CRYPTOCOCCOSIS: A bibliographic narrative review on antifungal resistance

KAKIZAKI, MARIA ISMÊNIA T.; MELHEM, MARCIA DE S.C.

doi:10.1590/0001-3765202320220862

Cited by 3 publications

(1 citation statement)

References 61 publications

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“…They can also lead to some neurological clinical conditions such as meningitis, meningoencephalitis, and cryptococcomas. 4 Regardless of the decreasing rate of cryptococcosis, world still has a high cryptococcal infection incidence in immunocompromised patients. 5 Despite the increase in information about this pathogen and the improvement of patients' prognosis, mortality due to cryptococcal meningoencephalitis is high, with ranging between 24% and 47% in different trials.…”

Section: Intorductionmentioning

confidence: 99%

Cryptococcal meningoencephalitis and pneumonia in a HIV positive patient: A case report

Mehdinezhad,

Ghadir,

Maleh

et al. 2024

Clinical Case Reports

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Key Clinical MessagesEarly diagnosis of cryptococcal infection is the key to improving outcomes, any newly diagnosed HIV patient presenting with subacute or chronic headache, particularly those who are CD4‐deplete, should be investigated for cryptococcal meningitis. We had some delay in our patient management, including delay in HIV diagnosis, delay in doing LP and delay in initiation of anti‐cryptococcal treatment and also early start of ART before specific cryptococcal treatment exacerbated IRIS in the patient. So, paying attention to these points can improve the prognosis of such patients.AbstractCryptocccus is a fungal pathogen and the causative agent of Cryptococcosis among human immunodeficiency virus (HIV) positive people. Meningoencephalitis is the most common manifestation of cryptococcal infection, while pulmonary cryptococcosis is often neglected due to nonspecific clinical and radiological presentation leading to a delay in diagnosis and disseminated disease. Here, we reported a 67‐year‐old man with newly diagnosed HIV who presented with concurrent cryptococcal meningoencephalitis and pulmonary cryptococcosis that admitted with the complaint of dyspnea and productive cough for 1.5 months, worsening shortness of breath, fever and weight loss since 15 days prior to admission. He also had severe oral candidiasis. Lung computed tomography (CT) revealed ill‐defined subpleural cavitary lesion in left lower zone with bilateral diffuse ground glass opacity and air bronchogram. His HIV PCR test was positive with absolute CD4 count less than 50 cells/mm3. After starting antiretroviral therapy (ART), he gradually developed a headache and decreased level of consciousness. Cerebrospinal fluid (CSF) analysis revealed 450 cells, predominantly lymphocytes, with protein of 343 mg/dL and glucose of 98 mg/dL (corresponding blood glucose 284 mg/dL). CSF India ink staining was positive for crypococcus spp. Liposomal amphotericin B in combination with fluconazole (due to the unavailability of flucytosin) was stated. He was intubated because of hypoxia and his bronchoalveolar lavage was positive for Cryptococcus spp. too. He died 2 weeks after starting antifungal therapy based on this study it should be mentioned that neurologic and respiratory symptoms may be the first presentation of acquired immunodeficiency syndrome.

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Section: Intorductionmentioning

confidence: 99%

Cryptococcal meningoencephalitis and pneumonia in a HIV positive patient: A case report

Mehdinezhad,

Ghadir,

Maleh

et al. 2024

Clinical Case Reports

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Antifungal susceptibility testing: applicability of methods and strategies for improving access in resource-constrained settings

Kwizera,

Abdolrasouli,

Garcia-Effron

et al. 2024

The Lancet Infectious Diseases

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Evolution of Laboratory Diagnostics for Cryptococcosis and Missing Links to Optimize Diagnosis and Outcomes in Resource-Constrained Settings

Kwizera,

Kiiza,

Akampurira

et al. 2024

Open Forum Infectious Diseases

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Cryptococcal meningitis is one of the leading causes of death in sub-Saharan Africa among advanced HIV disease patients. Early diagnosis is crucial in improving treatment outcomes. Despite advances and the availability of modern and point-of-care diagnostics for cryptococcosis, gaps still exist in resource-constrained settings leading to unfavorable treatment outcomes. Here, we review the current outstanding issues or missing links that need to be filled to optimize the diagnosis of cryptococcosis in resource-constrained settings to improve treatment outcomes. We highlight the evolution of cryptococcosis diagnostics, the role of early fungicidal activity, CrAg titres, antifungal susceptibility testing, therapeutic drug monitoring and the missing links to optimize diagnosis and outcomes, including some practical recommendations.

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CRYPTOCOCCOSIS: A bibliographic narrative review on antifungal resistance

Cited by 3 publications

References 61 publications

Cryptococcal meningoencephalitis and pneumonia in a HIV positive patient: A case report

Cryptococcal meningoencephalitis and pneumonia in a HIV positive patient: A case report

Antifungal susceptibility testing: applicability of methods and strategies for improving access in resource-constrained settings

Evolution of Laboratory Diagnostics for Cryptococcosis and Missing Links to Optimize Diagnosis and Outcomes in Resource-Constrained Settings

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