No abstract available.
Child, Preschool ; Cryptococcosis/drug therapy* ; Cytosine/analogs & derivatives* ; Female ; Flucytosine/therapeutic use* ; Human

Antifungal Agents ; therapeutic use ; Child, Preschool ; Cryptococcosis ; drug therapy ; Fluconazole ; therapeutic use ; Humans ; Male

OBJECTIVETo explore adverse effects of combined treatment of interleukin-12 (IL-12) and interleukin-18 (IL-18) against cryptococcosis in a murine model.

METHODSInfected mice were treated with a combination of IL-12 and IL-18. Their body weight and intake of water and food were observed and recorded. Serum levels of leptin were detected with an enzyme-linked immuno sorbent assay (ELISA).

RESULTSIn the combined treatment group, the intake volume of water and food were reduced, leading to weight loss and undetectable levels of leptin in the serum. These adverse effects were more profound in mice that had received higher doses of cytokines, which sometimes led to a fatal outcome. There was a significant difference compared with the control group. Neutralization of endogenous tumor necrosis factor-alpha (TNF-alpha) by its specific mAb did not alter the wasting effect of this treatment.

CONCLUSIONSThe combined IL-12/IL-18 treatment may cause a number of adverse effects independent of TNF-alpha and leptin synthesis. Further investigations for resolving these adverse effects are required before clinical application of these cytokines.

Animals ; Cryptococcosis ; drug therapy ; Disease Models, Animal ; Drug Therapy, Combination ; Female ; Interleukin-12 ; adverse effects ; Interleukin-18 ; adverse effects ; Mice ; Mice, Inbred A

Two decades witnessed the progress of medicine especially the diagnosis and management of fungal infection in the immunocompromised hosts using microbiology, molecular biology, and imaging techniques such as computerized tomography and magnetic resonance imaging. And the incidence of fungal infection increased as the number of organ transplant, AIDS, and chemotherapy with malignant neoplasm enlarged, but the contents of fungal infection altered from conventional Candida albicans to non-albicans Candida, less-well known mold and yeast. Furthermore, the resistance to antifungal agents appeared, became widely distributed, and it is now necessary to perform the fungal susceptibility test in the diagnostic laboratory. The fungal resistance test, for the time being, can only be speculated. Still candidiasis, cryptococcosis, aspergillosis, and mucormycosis outnumbered other unusual fungal infections and physicians take the opportunistic fungal infection into account in cases for the immunocompromied host based on the knowledge of newer antifungal agents such as liposomal amphotericin B, caspofungin, voriconazole, and so on.
Amphotericin B ; Antifungal Agents ; Aspergillosis ; Candida ; Candida albicans ; Candidiasis ; Cryptococcosis ; Diagnosis ; Drug Therapy ; Fungi ; Immunocompromised Host ; Incidence ; Magnetic Resonance Imaging ; Molecular Biology ; Mucormycosis ; Transplants ; Yeasts

Cutaneous involvement of patient with systemic cryptococcosis occur in 10% to 15% of the case reported in literature. We report a case of cutaneous cryptococcosis clinically mimiking keratoacanthoma in a 70-year-old male. The lesions showed multiple erythematous papules and elevated central crusted nodules with peripheral telangiectasia on the face, and he had been treated with chemotherapy for peripheral T-cell lymphoma. The skin biopsy specimen showed granulomatous reaction with lympohistiocytic infiltration and many round spores. The fungus culture from skin lesion showed mucoid creamy colored colonies and revealed microscopically thick encapsulated spores in India ink preparation. The culture on Christensen urea agar at 25degrees C for 1 week was positive. The patient was treated with intravenous administration of fluconazole 200 mg/day for a week with partial improvement. But he refused further treatment, and died after a month of discharge.
Administration, Intravenous ; Agar ; Aged ; Biopsy ; Cryptococcosis* ; Drug Therapy ; Fluconazole ; Fungi ; Humans ; India ; Ink ; Keratoacanthoma ; Lymphoma, T-Cell, Peripheral ; Male ; Skin ; Spores ; Telangiectasis ; Urea

Non-Hodgkin's lymphoma is monoclonal expansion of malignant B or T cells. The immunocompromised status in this disease is accompanied by many infections. The cryptococcosis, caused by Cryptococcus neoformans, frequently occurs in leukemia, Hodgkin's disease, sarcoidosis, diabetes mellitus, tuberculosis, and long-term steroid-using patients. Recent increasing incidence of fungal infection could be due to the spread of AIDS and transplantation. We experienced one patient with lung mass in Non-Hodgkin's lymphoma after three cycles of chemotherapy, which could not be discriminated from the newly developed lymphoma mass. Cryptococcus neoformans was isolated from the lung tissue obtained by thoracoscopic biopsy. Herein we report this case with brief review of pertinent literature.
Biopsy ; Cryptococcosis* ; Cryptococcus neoformans ; Diabetes Mellitus ; Drug Therapy* ; Hodgkin Disease ; Humans ; Incidence ; Leukemia ; Lung ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Sarcoidosis ; T-Lymphocytes ; Tuberculosis

Non-Hodgkin's lymphoma is monoclonal expansion of malignant B or T cells. The immunocompromised status in this disease is accompanied by many infections. The cryptococcosis, caused by Cryptococcus neoformans, frequently occurs in leukemia, Hodgkin's disease, sarcoidosis, diabetes mellitus, tuberculosis, and long-term steroid-using patients. Recent increasing incidence of fungal infection could be due to the spread of AIDS and transplantation. We experienced one patient with lung mass in Non-Hodgkin's lymphoma after three cycles of chemotherapy, which could not be discriminated from the newly developed lymphoma mass. Cryptococcus neoformans was isolated from the lung tissue obtained by thoracoscopic biopsy. Herein we report this case with brief review of pertinent literature.
Biopsy ; Cryptococcosis* ; Cryptococcus neoformans ; Diabetes Mellitus ; Drug Therapy* ; Hodgkin Disease ; Humans ; Incidence ; Leukemia ; Lung ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Sarcoidosis ; T-Lymphocytes ; Tuberculosis

INTRODUCTIONFungaemia carries with it high mortality rates and appropriate as well as timely antifungal therapy has been shown to be life saving.

