Disseminated Cryptococcosis in An Immunocompetent Host Presenting As Osteomyelitis and Leading to Adrenal Insufficiency

Hsu, Emory; Webster, Sara Markley; Nanes, Mark S.

doi:10.1016/j.amjms.2020.12.007

Cited by 12 publications

(9 citation statements)

References 16 publications

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“…Similarly, we identified several fungi including Aspergillus, Candida, Cladophialophora, Cryptococcus, Pneumocystis, and Rhizopus species, found widespread in nature, that mostly cause opportunistic infections. However, Cryptococcus neoformans and Cryptococcus gattii, detected in the study in 4.2% of the pools, are documented to produce severe infections in immunocompetent individuals as well (May et al, 2016;Hsu et al, 2022). Infections and genotypes of Cryptococcus species have been previously reported from Kenya (Kangogo et al, 2015).…”

Section: Discussionmentioning

confidence: 54%

Metagenomic Investigation of Ticks From Kenyan Wildlife Reveals Diverse Microbial Pathogens and New Country Pathogen Records

Ergünay

Mutinda²,

Bourke³

et al. 2022

Front. Microbiol.

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Focusing on the utility of ticks as xenosurveillance sentinels to expose circulating pathogens in Kenyan drylands, host-feeding ticks collected from wild ungulates [buffaloes, elephants, giraffes, hartebeest, impala, rhinoceros (black and white), zebras (Grévy’s and plains)], carnivores (leopards, lions, spotted hyenas, wild dogs), as well as regular domestic and Boran cattle were screened for pathogens using metagenomics. A total of 75 host-feeding ticks [Rhipicephalus (97.3%) and Amblyomma (2.7%)] collected from 15 vertebrate taxa were sequenced in 46 pools. Fifty-six pathogenic bacterial species were detected in 35 pools analyzed for pathogens and relative abundances of major phyla. The most frequently observed species was Escherichia coli (62.8%), followed by Proteus mirabilis (48.5%) and Coxiella burnetii (45.7%). Francisella tularemia and Jingmen tick virus (JMTV) were detected in 14.2 and 13% of the pools, respectively, in ticks collected from wild animals and cattle. This is one of the first reports of JMTV in Kenya, and phylogenetic reconstruction revealed significant divergence from previously known isolates and related viruses. Eight fungal species with human pathogenicity were detected in 5 pools (10.8%). The vector-borne filarial pathogens (Brugia malayi, Dirofilaria immitis, Loa loa), protozoa (Plasmodium spp., Trypanosoma cruzi), and environmental and water-/food-borne pathogens (Entamoeba histolytica, Encephalitozoon intestinalis, Naegleria fowleri, Schistosoma spp., Toxoplasma gondii, and Trichinella spiralis) were detected. Documented viruses included human mastadenovirus C, Epstein-Barr virus and bovine herpesvirus 5, Trinbago virus, and Guarapuava tymovirus-like virus 1. Our findings confirmed that host-feeding ticks are an efficient sentinel for xenosurveillance and demonstrate clear potential for wildlife-livestock-human pathogen transfer in the Kenyan landscape.

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Section: Discussionmentioning

confidence: 54%

Metagenomic Investigation of Ticks From Kenyan Wildlife Reveals Diverse Microbial Pathogens and New Country Pathogen Records

Ergünay

Mutinda²,

Bourke³

et al. 2022

Front. Microbiol.

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“…These primary adrenal insufficiency symptoms include fatigue, anorexia, hypotension, hyperkalemia, hyponatremia, skin hyperpigmentation, and hypoglycemia, with sudden death also possibly being a presenting symptom [ 17 , 18 , 19 ]. In previous reports [ 5 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ], adrenal gland involvement of cryptococci has been typically associated with disseminated disease, with CNS, or lung infections [ 5 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 30 , 32 , 33 , 36 , 37 ], but several exceptions exist in the literature (for complete list of previous cases with adrenal gland involvement see Table S2 [ 5 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 3...…”

Section: Discussionmentioning

confidence: 99%

“…In previous reports [ 5 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ], adrenal gland involvement of cryptococci has been typically associated with disseminated disease, with CNS, or lung infections [ 5 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 30 , 32 , 33 , 36 , 37 ], but several exceptions exist in the literature (for complete list of previous cases with adrenal gland involvement see Table S2 [ 5 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ])....…”

Section: Discussionmentioning

confidence: 99%

Diffuse Adrenal Gland and Pancreas Necrosis in a Patient with Disseminated Cryptococcosis—Case Report

