Granuloma and cryptococcosis

Shibuya, Kazutoshi; Hirata, A.; Omuta, Junko; Sugamata, Miho; Katori, Susumu; Saito, Norihiko; Murata, Naoki; Morita, Ayako; Takahashi, K.; Hasegawa, Chikako; Mitsuda, Aki; Hatori, Tsutomu; Nonaka, Hiroko

doi:10.1007/s10156-005-0387-x

Cited by 82 publications

(82 citation statements)

References 37 publications

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“…Nonenhanced, low-attenuation areas within the areas of consolidation or masses, previously shown to represent gelatinous collections of large numbers of fungal organisms or rarely ischemic necrosis (12,15,16) were also frequently demonstrated on CT images in our study but have rarely been described (17). Calcification within the pulmonary lesion, as shown in one of our cases, is also rare (14,15,17,18).…”

Section: Discussionsupporting

confidence: 61%

Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment

Suwatanapongched

Sangsatra²,

Boonsarngsuk³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to investigate clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment. MATERIALS AND METHODSWe retrospectively reviewed the medical records, initial and follow-up chest computed tomography scans and/or radiographs for initial clinical and radiologic manifestations and outcomes following antifungal treatment of 12 immunocompetent patients diagnosed with pulmonary cryptococcosis between 1990 and 2012. RESULTSTwelve patients (age range, 21-62 years; males, eight patients [66.7%]) were included. Nine (75%) patients were symptomatic, eight of whom had disseminated infection with central nervous system involvement. Initial pulmonary abnormalities consisted of single nodules/masses (n=5), single segmental or lobar mass-like consolidation (n=3), multiple cavitary and noncavitary nodules (n=1), and multifocal consolidation plus nodules (n=3). These lesions ranged from less than 1 cm to 15 cm in greatest diameter. Distinct subpleural and lower lung predominance was observed. Seven patients (58.3%) had one or more atypical/aggressive findings, namely endobronchial obstruction (n=4), calcified (n=1) or enlarged (n=4) mediastinal/hilar lymph nodes, vascular compression (n=1), pericardial involvement (n=1), and pleural involvement (n=2). Following antifungal therapy, radiologic resolution was variable within the first six months of eight nonsurgical cases. Substantial (>75%) improvement with some residual abnormalities, bronchiectasis, cavitation, and/or fibrotic changes were frequently observed after 12-24 months of treatment (n=6). CONCLUSIONPulmonary cryptococcosis in immunocompetent patients frequently causes disseminated infection with atypical/aggressive radiologic findings that are gradually and/or incompletely resolved after treatment. The presence of nonenhanced low-attenuation areas within subpleural consolidation or mass and the absence of tree-in-bud appearance should raise concern for pulmonary cryptococcosis, particularly in patients presenting with meningitis.

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Section: Discussionsupporting

confidence: 61%

Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment

Suwatanapongched

Sangsatra²,

Boonsarngsuk³

et al. 2013

Diagn Interv Radiol

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“…In individuals with impaired T-cell function, the cryptococcal lesion shows marked intracellular yeast-cell proliferation with a histiocytic response, and only minor lymphocytic and neutrophilic components. Giant cells, if present, are scarce, and well-defined granulomas are not found [10]. In the present case, the histopathology of gingival biopsies showed a massive proliferation of cryptococci and reactive macrophages with minor lymphocytic infiltrate accompanied by marked hyperplastic oral epithelium that surrounded the organisms.…”

Section: Discussionmentioning

confidence: 40%

14th International Congress IAOP/AAOMP Clinical Pathology Conference Case 6

Delgado

León

2008

Head and Neck Pathol

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The clinicopathologic features of oral cryptococcosis manifested as multifocal tumor-like lesions located in the upper and lower gingival tissues of a 36-year-old male patient with AIDS are described. The gingival lesions were the initial manifestation of disseminated cryptococcosis from which central nervous system involvement was established. Clinical differential diagnosis and histopathologic features are discussed. Effect of treatment on the gingival lesions after 18 months follow-up is presented.Keywords Cryptococcosis Á Diagnosis Á HIV Á Acquired immunodeficiency syndrome Á Gingiva Clinical PresentationA 36-year-old male patient with AIDS suffered with headaches for several months and was sent for consultation because he presented with mass lesions located in the gingivae of the anterior part of the maxilla, mandible, and left tuberosity. He was asymptomatic and mentioned that he had noticed the gingival enlargements for approximately 3 months. The upper and lower incisors presented moderate mobility. The patient had not received highly active antiretroviral therapy (HAART).Clinically the lesions appeared as tumor-like masses, with erythematous color, granular texture and microulcerations covered by serous secretions and some bleeding. Both buccal and lingual/palatal gingiva were involved.

