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Cryptococcosis and Cryptococcal Meningitis
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Cryptococcosis and Cryptococcal Meningitis

A special issue of Journal of Fungi (ISSN 2309-608X). This special issue belongs to the section "Fungal Pathogenesis and Disease Control".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 4438

Special Issue Editor

Dr. Radha Rajasingham

E-Mail Website
Guest Editor
Department of Medicine, University of Minnesota Twin Cities, Minneapolis, MN, USA
Interests: implementation and cost-effectiveness of point-of-care diagnostics; cryptococcal screening and prevention; cryptococcal meningitis

Special Issue Information

Dear Colleagues,

Despite marked progress with ART delivery and expansion, cryptococcal meningitis remains a leading cause of AIDS-related deaths, with the majority of deaths occurring in low- and middle-income countries. Questions remain regarding optimal prevention strategies among persons with asymptomatic cryptococcal antigenemia, including the benefit of lumbar puncture in asymptomatic persons, timing of ART, and optimal antifungal regimen. With respect to cryptococcal meningitis, despite large clinical trials demonstrating the efficacy of highly potent antifungals, implementation of high-dose AmBisome and/or flucytosine is lacking. Access to diagnostics and antifungals remains inadequate. Implementation science studies evaluating inpatient meningitis diagnostic algorithms and strategies are needed. Novel diagnostics for cryptococcal infection, burden of disease studies in high- and middle-income countries, and management among persons without HIV infection are topics that are yet to be explored. Such topics would be ideal for this Special Issue on “Cryptococcosis and Cryptococcal Meningitis” in the Journal of Fungi.

Dr. Radha Rajasingham
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Fungi is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • advanced HIV disease
  • antiretroviral therapy
  • flucytosine
  • ambisome
  • amphotericin
  • lumbar puncture
  • burden of disease

Published Papers (3 papers)

