Pleural Cryptococcosis in the Acquired Immune Deficiency Syndrome

Newman, Thomas; Soni, Anita; Acaron, Sifredo; Huang, Chin Tang

doi:10.1378/chest.91.3.459

Cited by 51 publications

(16 citation statements)

References 7 publications

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“…Although the lungs, central nervous system, and skin are often involved, pleural effusion (2,3) and ascites (4) are rare. Here, we report a case of disseminated cryptococcosis complicated with pulmonary lesions, bilateral pleural effusion, and ascites, and also discuss the significance of cryptococcal antigen.…”

Section: Introductionmentioning

confidence: 99%

Disseminated Cryptococcosis Complicated with Bilateral Pleural Effusion and Ascites during Corticosteroid Therapy for Organizing Pneumonia with Myelodysplastic Syndrome

et al. 2008

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Section: Introductionmentioning

confidence: 99%

Disseminated Cryptococcosis Complicated with Bilateral Pleural Effusion and Ascites during Corticosteroid Therapy for Organizing Pneumonia with Myelodysplastic Syndrome

et al. 2008

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“…Among pulmonary infections, pleural cryptococcosis is extremely rare, and, for the early diagnosis, it is important to pay attention to immuno-deficientive status such as acquired immuno-deficiency syndrome (AIDS) (2).…”

Section: Introductionmentioning

confidence: 99%

Pleural Cryptococcosis with Idiopathic CD4 Positive T-lymphocytopenia

et al. 2004

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A 19-year-old man was admitted to our hospital because of chest pain. He was diagnosed as having pleural cryptococcosis by pleural biopsy. His CD4 positive Tlymphocyte count was low (<300 µl) and there was no evidence of human immunodeficiency virus infection. He was successfully treated with fluconazole. However, his CD4 positive lymphocyte counts remained low after the recovery and he was diagnosed as idiopathic CD4 positive T-lymphocytopenia. Pleural cryptococcosis is rare and its predisposing condition is still controversial. To our knowledge, this is the first case of pleural cryptococcosis associated with idiopathic CD4 positive T lymphocytopenia. (Internal Medicine 43: 977-981, 2004)

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“…The AMB concentration in the pleural effusion from patient 7, who had received a cumulative dose of 12,750 mg of ABLC, reached 0.18 g/ml (penetration ratio, 44%). The respective level in plasma was as low as 0.4 g/ml.Since several mycoses, such as candidiasis, aspergillosis, blastomycosis, histoplasmosis, cryptococcosis, and coccidioidomycosis, can cause pleural manifestations (5,6,9,11,13,20), AMB concentrations in pleural effusions can be crucial for …”

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confidence: 99%

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confidence: 99%

“…Since several mycoses, such as candidiasis, aspergillosis, blastomycosis, histoplasmosis, cryptococcosis, and coccidioidomycosis, can cause pleural manifestations (5,6,9,11,13,20), AMB concentrations in pleural effusions can be crucial for clinical response. After treatment with AMB lipid formulations, AMB concentrations were substantially lower in pleural effusions than in plasma samples and lung tissue (19).…”

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Penetration of Amphotericin B Lipid Formulations into Pleural Effusion

Weiler

Bellmann‐Weiler²,

Joannidis

et al. 2007

Antimicrob Agents Chemother

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The penetration of the amphotericin B (AMB) lipid formulations (liposomal AMB, AMB colloidal dispersion, and AMB lipid complex formulations) into pleural effusions in seven critically ill patients was assessed. AMB was detected in all pleural effusion samples at concentrations ranging from 0.02 to 0.43 g/ml. The penetration ratio was 3 to 44%.Invasive fungal infections are a major cause of morbidity and mortality in immunocompromised patients, particularly when the pleural compartment is affected (9). Although many studies on the penetration of antibacterial agents into pleural effusions have been performed, less attention has been paid to target site concentrations of antimycotic drugs in pleural effusions (2, 8, 12, 15-17, 22, 23). Amphotericin B (AMB) lipid formulations have been introduced in therapy to reduce the toxicity of AMB. The lipid moieties of liposomal AMB (LAMB), the AMB colloidal dispersion formulation (ABCD), and the AMB lipid complex (ABLC) exhibit different compositions, structures, and particle sizes, which are reflected in different plasma pharmacokinetics and degrees of lung penetration (1,7,19,21). The aim of the present study was to investigate AMB penetration into pleural effusions during treatment with LAMB, ABCD, or ABLC.The study was approved by the local ethics committee. We determined AMB levels in specimens from seven critically ill patients treated with LAMB (one patient [two sample sets]), ABCD (five patients), or ABLC (one patient) for suspected invasive fungal infection. Demographic and clinical characteristics of the enrolled patients are shown in Table 1. LAMB (AmBisome; Gilead, San Dimas, CA), ABCD (Amphocil; Torrex-Chiesi Pharma, Vienna, Austria), and ABLC (Abelcet; Elan Pharma International Limited, Athlone, Ireland) were dissolved as recommended by the manufacturers and administered intravenously at doses of 3 to 5 mg/kg of body weight over 4 h once a day. Aliquots of pleural effusions were taken during therapeutic thoracentesis. Blood samples were drawn simultaneously from an arterial line and were centrifuged immediately. The plasma and the pleural effusion samples were stored frozen at Ϫ80°C. Samples were purified and concentrated. The lipid-associated fractions of LAMB and ABCD were separated from AMB that had been liberated from its lipid encapsulation (comprising free and protein-bound AMB) by C 18 solid-phase extraction as described previously (with modifications for pleural effusion samples) (3). For ABLC, this separation technique is not feasible. Pleural effusion and plasma specimens were analyzed by reversed-phase high-performance liquid chromatography using a LiChrosorb-RP-8 column, UV detection ( ϭ 405 nm), and acetonitrile-methanol-0.010 M NaH 2 PO 4 buffer (41:10:49, vol/vol) as the mobile phase (3). The detection limit was 0.005 g/ml. The intraassay coefficient of variation was 2.06%. The concentrations were assessed by means of a linear standard curve (R, 0.998 to 0.999) obtained by using external standards comprising pleural effusion samples spiked with ...

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Pleural Cryptococcosis in the Acquired Immune Deficiency Syndrome

Cited by 51 publications

References 7 publications

Disseminated Cryptococcosis Complicated with Bilateral Pleural Effusion and Ascites during Corticosteroid Therapy for Organizing Pneumonia with Myelodysplastic Syndrome

Disseminated Cryptococcosis Complicated with Bilateral Pleural Effusion and Ascites during Corticosteroid Therapy for Organizing Pneumonia with Myelodysplastic Syndrome

Pleural Cryptococcosis with Idiopathic CD4 Positive T-lymphocytopenia

Penetration of Amphotericin B Lipid Formulations into Pleural Effusion

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