Cryptococcus neoformans-Meningoencephalitis und Mehrfachinfektionen bei AIDS

Zoller, WG; Kellner, H.; Goebel, F. D.; Schmiedtke, K.; Holecek, Brigitte U.; Staib, F.; Seibold, Michael; Zöllner, N.

doi:10.1007/bf01721688

Cited by 7 publications

(3 citation statements)

References 14 publications

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“…AIDS, the end stage of HIV infection [ 27 ], is characterized by profound impairment of CMI [ 5 – 11 ], which predisposes people to invasive C . neoformans diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Current understanding of the pathogenesis of invasive cryptococcal diseases is primarily based on clinical case series [ 5 – 11 ] and mouse experiments [ 12 – 17 ], which suggest that host conditions that impair cell-mediated immunity (CMI) (e.g., human immunodeficiency virus [HIV] infection with acquired immunodeficiency syndrome [AIDS], immunosuppressive therapy) play a critical role. Liver cirrhosis has also been reported as a condition that may increase the risk of cryptococcosis [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Invasive Cryptococcus neoformans Diseases: A Case-Control Study

2015

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Background Cryptococcus neoformans is a ubiquitous environmental fungus that can cause life-threatening meningitis and fungemia, often in the presence of acquired immunodeficiency syndrome (AIDS), liver cirrhosis, diabetes mellitus, or other medical conditions. To distinguish risk factors from comorbidities, we performed a hospital-based, density-sampled, matched case-control study.MethodsAll new-onset cryptococcal meningitis cases and cryptococcemia cases at a university hospital in Taiwan from 2002–2010 were retrospectively identified from the computerized inpatient registry and were included in this study. Controls were selected from those hospitalized patients not experiencing cryptococcal meningitis or cryptococcemia. Controls and cases were matched by admission date, age, and gender. Conditional logistic regression was used to analyze the risk factors.ResultsA total of 101 patients with cryptococcal meningitis (266 controls) and 47 patients with cryptococcemia (188 controls), of whom 32 patients had both cryptococcal meningitis and cryptococcemia, were included in this study. Multivariate regression analysis showed that AIDS (adjusted odds ratio [aOR] = 181.4; p < 0.001), decompensated liver cirrhosis (aOR = 8.5; p = 0.008), and cell-mediated immunity (CMI)-suppressive regimens without calcineurin inhibitors (CAs) (aOR = 15.9; p < 0.001) were independent risk factors for cryptococcal meningitis. Moreover, AIDS (aOR = 216.3, p < 0.001), decompensated liver cirrhosis (aOR = 23.8; p < 0.001), CMI-suppressive regimens without CAs (aOR = 7.3; p = 0.034), and autoimmune diseases (aOR = 9.3; p = 0.038) were independent risk factors for developing cryptococcemia. On the other hand, diabetes mellitus and other medical conditions were not found to be risk factors for cryptococcal meningitis or cryptococcemia.ConclusionsThe findings confirm AIDS, decompensated liver cirrhosis, CMI-suppressive regimens without CAs, and autoimmune diseases are risk factors for invasive C. neoformans diseases.

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“…AIDS, the end stage of HIV infection [ 27 ], is characterized by profound impairment of CMI [ 5 – 11 ], which predisposes people to invasive C . neoformans diseases.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Invasive Cryptococcus neoformans Diseases: A Case-Control Study

2015

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“…The incidence of cryptococcosis, which is a frequent lifethreatening infection among patients with AIDS, is increasing in AIDS patients (81,121,144,166,239,448,528,529). Cryptococcosis is the first manifestation of HIV infection in 26 to 45% of patients (81,239), and recent data indicate that C. neoformans appears to potentiate HIV infection (357,394).…”

Section: Interaction Between C Neoformans and Hivmentioning

confidence: 99%

Cryptococcosis in the era of AIDS--100 years after the discovery of Cryptococcus neoformans

1995

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Although Cryptococcus neoformans and cryptococcosis have existed for several millennia, a century has passed since the discovery of this encapsulated yeast and its devastating disease. With the advent of the AIDS pandemic, cryptococcal meningitis has emerged as a leading cause of infectious morbidity and mortality and a frequently life-threatening opportunistic mycosis among patients with AIDS. Both basic and clinical research have accelerated in the 1990s, and this review attempts to highlight some of these advances. The discussion covers recent findings, current concepts, controversies, and unresolved issues related to the ecology and genetics of C. neoformans; the surface structure of the yeast; and the mechanisms of host defense. Regarding cell-mediated immunity, CD4+ T cells are crucial for successful resistance, but CD8+ T cells may also participate significantly in the cytokine-mediated activation of anticryptococcal effector cells. In addition to cell-mediated immunity, monoclonal antibodies to the major capsular polysaccharide, the glucuronoxylomannan, offer some protection in murine models of cryptococcosis. Clinical concepts are presented that relate to the distinctive features of cryptococcosis in patients with AIDS and the diagnosis, treatment, and prevention of cryptococcosis in AIDS patients.

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