Cryptococcosis Natural History, Complications and Prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
[[Cryptococcus neoformans|C. neoformans]] can either cause no infection, latent infection, or symptomatic disease. [[Cryptococcus neoformans|C. neoformans]] enters the body through the respiratory route, infection can present as [[pneumonia]]-like illness, with symptoms such as [[cough]], [[fever]], [[chest pain]], and [[weight loss]]. If left untreated [[Cryptococcus neoformans|C. neoformans]] can [[Disseminated disease|disseminate]] to the [[central nervous system]] and cause [[meningoencephalitis]]. [[Prognosis]] is poor without treatment with a [[mortality]] reaching 10 to 30% within 3 weeks of presentation. | [[Cryptococcus neoformans|C. neoformans]] can either cause no [[infection]], latent [[infection]], or [[symptomatic]] disease. [[Cryptococcus neoformans|C. neoformans]] enters the body through the [[respiratory]] route, infection can present as [[pneumonia]]-like illness, with symptoms such as [[cough]], [[fever]], [[chest pain]], and [[weight loss]]. If left untreated [[Cryptococcus neoformans|C. neoformans]] can [[Disseminated disease|disseminate]] to the [[central nervous system]] and cause [[meningoencephalitis]]. [[Prognosis]] is poor without treatment with a [[mortality]] reaching 10 to 30% within 3 weeks of presentation. | ||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
Depending on the [[virulence]] of the yeast strain and the [[immune]] status of the host, [[Cryptococcus neoformans|C. neoformans]] can either cause no infection, latent infection, or symptomatic disease. C. neoformans can present as [[pneumonia]]-like illness, with symptoms such as [[cough]], [[fever]], [[chest pain]], and [[weight loss]]. If left untreated [[Cryptococcus neoformans|C. neoformans]] can disseminate to the [[central nervous system]] and cause [[meningoencephalitis]]. | Depending on the [[virulence]] of the [[yeast]] [[Strain (biology)|strain]] and the [[immune]] status of the host, [[Cryptococcus neoformans|C. neoformans]] can either cause no [[infection]], latent [[infection]], or [[symptomatic]] disease. C. neoformans can present as [[pneumonia]]-like illness, with symptoms such as [[cough]], [[fever]], [[chest pain]], and [[weight loss]]. If left untreated [[Cryptococcus neoformans|C. neoformans]] can disseminate to the [[central nervous system]] and cause [[meningoencephalitis]]. | ||
===Complications=== | ===Complications=== | ||
*[[Meningitis]] | *[[Meningitis]] | ||
*Disseminated cryptococcal infection | *[[Disseminated disease|Disseminated]] [[cryptococcal infection]] | ||
*Treatment of [[fungal meningitis]] in [[Human Immunodeficiency Virus (HIV)|HIV]]-infected patients receiving [[HIV AIDS medical therapy|HAART]], [[organ transplantation]], and [[pregnancy]] may result in [[immune reconstitution syndrome]].<ref name="pmid17521592">{{cite journal| author=Singh N, Perfect JR| title=Immune reconstitution syndrome associated with opportunistic mycoses. | journal=Lancet Infect Dis | year= 2007 | volume= 7 | issue= 6 | pages= 395-401 | pmid=17521592 | doi=10.1016/S1473-3099(07)70085-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17521592 }} </ref><ref name="pmid12471589">{{cite journal| author=Jenny-Avital ER, Abadi M| title=Immune reconstitution cryptococcosis after initiation of successful highly active antiretroviral therapy. | journal=Clin Infect Dis | year= 2002 | volume= 35 | issue= 12 | pages= e128-33 | pmid=12471589 | doi=10.1086/344467 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12471589 }} </ref><ref name="pmid10225395">{{cite journal| author=Blanche P, Gombert B, Ginsburg C, Passeron A, Stubei I, Rigolet A et al.| title=HIV combination therapy: immune restitution causing cryptococcal lymphadenitis dramatically improved by anti-inflammatory therapy. | journal=Scand J Infect Dis | year= 1998 | volume= 30 | issue= 6 | pages= 615-6 | pmid=10225395 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10225395 }} </ref><ref name="pmid9727570">{{cite journal| author=Woods ML, MacGinley R, Eisen DP, Allworth AM| title=HIV combination therapy: partial immune restitution unmasking latent cryptococcal infection. | journal=AIDS | year= 1998 | volume= 12 | issue= 12 | pages= 1491-4 | pmid=9727570 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9727570 }} </ref> | *Treatment of [[fungal meningitis]] in [[Human Immunodeficiency Virus (HIV)|HIV]]-infected patients receiving [[HIV AIDS medical therapy|HAART]], [[organ transplantation]], and [[pregnancy]] may result in [[immune reconstitution syndrome]].