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Research

17 pages, 5103 KiB  
Article
Genotyping Analysis of Cryptococcus deuterogattii and Correlation with Virulence Factors and Antifungal Susceptibility by the Clinical and Laboratory Standards Institute and the European Committee on Antifungal Susceptibility Testing Methods
by Leonardo Euripedes Andrade-Silva, Anderson Vilas-Boas, Kennio Ferreira-Paim, Juliana Andrade-Silva, Daniel de Assis Santos, Thatiana Bragine Ferreira, Aercio Sebastião Borges, Delio Jose Mora, Marcia de Souza Carvalho Melhem and Mario Léon Silva-Vergara
J. Fungi 2023, 9(9), 889; https://doi.org/10.3390/jof9090889 - 31 Aug 2023
Viewed by 1097
Abstract
Data about the relationship between their molecular types, virulence factors, clinical presentation, antifungal susceptibility profile, and outcome are still limited for Cryptococcus deuterogattii. This study aimed to evaluate the molecular and phenotypic characteristics of 24 C. deuterogattii isolates from the southeast [...] Read more.
Data about the relationship between their molecular types, virulence factors, clinical presentation, antifungal susceptibility profile, and outcome are still limited for Cryptococcus deuterogattii. This study aimed to evaluate the molecular and phenotypic characteristics of 24 C. deuterogattii isolates from the southeast region of Brazil. The molecular characterization was performed by multilocus sequence typing (MLST). The antifungal susceptibility profile was obtained according to CLSI-M27-A3 and EUCAST-EDef 7.1 methods. The virulence factors were evaluated using classic techniques. The isolates were divided into four populations. The molecular analysis suggests recombinant events in most of the groups evaluated. Resistance and susceptibility dose-dependent to fluconazole were evidenced in four isolates (16%) by EUCAST and in four isolates (16%) by CLSI methods. The agreement at ±two dilutions for both methods was 100% for itraconazole, ketoconazole, and voriconazole, 96% for amphotericin B, and 92% for fluconazole. Significant differences in virulence factor expression and antifungal susceptibility to itraconazole and amphotericin B were found. The mixed infection could be suggested by the presence of variable sequence types, differences in virulence factor production, and decreased antifungal susceptibility in two isolates from the same patient. The data presented herein corroborate previous reports about the molecular diversity of C. deuterogattii around the world. Full article
(This article belongs to the Special Issue Cryptococcosis and Cryptococcal Meningitis)
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10 pages, 269 KiB  
Article
Clinical Features of Cryptococcal Meningoencephalitis in HIV-Positive and -Negative Patients in a Resource-Limited Setting
by Rattagan Kajeekul, Pawut Mekawichai and Methee Chayakulkeeree
J. Fungi 2023, 9(9), 869; https://doi.org/10.3390/jof9090869 - 23 Aug 2023
Cited by 1 | Viewed by 1169
Abstract
Cryptococcal meningoencephalitis is a systemic fungal infection in immunocompromised and immunocompetent individuals. This study investigated the clinical characteristics and factors associated with mortality in HIV-associated and non-HIV-associated cryptococcal meningoencephalitis in a resource-limited setting. This was a retrospective cohort study of patients with cryptococcal [...] Read more.
Cryptococcal meningoencephalitis is a systemic fungal infection in immunocompromised and immunocompetent individuals. This study investigated the clinical characteristics and factors associated with mortality in HIV-associated and non-HIV-associated cryptococcal meningoencephalitis in a resource-limited setting. This was a retrospective cohort study of patients with cryptococcal meningoencephalitis between January 2009 and December 2019 at a tertiary teaching hospital in Thailand. Overall, 1019 patients with cryptococcal meningoencephalitis were enrolled, and 923 (90.6%) were HIV-positive. The patients with HIV-associated cryptococcal meningoencephalitis were younger than the HIV-negative patients (37 versus 56 years, p < 0.01). The HIV-negative patients were more likely to have underlying conditions (52.1% versus 7.5%; p < 0.01), had a longer median duration of headaches prior to admission (14 days versus 6 days, p < 0.01), and were more likely to have an altered mental status at presentation (36.5% versus 18.6%, p < 0.01) and pulmonary involvement (15.6% versus 0.8%, p < 0.01). The HIV-positive patients had lower cerebrospinal fluid (CSF) white blood cell counts (4 versus 94 cells/mm3; p < 0.01), lower CSF protein (69 versus 157 mg/dL; p < 0.01), higher CSF glucose (38.8 versus 21 mg/dL; p < 0.01), and more frequent cryptococcemia (44.1% versus 20.5%; p < 0.01). The mortality rate was high but not significantly different between the two groups (30.2% versus 33.2%; p = 0.53). The HIV-positive patients with comorbidities, fever, an altered mental status at presentation, a CSF white blood cell count below 20 cell/mm3, fungemia, and positive CSF India ink were independently associated with 30-day mortality. In comparison, an altered mental status at presentation and fungemia were associated with 30-day mortality in HIV-negative patients. In conclusion, HIV-negative patients with cryptococcal meningoencephalitis had more extensive central nervous system inflammation, although the two groups’ mortality rates were similar. Unfavorable prognostic factors included comorbidities, fever, an altered mental status at presentation, a low CSF white blood cell count, fungemia, and positive CSF India ink. Full article
(This article belongs to the Special Issue Cryptococcosis and Cryptococcal Meningitis)
9 pages, 807 KiB  
Communication
Disseminated Cryptococcosis Is a Common Finding among Human Immunodeficiency Virus-Infected Patients with Suspected Sepsis and Is Associated with Higher Mortality Rates
by Tafese Beyene Tufa, Hans Martin Orth, Tobias Wienemann, Bjoern-Erik Ole Jensen, Colin R. Mackenzie, David R. Boulware, Tom Luedde and Torsten Feldt
J. Fungi 2023, 9(8), 836; https://doi.org/10.3390/jof9080836 - 9 Aug 2023
Cited by 1 | Viewed by 1916
Abstract
Cryptococcosis is the leading cause of death among people with HIV in Sub-Saharan Africa. The lack of optimum diagnoses and medications significantly impair the management of the disease. We investigated the burden of cryptococcosis and related mortality among people with HIV and suspected [...] Read more.
Cryptococcosis is the leading cause of death among people with HIV in Sub-Saharan Africa. The lack of optimum diagnoses and medications significantly impair the management of the disease. We investigated the burden of cryptococcosis and related mortality among people with HIV and suspected sepsis in Ethiopia. We conducted a prospective study at (1) Adama Hospital Medical College and (2) Asella Referral and Teaching Hospital from September 2019 to November 2020. We enrolled adult, HIV-infected patients presenting with suspected sepsis and assessed their 28-day survival rates. We performed blood cultures and cryptococcal antigen (CrAg) testing. In total, 82 participants were enrolled with a median age of 35 years, and 61% were female. Overall, eleven (13%) had positive CrAg tests, of which five grew Cryptococcus in blood cultures. Despite high-dose fluconazole (1200 mg/d) monotherapy being given to those with positive CrAg tests, the 28-day mortality was 64% (7/11), with mortality being significantly higher than among the CrAg-negative patients (9% (6/71); p < 0.001). Cryptococcosis was the leading cause of mortality among HIV-infected sepsis patients in this Ethiopian cohort. The CrAg screening of HIV-infected patients attending an emergency department can minimize the number of missed cryptococcosis cases irrespective of the CD4 T cell count and viral load. These findings warrant the need for a bundle approach for the diagnosis of HIV-infected persons presenting with sepsis in low- and middle-income countries. Full article
(This article belongs to the Special Issue Cryptococcosis and Cryptococcal Meningitis)
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