Cryptococcosis in patients with diabetes mellitus <scp>II</scp> in mainland China: 1993‐2015

Li, Yingfang; Fang, Wenzhang; Jiang, Weiwei; Hagen, Ferry; Liu, Jia; Zhang, Lei; Hong, Nan; Zhu, Yu; Xu, Xianlin; Lei, Xia; Deng, Di; Xu, Jianping; Liao, Wanqing; Boekhout, Teun; Chen, Min; Pan, Weihua

doi:10.1111/myc.12645

Cited by 31 publications

(27 citation statements)

References 36 publications

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“…Li et al in another study reported a hospital-based prevalence of cryptococcosis in Type II diabetes of 0.21% where infection was associated with poor control of diabetes. Mortality is reported to be 33% [49].…”

Section: Epidemiologymentioning

confidence: 99%

Central Nervous System Cryptococcal Infections in Non-HIV Infected Patients

Beardsley

Sorrell

Chen

2019

JoF

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Central nervous system (CNS) cryptococcosis in non-HIV infected patients affects solid organ transplant (SOT) recipients, patients with malignancy, rheumatic disorders, other immunosuppressive conditions and immunocompetent hosts. More recently described risks include the use of newer biologicals and recreational intravenous drug use. Disease is caused by Cryptococcus neoformans and Cryptococcus gattii species complex; C. gattii is endemic in several geographic regions and has caused outbreaks in North America. Major virulence determinants are the polysaccharide capsule, melanin and several ‘invasins’. Cryptococcal plb1, laccase and urease are essential for dissemination from lung to CNS and crossing the blood–brain barrier. Meningo-encephalitis is common but intracerebral infection or hydrocephalus also occur, and are relatively frequent in C. gattii infection. Complications include neurologic deficits, raised intracranial pressure (ICP) and disseminated disease. Diagnosis relies on culture, phenotypic identification methods, and cryptococcal antigen detection. Molecular methods can assist. Preferred induction antifungal therapy is a lipid amphotericin B formulation (amphotericin B deoxycholate may be used in non-transplant patients) plus 5-flucytosine for 2–6 weeks depending on host type followed by consolidation/maintenance therapy with fluconazole for 12 months or longer. Control of raised ICP is essential. Clinicians should be vigilant for immune reconstitution inflammatory syndrome.

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Section: Epidemiologymentioning

confidence: 99%

Central Nervous System Cryptococcal Infections in Non-HIV Infected Patients

Beardsley

Sorrell

Chen

2019

JoF

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“…The risk of mycoses increases 1.38‐fold in patients with diabetes, and diabetes is widely recognized as a risk factor for invasive pulmonary aspergillosis. Uncontrolled hyperglycemia contributes to a poor prognosis of type 2 diabetes patients with cryptococcosis. Diabetes is a potential risk factor for IFD caused by unusual fungi, such as Histoplasma capsulatum .…”

Section: Introductionmentioning

confidence: 99%

Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors

Lao

Jin

et al. 2019

J of Diabetes Invest

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Aims/Introduction: A retrospective study was carried out to investigate the clinical characteristics and associated factors for invasive fungal disease in patients with type 2 diabetes mellitus. Materials and Methods: Demographic and clinical data were recorded. Associated factors were analyzed by logistic regression analysis. Results: Invasive fungal disease was diagnosed in 120 patients with type 2 diabetes mellitus (prevalence, 0.4%). Yeast infection (56/120, 46.7%), including candidiasis (31/56, 55.4%) and cryptococcosis (25/56, 44.6%), was the most common. The urinary tract was mainly involved in candidiasis (12/31, 38.7%). More than half of the cryptococcosis (16/25, 64.0%) presented as pneumonia. Mold infection accounted for 40.8% of the cases, and predominantly involved the lung (34/49, 69.4%). A total of 15 (12.5%) patients had mixed fungal infection. Candida albicans (24/111, 21.6%), Cryptococcus neoformans (19/111, 17.1%) and Aspergillus fumigatus (14/111, 12.6%) were the leading agents. Co-infection occurred in 58 (48.3%) patients, mainly presenting as pneumonia caused by Gram-negative bacteria.The inpatient mortality rate of invasive fungal disease was 23.3% (28/120). Glycated hemoglobin levels were higher in non-survivors than survivors (8.8 -2.5 vs 7.7 -2.1%, P = 0.02). Anemia (adjusted odds ratio, 3.50, 95% confidence interval 1.95-6.27, P < 0.001), hypoalbuminemia (adjusted odds ratio, 5.42, 95% confidence interval 3.14-9.36, P < 0.001) and elevated serum creatinine (adjusted odds ratio, 2.08, 95% confidence interval 1.07-4.04, P = 0.03) were associated with invasive fungal disease in type 2 diabetes mellitus patients. Conclusions: Invasive fungal disease is a life-threatening complication in type 2 diabetes mellitus patients. C. a albicans, C. neoformans, and A. fumigatus are the leading agents. Prolonged hyperglycemia results in unfavorable outcomes. Correction of anemia and hypoalbuminemia might improve prognosis.

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“…In conclusion, this case demonstrates that with the rising prevalence of diabetes in Sub-Saharan Africa, just like in China, cryptococcal meningitis should be considered in the differential diagnosis for diabetic patients presenting with chronic headache accompanied with fever and neurologic deficits [17]. It is important to note that presentations may be dramatic and the outcomes grave due to the paradoxically exaggerated immune response to C. neoformans [18].…”

Section: Discussionmentioning

confidence: 99%

CRYPTOCOCCAL meningitis in a HIV negative newly diagnosed diabetic patient: a CASE report

Owuor

Chege

2019

BMC Infect Dis

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BackgroundThis case report emphasizes the need to recognize cryptococcus as a possible cause of meningitis in non-HIV patients in Sub-Saharan Africa and to highlight the possibility of grave outcomes due to the paradoxical immune response in diabetic patients with cryptococcus meningitis. It also highlights the need for widespread availability of amphotericin-B and flucytosine in hospitals in Sub-Saharan Africa.Case presentationA 27 year old African lady was admitted with generalized tonic clonic seizures lasting 5 to 10 min. These seizures were preceded by severe frontal headaches radiating to the occiput and neck and associated with chills, photophobia and loss of consciousness. She was tachycardic and had tongue bites on the lateral aspects of her tongue. Kernig’s and Brudzinski’s signs were positive. India ink was positive on two cerebrospinal fluid (CSF) samples. She had hyperglycemia and glucosuria as well. She was diagnosed with cryptococcal meningitis in diabetes and had a remarkable response to fluconazole monotherapy. She went home on maintenance dose of fluconazole having made full recovery. and is currently on prophylactic doses of fluconazole.ConclusionsWith the rising prevalence of diabetes in Sub-Saharan Africa, coupled with the low levels of adequate glucose control, cryptococcal meningitis should be considered in the differential diagnosis for diabetic patients presenting with chronic headache, fever and neurologic deficits.

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Cryptococcosis in patients with diabetes mellitus II in mainland China: 1993‐2015

Cited by 31 publications

References 36 publications

Central Nervous System Cryptococcal Infections in Non-HIV Infected Patients

Central Nervous System Cryptococcal Infections in Non-HIV Infected Patients

Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors

CRYPTOCOCCAL meningitis in a HIV negative newly diagnosed diabetic patient: a CASE report

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