<ref name="pmid17521592">{{cite journal| author=Singh N, Perfect JR| title=Immune reconstitution syndrome associated with opportunistic mycoses. | journal=Lancet Infect Dis | year= 2007 | volume= 7 | issue= 6 | pages= 395-401 | pmid=17521592 | doi=10.1016/S1473-3099(07)70085-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17521592 }} </ref><ref name="pmid12471589">{{cite journal| author=Jenny-Avital ER, Abadi M| title=Immune reconstitution cryptococcosis after initiation of successful highly active antiretroviral therapy. | journal=Clin Infect Dis | year= 2002 | volume= 35 | issue= 12 | pages= e128-33 | pmid=12471589 | doi=10.1086/344467 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12471589 }} </ref><ref name="pmid10225395">{{cite journal| author=Blanche P, Gombert B, Ginsburg C, Passeron A, Stubei I, Rigolet A et al.| title=HIV combination therapy: immune restitution causing cryptococcal lymphadenitis dramatically improved by anti-inflammatory therapy. | journal=Scand J Infect Dis | year= 1998 | volume= 30 | issue= 6 | pages= 615-6 | pmid=10225395 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10225395 }} </ref><ref name="pmid9727570">{{cite journal| author=Woods ML, MacGinley R, Eisen DP, Allworth AM| title=HIV combination therapy: partial immune restitution unmasking latent cryptococcal infection. | journal=AIDS | year= 1998 | volume= 12 | issue= 12 | pages= 1491-4 | pmid=9727570 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9727570 }} </ref> | ||
===Prognosis=== | ===Prognosis=== | ||
Prior to the introduction of [[amphotericin B]] therapy, [[Cryptococcal Meningitis|cryptococcal meningitis]] was almost always fatal. Now, although most of these patients can be cured with course of [[Intravenous therapy|intravenous]] [[amphotericin B]], the optimum duration of therapy is often unclear, and there is still a significant percentage of early deaths and late treatment failure.<ref name="pmid4811791">{{cite journal| author=Diamond RD, Bennett JE| title=Prognostic factors in cryptococcal meningitis. A study in 111 cases. | journal=Ann Intern Med | year= 1974 | volume= 80 | issue= 2 | pages= 176-81 | pmid=4811791 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4811791 }} </ref><ref name="pmid5054723">{{cite journal| author=Lewis JL, Rabinovich S| title=The wide spectrum of cryptococcal infections. | journal=Am J Med | year= 1972 | volume= 53 | issue= 3 | pages= 315-22 | pmid=5054723 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5054723 }} </ref><ref name="pmid13728643">{{cite journal| author=NEWCOMER VD, STERNBERG TH, WRIGHT ET, REISNER RM, McNALL EG, SORENSEN LJ| title=The treatment of systemic fungus infections with amphotericin B. | journal=Ann N Y Acad Sci | year= 1960 | volume= 89 | issue= | pages= 221-39 | pmid=13728643 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13728643 }} </ref> | Prior to the introduction of [[amphotericin B]] therapy, [[Cryptococcal Meningitis|cryptococcal meningitis]] was almost always [[fatal]]. Now, although most of these patients can be cured with course of [[Intravenous therapy|intravenous]] [[amphotericin B]], the optimum duration of therapy is often unclear, and there is still a significant percentage of early deaths and late treatment failure.<ref name="pmid4811791">{{cite journal| author=Diamond RD, Bennett JE| title=Prognostic factors in cryptococcal meningitis. A study in 111 cases. | journal=Ann Intern Med | year= 1974 | volume= 80 | issue= 2 | pages= 176-81 | pmid=4811791 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4811791 }} </ref><ref name="pmid5054723">{{cite journal| author=Lewis JL, Rabinovich S| title=The wide spectrum of cryptococcal infections. | journal=Am J Med | year= 1972 | volume= 53 | issue= 3 | pages= 315-22 | pmid=5054723 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5054723 }} </ref><ref name="pmid13728643">{{cite journal| author=NEWCOMER VD, STERNBERG TH, WRIGHT ET, REISNER RM, McNALL EG, SORENSEN LJ| title=The treatment of systemic fungus infections with amphotericin B. | journal=Ann N Y Acad Sci | year= 1960 | volume= 89 | issue= | pages= 221-39 | pmid=13728643 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13728643 }} </ref> | ||
