Pulmonary cryptococcosis associated with HIV-1 infection in Rwanda: a retrospective study of 37 cases

Batungwanayo, J; Taelman, H; Bogaerts, J; Allen, S; Lucas, SB; Kagame, A; Clerinx, Jan; Montane, Josep M.; Saraux, A.; Mühlberger, F

doi:10.1097/00002030-199409000-00008

Cited by 41 publications

(19 citation statements)

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“…Those findings were closely consistent with our previous observation which suggested that solitary cavitary pulmonary nodule may be a common CT finding in HIV-associated PC[8]. Nevertheless, pulmonary nodular lesions with or without cavitation, although reported in other studies, were not recognized as common manifestations of HIV-associated PC [6, 7, 10]. More recently, Lin et al reported that PC contributed to about 17% of the cavitary pulmonary lesions in HIV-infected patients [11].…”

Section: Discussionsupporting

confidence: 92%

“…However, PC in HIV-infected is less well defined. Knowledge of HIV-associated PC are largely based on studies performed about 2 decades ago which reported that the most common findings on chest radiograph were diffuse interstitial infiltrates [5–7]. In those HIV-infected immunocompromised patients, PC was thought to be an important contributor to fetal respiratory failure [5].…”

Section: Introductionmentioning

confidence: 99%

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Radiological characteristics of pulmonary cryptococcosis in HIV-infected patients

Wang

Xiong

et al. 2017

PLoS ONE

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BackgroundCurrent understanding of human immunodeficiency virus (HIV)-associated pulmonary cryptococcosis (PC) is largely based on studies performed about 2 decades ago which reported that the most common findings on chest radiograph were diffuse interstitial infiltrates. Few studies are available regarding the computed tomography (CT) findings. The aim of this study was to characterize chest CT features of HIV-associated PC.MethodsHIV patients with cryptococccal infection and pulmonary abnormalities on Chest CT between September 2010 and May 2016 in the Second Affiliated Hospital of the Southeast University were retrospectively analyzed. Confirmed cases of tumors, mycobacterial infections and other fungal infections were excluded from the analysis.Results60 cases were identified. The median CD4 T-cell counts were 20 cells/μL (range, 0–205 cells/μL). Chest CT scans demonstrated nodular lesions in 93.3% of the studied patients. Those nodular lesions were usually cavitated and solitary nodule was the most common form. Pleural effusions and pneumonic infiltrates occurred in 11.6% and 31.7% of the cases respectively. Those lesions were usually had co-existing nodular lesions. Etiological analysis suggested that 76.8% of the nodular lesions could have a relationship with PC that 12.5% of the nodular lesions were “laboratory-confirmed” cases, 48.2% were “clinically confirmed” cases and 16.1% were “clinically probable” cases. 85.7% of the pleural effusions could be “clinically confirmed” cases of PC. At least, 38.5% of the diffuse pneumonic infiltrates may be clinically attributed to pneumocystis pneumonia.ConclusionsThis study suggested that pulmonary nodules but not diffuse pneumonia are the most common radiological characteristics of HIV-associated PC. HIV-infected patients with pulmonary nodules on Chest CT should particularly be screened for cryptococcal infection.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Radiological characteristics of pulmonary cryptococcosis in HIV-infected patients

Wang

Xiong

et al. 2017

PLoS ONE

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“…Although itraconazole cannot access the cerebrospinal fluid easily, some studies have demonstrated that it provides good results in the prophylaxis and treatment of cryptococcosis in patients with or without AIDS (8,9).…”

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confidence: 99%

Heteroresistance to Itraconazole Alters the Morphology and Increases the Virulence of Cryptococcus gattii

Ferreira

Santos

Costa

et al. 2015

Antimicrob Agents Chemother

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cCryptococcus gattii is the main etiological agent of cryptococcosis in immunocompetent individuals. The triazole drug itraconazole is one of the antifungals used to treat patients with cryptococcosis. Heteroresistance is an adaptive mechanism to counteract the stress of increasing drug concentrations, and it can enhance the ability of a microorganism to survive under antifungal pressure. In this study, we evaluated the ability of 11 C. gattii strains to develop itraconazole heteroresistance. Heteroresistant clones were analyzed for drug susceptibility, alterations in cell diameter, capsule properties, and virulence in a murine model. Heteroresistance to itraconazole was intrinsic in all of the strains analyzed, reduced both the capsule size and the cell diameter, induced molecular heterogeneity at the chromosomal level, changed the negatively charged cells, reduced ergosterol content, and improved the antioxidant system. A positive correlation between surface/volume ratio of original cells and the level of heteroresistance to itraconazole (LHI) was observed in addition to a negative correlation between capsule size of heteroresistant clones and LHI. Moreover, heteroresistance to itraconazole increased the engulfment of C. gattii by macrophages and augmented fungal proliferation inside these cells, which probably accounted for the reduced survival of the mice infected with the heteroresistant clones and the higher fungal burden in lungs and brain. Our results indicate that heteroresistance to itraconazole is intrinsic and increases the virulence of C. gattii. This phenomenon may represent an additional mechanism that contributes to relapses of cryptococcosis in patients during itraconazole therapy.

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“…neoformans is the life-threatening fungal pathogen most commonly seen in AIDS patients [23]. Our study has documented a very low prevalence of cryptococcosis (2.2%) and aspergillosis (4.5%) compared to the study conducted in Rwanda [24] which reported 78.4% of pulmonary cryptococcosis associated with HIV-1 infection and an Indian study [25] which found 15.4% of aspergillosis. Similarly a retrospective study was conducted in Bronx-Lebanon Hospital Center in New York City [26] to determine the incidence at autopsy of fungal and non-fungal pneumonia in HIV patients, reported Candida 48%, Aspergillus 28% and Cryptococcus 10%.…”

Section: Discussionmentioning

confidence: 48%

Mycobacterial, bacterial and fungal pathogens causing pulmonary complications in patients with HIV infection

Rasheed

Thajuddin

2011

HIV & AIDS Review

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a b s t r a c tBackground: To describe the socio-demographic profile of HIV patients, who are clinically suspected to have lower respiratory tract infections (LRTI) and to estimate the prevalence and types of mycobacterial, bacterial and fungal pathogens in these patients. Materials and methods: Sputum samples were collected from ninety-four subjects attending at Jimma University Hospital, Ethiopia and examined microbiologically. Results: Ninety-two pathogens were isolated from eighty-nine patients of the total ninety-four patients. Out of all isolates, 45.6% of the isolates constitute bacteria, 38% were Mycobacterium tuberculosis and 16.3% belong to different fungal classes. Mixed infection was identified in two cases. Klebsiella pneumonia and Candida albicans were the most common bacterial and fungal pathogens isolated respectively. Conclusion: This study demonstrates that there is a difference in the incidence rates of bacterial and fungal isolates of this study and of other studies conducted within Africa and outside Africa.

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Pulmonary cryptococcosis associated with HIV-1 infection in Rwanda: a retrospective study of 37 cases

Cited by 41 publications

References 0 publications

Radiological characteristics of pulmonary cryptococcosis in HIV-infected patients

Radiological characteristics of pulmonary cryptococcosis in HIV-infected patients

Heteroresistance to Itraconazole Alters the Morphology and Increases the Virulence of Cryptococcus gattii

Mycobacterial, bacterial and fungal pathogens causing pulmonary complications in patients with HIV infection

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