Microbiol 2011;14:148-152)

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Cryptococcal antigen detection from the urine of AIDS patients

Cited by 19 publications

References 14 publications

In Vivo Clearance of Glucuronoxylomannan, the Major Capsular Polysaccharide ofCryptococcus neoformans:A Critical Role for Tissue Macrophages

In Vivo Clearance of Glucuronoxylomannan, the Major Capsular Polysaccharide ofCryptococcus neoformans:A Critical Role for Tissue Macrophages

Cryptococcus gattii Infections

Two Cases of Cryptococcuria Developed as Isolated Cryptococcuria and Disseminated Cryptococcosis

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