MATERIALS AND METHODSWe studied the invitro activities of antifungal agents using the Etest method, against 100 Candida isolates from blood cultures, 10 Cryptococcus isolates from blood or cerebrospinal fluid and 50 mould isolates from various clinically significant sites of patients in Singapore General Hospital, from June 2004 to December 2006.

RESULTSOverall, the yeasts appeared to have low minimum inhibitory concentrations (MICs) for all the 5 antifungal drugs tested except for fluconazole. The overall high MIC90 values of the moulds against the azoles were largely attributed to the non-Aspergillus moulds. Posaconazole, itraconazole, voriconazole and caspofungin appear effective against local strains of Aspergillus species, although there are no interpretive breakpoints.

CONCLUSIONSThe results show that the local fungal strains studied appear to be susceptible to the usual antifungal drugs recommended in the literature.

Antifungal Agents ; pharmacology ; therapeutic use ; Candida ; drug effects ; isolation & purification ; Candidiasis ; microbiology ; Cryptococcosis ; microbiology ; Cryptococcus ; drug effects ; isolation & purification ; Fungemia ; drug therapy ; microbiology ; Fungi ; drug effects ; Hospitals, Public ; Humans ; Microbial Sensitivity Tests ; methods ; Reproducibility of Results ; Singapore ; Yeasts ; drug effects

OBJECTIVETo clarify the clinical feature, diagnosis and therapy of the pulmonary cryptococcosis (PC).

METHODSA retrospective study of cases with PC who were diagnosed by pathological examinations between January 1996 and December 2010 was conducted. Eighty-one cases were enrolled in the study (58 male and 23 female patients; mean age of (51±11) years). Forty-one cases were asymptomatic at the time of diagnosis. There were single pulmonary lesions in 50 cases, and multiple lesions in 31 cases. Fourteen lesions (17.3%) were located in left upper lobe, 27 (33.3%) in left lower lobe, 21 (25.9%) in right upper lobe, 3 (3.7%) in right middle lobe, 28 (34.6%) in right lower lobe, and 3 (3.7%) diffusely involved bilateral lungs. The tumors ranged from 0.8 to 10.0 cm in diameter with a mean of (2.9±1.8) cm. All the cases were misdiagnosis prior to the surgical resection, and histologically confirmed by postoperative pathological specimens.

RESULTSAll the cases received surgical treatment including complete resection in 69 cases, and palliative resection in 12 cases. Resections were performed by means of video-assisted thoracoscopy in 31 cases and thoracotomy in 50 cases. Surgical resections included pulmonary wedge excisions in 42 cases, and lobectomies in 39 cases. After histological confirmation, 63 cases (77.8%) were treated with antifungal agents, which consisted of fluconazole in 38 cases, itraconazole in 18 cases, amphotericin B in 6 cases, and flucytosine in 4 cases. There were no intraoperative death, but two cases died for cryptococcal meningoencephalitis in the postoperative period. Operative morbidity occurred in 7 (8.6%) cases. The median follow-up was 42.5 months (6 to 84 months). There were 2 local relapses of PC, and 9 cases with complications of anti-fungal agents.

CONCLUSIONSThe clinical manifestations of PC are mild and non-specific, with no characteristic radiographic manifestations. Surgical resection is usually indicated for definite diagnosis and treatment. Antifungal drug therapy is indispensable even after complete resection.

Adult ; Aged ; Antifungal Agents ; therapeutic use ; Cryptococcosis ; diagnosis ; drug therapy ; surgery ; Female ; Follow-Up Studies ; Humans ; Lung ; microbiology ; pathology ; Lung Diseases, Fungal ; diagnosis ; drug therapy ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

We experienced a rare case of colonic cryptococcosis in an apparently immunocompetent individual. A 27-year- old woman admitted our hospital for intermittent melena. Initial abdominal CT scan revealed a mass lesion obstructing most of the lumen in ascending colon. Colonoscopy showed huge ulcerofungating mass in proximal ascending colon. Colonoscopic biopsy was performed and pathologic diagnosis was made as colonic cryptococcosis with positive PAS stain. Laboratory test evaluating immune status and bone marrow examination was normal. The patient was treated with intravenous amphotericin B for four weeks and six months of oral fluconazole afterwards. Follow-up abdominal CT scan and colonoscopy were taken at four weeks and seven months after the beginning of treatment. On completion of intravenous amphotericin B treatment, the mass lesion was decreased in abdominal CT and colonoscopy. After seven months, abdominal CT and colonoscopy showed near-complete resolution of the colonic lesion so the treatment ended. Cryptococcosis in a healthy individual is a rare disease and there have been only several sporadic case reports on pulmonary or central nervous system involvement. Hence, we report a case of colonic cryptococcosis in an apparently immunocompetent individual.
Adult ; Amphotericin B/therapeutic use ; Antifungal Agents/therapeutic use ; Colonic Diseases/*diagnosis/drug therapy/pathology ; Colonoscopy ; Cryptococcosis/*diagnosis/drug therapy ; *Cryptococcus neoformans ; Female ; Fluconazole/therapeutic use ; Humans ; Injections, Intravenous ; Tomography, X-Ray Computed