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“…(42) The reactive pattern is characterized by a granulomatous inflammatory response composed of histiocytes, multinucleated giant cells and lymphocytic infiltration. (41)(42)(43)(44)(45)(46) The yeasts are primarily intracellular (phagocytosis). (41,46) Regions of necrosis are occasionally associated with neutrophilic infiltrates.…”

Section: Histopathological Examinationmentioning

confidence: 99%

“…(41)(42)(43)(44)(45)(46) The yeasts are primarily intracellular (phagocytosis). (41,46) Regions of necrosis are occasionally associated with neutrophilic infiltrates. (42,43,46) Fibrotic nodules-cryptococcomas, considered to be a variant of the reactive pattern-are also found.…”

Section: Histopathological Examinationmentioning

confidence: 99%

“…(41,46) Regions of necrosis are occasionally associated with neutrophilic infiltrates. (42,43,46) Fibrotic nodules-cryptococcomas, considered to be a variant of the reactive pattern-are also found. Fibrotic nodules are formed by surrounding fibrotic tissue and present central areas of necrosis that contain yeasts and a variable number of inflammatory cells (Figure 4).…”

Section: Histopathological Examinationmentioning

confidence: 99%

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Capítulo 3: criptococose pulmonar

Severo

Gazzoni²,

Severo

2009

J. bras. pneumol.

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on the agglutination reactions of capsular polysaccharide antigens. Serotype A and serotype D strains, as well as the AD hybrid, are classified as C. neoformans, whereas serotype B and serotype C strains have been classified as C. gattii. Serotype A strains have been designated C. neoformans var. grubii, whereas serotype D strains have been designated C. neoformans var. neoformans.(3) This classification was based on the differences in capsular structure and DNA between the strains, as well as on a complete comparison of the genomic sequencing of these two serotypes (strains).(3) In addition, based on new molecular data and on evolutionary studies, IntroductionCryptococcosis is an infection caused by the naturally encapsulated basidiomycete of the genus Cryptococcus, which has recently become the most relevant opportunistic fungal pathogen.(1) The infection caused by the species C. neoformans has become the most critically relevant opportunistic infection as a consequence of the AIDS epidemic. In addition, C. gattii recently caused an isolated cryptococcosis outbreak among apparently immunocompetent humans and animals on Vancouver Island, Canada. AbstractCryptococcosis is a systemic mycosis caused by two species of the encapsulated basidiomycetes, Cryptococcus neoformans and C. gattii, which, respectively, cause infection in immunocompromised individuals and in immunologically normal hosts. Patients with T-cell deficiencies are more susceptible to this infection. The spectrum of the disease ranges from asymptomatic pulmonary lesions to disseminated infection with meningoencephalitis. The medical relevance of cryptococcosis increased dramatically as a consequence of the AIDS epidemic and organ transplants.Keywords: Cryptococcus neoformans; Pneumonia; Acquired immunodeficiency syndrome; Amphotericin B; Fluconazole. ResumoCriptococose é uma micose sistêmica causada por duas espécies do basidiomiceto encapsulado, Cryptococcus neoformans e C. gattii, que, respectivamente, causam infecção em indivíduos imunocomprometidos e em hospedeiros imunocompetentes, respectivamente. Pacientes com deficiência em células T são mais suscetíveis. A infecção se inicia por lesões pulmonares assintomáticas e a doença disseminada frequentemente cursa com meningoencefalite. A importância médica da criptococose aumentou significativamente em consequência da epidemia da AIDS e dos transplantes de órgãos.

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Granuloma and cryptococcosis

Cited by 82 publications

References 37 publications

Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment

Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment

14th International Congress IAOP/AAOMP Clinical Pathology Conference Case 6

Capítulo 3: criptococose pulmonar

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