Wappler-Guzzetta

Gray

Dagostino

et al. 2022

Life

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(1) Background: Cryptococcus neoformans is mostly known for causing meningitis, with or without disseminated disease. (2) Case presentation: An immunocompromised 75-year-old gentleman presented post renal transplant with generalized weakness, altered mental status, hypoxemia, and hyponatremia, and was found to have disseminated cryptococcal infection. After an initial improvement, the patient became suddenly hypotensive, and passed away soon after. The autopsy revealed widespread cryptococcal involvement, with the most severely affected organs being the brain, lungs, pancreas, adrenal glands, and spleen. The pancreas and one of the adrenal glands revealed diffuse granulomatous cryptococcal infection, with large areas of necrosis. The spleen also showed a large area of cryptococcal necrosis. In addition, the patient had chylous ascites, without histologically identifiable organisms. (3) Conclusions: This is a rare case of disseminated cryptococcal infection with severe necrotizing adrenalitis and pancreatitis, in addition to significant spleen, lung, and central nervous system involvement. The early recognition and treatment of the adrenal gland and pancreas cryptococcosis with surgical interventions may lead to better outcomes in affected patients. Furthermore, steroid treatment and diabetes mellitus may be risk factors for adrenal gland involvement. Additionally, clinicians should keep cryptococcal infection in their differential diagnosis for isolated adrenal gland and pancreas lesions.

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“…Cryptococcosis in immunocompetent people is infrequent, and isolated cryptococcal osteomyelitis is extremely rare [ 13 , 15 , 16 ]. The spine vertebrae are considered the most common site of cryptococcal osteomyelitis [ 12 – 14 ]; however, its incidence remains low, and the preferred section of the spine for Cryptococcus infection remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Isolated cryptococcal osteomyelitis of the sacrum in an immunocompetent patient: a case report and literature review

et al. 2023

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Background Cryptococcus neoformans, an opportunistic fungal pathogen, seldom causes infection in immunocompetent people. Cryptococcal osteomyelitis is an uncommon condition in which Cryptococcus invades the bone. It usually occurs as part of a disseminated infection and rarely in isolation. The spine has been reported as the most common site of cryptococcal osteomyelitis; however, isolated case of sacrum involvement in immunocompetent patients has never been reported. Case presentation We report the case of a 37-year-old man without underlying disease who presented with progressive low back and sacrococcygeal pain. The patient was initially diagnosed with sacral tumour by a local doctor, and subsequently, after admission, was diagnosed with sacral tuberculosis. He was empirically treated with antitubercular drugs. The patient failed to respond to antitubercular drugs and complained of worsening low back pain. Additionally, he developed persistent radiating pain and numbness in his legs. For further diagnosis, we performed a computed tomography-guided puncture biopsy of the sacrum, which revealed granulomatous inflammation with massive macrophage infiltration and special staining revealed a fungal infection. We performed sacral debridement and drainage and obtained purulent specimens for pathological examination and microbial culture. Microbial identification and drug susceptibility tests revealed a Cryptococcus neoformans infection sensitive to fluconazole. Postoperatively, the persistent radiating pain and numbness in the legs resolved. After 12 consecutive weeks of antifungal therapy, all his symptoms resolved. The patient remained without any signs of recurrence at the 8-month follow-up. Conclusion We reported a rare case of isolated sacrum cryptococcal osteomyelitis in an immunocompetent patient. Furthermore, we identified and reviewed 18 published cases of spine cryptococcal osteomyelitis. Immunocompetent individuals are also at risk for cryptococcal osteomyelitis. Clinical manifestation and imaging are insufficient to diagnose cryptococcal osteomyelitis of the spine, and invasive examinations, such as puncture biopsy and fungal examinations, are needed. Antifungal therapy yields satisfactory results for the treatment of cryptococcal osteomyelitis of the spine, however, if the infective lesion is large, especially when it compresses the spinal cord and nerves, a regimen combining aggressive surgery with antifungal therapy is indispensable.

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Disseminated Cryptococcosis in An Immunocompetent Host Presenting As Osteomyelitis and Leading to Adrenal Insufficiency

Cited by 12 publications

References 16 publications

Metagenomic Investigation of Ticks From Kenyan Wildlife Reveals Diverse Microbial Pathogens and New Country Pathogen Records

Metagenomic Investigation of Ticks From Kenyan Wildlife Reveals Diverse Microbial Pathogens and New Country Pathogen Records

Diffuse Adrenal Gland and Pancreas Necrosis in a Patient with Disseminated Cryptococcosis—Case Report

Isolated cryptococcal osteomyelitis of the sacrum in an immunocompetent patient: a case report and literature review

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