Infekcie, ktorých póvodcom je Cryptococcus neoformans, sa vyskytujú převážné u pacientov s poruchami funkcie T-lymfocytov, a najma u osob s AIDS.Autoři sa domnievajú, že touto infekciou sú ohrození tiež fudia vyššieho veku, a to aj relativné zdraví. Zaznamenali fatálnu kryptokokovú meningoencefalitídu s fulminantným priebehom u 76-ročnej pacientky bez prejavov imunodeficitu v anamnéze.
Infections caused by Cryptococcus neoformans affect mainly patients with impaired functions oř T-cells, and in particular individuals with AIDS.The authors suppose also older subjects in relatively good health to be endangered by this infection. A čase of fatal cryptococcal meningoencephalitis with fulminant coarse was detected in a 76-year female patient without evident immunodeficiency.
- MeSH
- Cryptococcus neoformans isolation & purification pathogenicity MeSH
- Adult MeSH
- Immune System pathology MeSH
- Respiratory Tract Infections MeSH
- Meningitis, Cryptococcal etiology pathology therapy MeSH
- Humans MeSH
- Meningoencephalitis etiology pathology therapy MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Autoři popisují případ 52letého muže s oboustrannou pneumonií, která vyústila v respirační selhání vyžadující umělou plicní ventilaci. Jako etiologické agens byl zjištěn metodou sekvenace DNA Cryptococcus carnescens patřící mezi „non-neoformans“ kryptokoky. Příčinou imunodeficitu byla u tohoto pacienta raritní forma akutní myeloidní leukémie.
Authors present a case history of a 52-years-old male patient with bilateral pneumonia which resulted in respiratory failure requiring mechanical ventilation. DNA sequencing revealed non-neoformans cryptococcus, Cryptococcus carnescens as a major pathogen. A rare form of acute myeloid leukemia was a reason of severe immunodeficiency in this patient.
- Keywords
- Cryptococcus carnescens, sekvenace DNA,
- MeSH
- Leukemia, Myeloid, Acute diagnosis complications MeSH
- Cryptococcus genetics immunology MeSH
- Immunocompromised Host immunology MeSH
- Middle Aged MeSH
- Humans MeSH
- Pneumonia etiology complications microbiology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
Cryptococcosis is an invasive mycosis caused mainly by Cryptococcus gattii and C. neoformans and is treated with amphotericin B (AMB), fluconazole and 5-fluorocytosine. However, antifungal resistance, limited and toxic antifungal arsenal stimulate the search for therapeutic strategies such as drug repurposing. Among the repurposed drugs studied, the selective serotonin reuptake inhibitors (SSRIs) have shown activity against Cryptococcus spp. However, little is known about the antifungal effect of duloxetine hydrochloride (DH), a selective serotonin and norepinephrine reuptake inhibitor (SSNRI), against C. neoformans and C. gattii. In this study, DH inhibited the growth of several C. neoformans and C. gattii strains at concentrations ranging from 15.62 to 62.50 μg/mL. In addition, DH exhibited fungicidal activity ranging from 15.62 to 250 μg/mL. In biofilm, DH treatment reduced Cryptococcus spp. biomass at a level comparable to AMB, with a significant reduction (85%) for C. neoformans biofilms. The metabolic activity of C. neoformans and C. gattii biofilms decreased significantly (99%) after treatment with DH. Scanning electron micrographs confirmed the anti-biofilm activity of DH, as isolated cells could be observed after treatment. In conclusion, DH showed promising antifungal activity against planktonic cells and biofilms of C. neoformans and C. gattii, opening perspectives for further studies with DH in vivo.