*The mortality of [[Cryptococcal Meningitis|cryptococcal meningitis]] is high (10-30%).<ref>Van der Horst CM, Saag MS, Cloud GA et al. (1997) Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. N Engl J Med, 337, 15–21.</ref> | *The [[mortality]] of [[Cryptococcal Meningitis|cryptococcal meningitis]] is high (10-30%).<ref>Van der Horst CM, Saag MS, Cloud GA et al. (1997) Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. N Engl J Med, 337, 15–21.</ref> | ||
*Increasing levels of the following worsens the prognosis of [[Human Immunodeficiency Virus (HIV)|HIV]]-negative [[Cryptococcal Meningitis|cryptococcal meningitis]] patients with acute/subacute onset; | *Increasing levels of the following worsens the prognosis of [[Human Immunodeficiency Virus (HIV)|HIV]]-negative [[Cryptococcal Meningitis|cryptococcal meningitis]] patients with acute/subacute onset; | ||
**Ratio of [[CSF]] [[glucose]]/[[blood glucose]] | **Ratio of [[CSF]] [[glucose]]/[[blood glucose]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
C. neoformans can either cause no infection, latent infection, or symptomatic disease. C. neoformans enters the body through the respiratory route, infection can present as pneumonia-like illness, with symptoms such as cough, fever, chest pain, and weight loss. If left untreated C. neoformans can disseminate to the central nervous system and cause meningoencephalitis. Prognosis is poor without treatment with a mortality reaching 10 to 30% within 3 weeks of presentation.
Natural History, Complications and Prognosis
Natural History
Depending on the virulence of the yeast strain and the immune status of the host, C. neoformans can either cause no infection, latent infection, or symptomatic disease. C. neoformans can present as pneumonia-like illness, with symptoms such as cough, fever, chest pain, and weight loss. If left untreated C. neoformans can disseminate to the central nervous system and cause meningoencephalitis.
Complications
- Meningitis
- Disseminated cryptococcal infection
- Treatment of fungal meningitis in HIV-infected patients receiving HAART, organ transplantation, and pregnancy may result in immune reconstitution syndrome.[1][2][3][4]
Prognosis
Prior to the introduction of amphotericin B therapy, cryptococcal meningitis was almost always fatal. Now, although most of these patients can be cured with course of intravenous amphotericin B, the optimum duration of therapy is often unclear, and there is still a significant percentage of early deaths and late treatment failure.[5][6][7]
- The mortality of cryptococcal meningitis is high (10-30%).[8]
- Increasing levels of the following worsens the prognosis of HIV-negative cryptococcal meningitis patients with acute/subacute onset;
- Ratio of CSF glucose/blood glucose
- Impaired consciousness
- Hospitalization duration
References
- ↑ Singh N, Perfect JR (2007). "Immune reconstitution syndrome associated with opportunistic mycoses". Lancet Infect Dis. 7 (6): 395–401. doi:10.1016/S1473-3099(07)70085-3. PMID 17521592.
- ↑ Jenny-Avital ER, Abadi M (2002). "Immune reconstitution cryptococcosis after initiation of successful highly active antiretroviral therapy". Clin Infect Dis. 35 (12): e128–33. doi:10.1086/344467. PMID 12471589.
- ↑ Blanche P, Gombert B, Ginsburg C, Passeron A, Stubei I, Rigolet A; et al. (1998). "HIV combination therapy: immune restitution causing cryptococcal lymphadenitis dramatically improved by anti-inflammatory therapy". Scand J Infect Dis. 30 (6): 615–6. PMID 10225395.
- ↑ Woods ML, MacGinley R, Eisen DP, Allworth AM (1998). "HIV combination therapy: partial immune restitution unmasking latent cryptococcal infection". AIDS. 12 (12): 1491–4. PMID 9727570.
- ↑ Diamond RD, Bennett JE (1974). "Prognostic factors in cryptococcal meningitis. A study in 111 cases". Ann Intern Med. 80 (2): 176–81. PMID 4811791.
- ↑ Lewis JL, Rabinovich S (1972). "The wide spectrum of cryptococcal infections". Am J Med. 53 (3): 315–22. PMID 5054723.
- ↑ NEWCOMER VD, STERNBERG TH, WRIGHT ET, REISNER RM, McNALL EG, SORENSEN LJ (1960). "The treatment of systemic fungus infections with amphotericin B." Ann N Y Acad Sci. 89: 221–39. PMID 13728643.
- ↑ Van der Horst CM, Saag MS, Cloud GA et al. (1997) Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. N Engl J Med, 337, 15–21.