- MeSH
- Antifungal Agents * pharmacology MeSH
- Biofilms * drug effects MeSH
- Cryptococcus gattii * drug effects MeSH
- Cryptococcus neoformans * drug effects growth & development MeSH
- Duloxetine Hydrochloride * pharmacology MeSH
- Cryptococcosis drug therapy microbiology MeSH
- Microbial Sensitivity Tests * MeSH
- Publication type
- Journal Article MeSH
Kryptokokální meningitida (KM) je potenciálně fatální onemocnění. Popisujeme úspěšnou léčbu pomocí Ommaya rezervoáru a intratekální injekce amfotericinu B ke zvládnutí refrakterní cerebrální kryptokokózy způsobené Cryptococcus gattii AFLP4/VGI. U 63letého pacienta s hypertermií a bolestmi hlavy v trvání 2 týdnů byla diagnostikována KM. Byla zahájena kombinovaná léčba amfotericinem B a 5-flucytosinem a následována léčbou flukonazolem. Po 7 měsících byl refrakterní k tradiční léčbě KM a byla zvolena záchranná léčba pomocí Ommaya rezervoáru a intratékální injekce amfotericinu B. Neurologické příznaky postupně odezněly bez zřejmého relapsu během 12 měsíců sledování. Izolát byl přešetřen kultivací na médiu s kanavaninem, glycinem a bromthymolovou modří a molekulární typizací pomocí URA5 byl identifikován Cryptococcus gattii AFLP4/VGI. Ommaya rezervoár lze doporučit jako alternativní léčbu KM vyvolané Cryptococcus gattii AFLP4/VGI, která špatně odpovídá na standardní léčebné režimy.
Cryptococcal meningitis (CM) is a potentially fatal disease. We report successful treatment with the Ommaya reservoir and intrathecal injection of amphotericin B for the control of refractory cerebral cryptococcosis due to Cryptococcus gattii AFLP4/VGI. A 63-year-old male patient presented with a 2-week history of fever and headache, and was he diagnosed with CM. Combined amphotericin B and 5-flucytosine treatment was initiated and followed by fluconazole therapy. After 7 months, he was refractory to traditional CM treatment and received salvage therapy with an Ommaya reservoir and intrathecal injection of amphotericin B. His neurological symptoms recovered gradually with no evidence of relapse during 12-month follow-up. The isolate was re-identified by culturing in canavanine-glycine-bromothymol Blue media and by molecular typing using URA5 as Cryptococcus gattii AFLP4/VGI. The Ommaya reservoir could serve as an alternative treatment for Cryptococcus gattii AFLP4/VGI-induced CM, which responds poorly to standard regimens.
- Keywords
- Ommaya rezervoár,
- MeSH
- Amphotericin B therapeutic use MeSH
- Antifungal Agents therapeutic use MeSH
- Cryptococcus gattii isolation & purification MeSH
- Flucytosine therapeutic use MeSH
- Fluconazole MeSH
- Hydrocephalus etiology MeSH
- Drug Therapy, Combination MeSH
- Meningitis, Cryptococcal * diagnosis drug therapy physiopathology MeSH
- Drug Resistance MeSH
- Drug Delivery Systems MeSH
- Middle Aged MeSH
- Humans MeSH
- Cerebral Ventricles * drug effects MeSH
- Recurrence MeSH
- Injections, Spinal MeSH
- Catheters, Indwelling * MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
Cryptococcosis is caused by members of the Cryptococcus neoformans/Cryptococcus gattii species complex. Based on molecular identification, these two species have been further differentiated into molecular types. The aim of this work was to characterize clinical cryptococcal isolates recovered from six hospitals in Northeast Mexico from 1995 to 2011. One hundred and sixty-six isolates, which were characterized by biochemical tests and in vitro susceptibility to amphotericin B, fluconazole, and voriconazole, and M13 PCR fingerprinting, were included in this study. Utilizing phenotypic tests, 153 isolates (92.16 %) were identified as C. neoformans and 13 (7.83 %) as C. gattii. All isolates were susceptible to all antifungals tested. Employing M13 PCR fingerprinting, eight molecular types were detected. VNI was the most common genotype (124 cases; 74.6 %), followed by VNII (15 cases; 9 %), VNIII (8 cases; 4.8 %), VNIV (6 cases; 3.6 %), VGI (6 cases; 3.6 %), VGII (3 cases; 1.8 %), and VGIII and VGIV (2 cases, 1.2 % each). We confirm the presence of C. gattii in clinical isolates in Northeast Mexico, and a high clonal diversity in the studied strains of C. neoformans/C. gattii species complex.
- MeSH
- Antifungal Agents pharmacology MeSH
- Cryptococcus gattii classification genetics isolation & purification MeSH
- Cryptococcus neoformans classification genetics isolation & purification MeSH
- DNA Fingerprinting MeSH
- Adult MeSH
- Cryptococcosis epidemiology microbiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Microbial Sensitivity Tests MeSH
- Adolescent MeSH
- Young Adult MeSH
- Molecular Epidemiology MeSH
- Molecular Typing * MeSH
- Mycological Typing Techniques * MeSH
- Hospitals MeSH
- Polymerase Chain Reaction MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Mexico epidemiology MeSH
