Cryptococcus neoformans and Cryptococcus gattii as causative causes of cryptococcosis in immunosuppressed patients: an integrative review
DOI:
https://doi.org/10.33448/rsd-v12i8.42901Keywords:
Cryptococcosis; Cryptococcus neoformans; Cryptococcus gattii; Cryptococcal meningitis; Cryptococcus; Immunosuppression.Abstract
This study aimed to describe Cryptococcus neoformans and Cryptococcus gattii as causes of cryptococcosis in immunosuppressed patients. To carry out this integrative literature review, a survey of articles in the literature was carried out in the following databases: LILACS, BVS (virtual health library), PubMed and Scielo. The survey took place between October and December 2022. Cryptococcosis is considered a systemic mycosis that is commonly observed in immunosuppressed patients. The invasive fungal infection is provoked by the fungi Cryptococcus neoformans and Cryptococcus gattii that are found in the excreta of birds, mainly in faeces of pigeons. In humans, cryptococcal infection commonly occurs after the fungus is inhaled and involves lung colonization and meningeal involvement. Most patients diagnosed with cryptococcosis have an identified predisposition related to cellular immunosuppression. The most common propensity is HIV infection, but we can also cite situations that include prolonged treatment with corticosteroids, solid organ receptors, idiopathic CD4 lymphocytopenia, advanced malignancy, sarcoidosis and severe states of cellular immunosuppression. Immunosuppressed patients with cryptococcosis have reported dimensions of complications, including cryptococcal meningitis, case fatality rates, or other variables associated with these complications. Among the consequences of cryptococcosis in these patients, case studies of pulmonary cryptococcosis, cryptococcal osteomyelitis, mammary cryptococcosis, central nervous system infection, extrameningeal cryptococcosis, disseminated cryptococcosis, meningoencephalitis and cryptococcal meningitis were found. We conclude that cryptococcosis caused by Cryptococcus neoformans and Cryptococcus gattii is regularly reported in immunosuppressed patients, which significantly influences the severity and mortality rates from cryptococcosis.
References
Abdoli, A., Falahi, S., & Kenarkoohi, A. (2022). COVID-19-associated opportunistic infections: a snapshot on the current reports. Clinical and Experimental Medicine, 22(3), 327-346. 10.1007/s10238-021-00751-7.
Baltazar, L. M., & Ribeiro, M. A. (2008). Primeiro isolamento ambiental de Cryptococcus gattii no Estado do Espírito Santo. Revista da Sociedade Brasileira de Medicina Tropical, 41(5), 449-453. 10.1590/S0037-86822008000500003.
Barbosa, S., R., Guazzelli, L., S., & Severo, L., C. (2004). Criptococose mamária manifesta após corticoterapia. Revista da Sociedade Brasileira de Medicina Tropical, 37(1), 65-66. 10.1590/S0037-86822004000100018.
Baroni, F. A., Paula, C. R., Silva, E. G., Viani, F. C., Rivera, I. N., Oliveira, M. T., & Gambale, W. (2006). Cryptococcus neoformans strains isolated from church towers in Rio de Janeiro City, RJ, Brazil. Revista do Instituto de Medicina Tropical de São Paulo, 48(2), 71-75. 10.1590/s0036-46652006000200003.
Bielska, E., & May, R. C. (2015). What makes Cryptococcus gattii a pathogen? FEMS Yeast Research, 16(1), fov106. 10.1093/femsyr/fov106.
Byrnes, E. J. 3rd., Bartlett, K. H., Perfect, J. R., & Heitman, J. (2011). Cryptococcus gattii: an emerging fungal pathogen infecting humans and animals. Microbes and Infection, 13(11), 895-907. 10.1016/j.micinf.2011.05.009.
Chang, C. C., Hall, V., Cooper, C., Grigoriadis, G., Beardsley, J., Sorrell, T. C., Heath, C. H., & The Australasian Antifungal Guidelines Steering Committee. (2021). Consensus guidelines for the diagnosis and management of cryptococcosis and rare yeast infections in the haematology/oncology setting. Intern Med J, 51(Suppl 7), 118-142. 10.1111/imj.15590.
Chang, C. Y., Shah, S. H.M., Lio, J. Y., Bahari, N., & Radhakrishnan, A. P. (2021). Cryptococcus gattii meningitis complicated by immune reconstitution inflammatory syndrome in an apparent immunocompetent host in Malaysia. Medical Mycology Case Reports, 35, 1-4. 10.1016/j.mmcr.2021.12.004.
Chang, M. R., Paniago, A. M. M., Silva, M. M., Lazéra, M. S., & Wanke, B. (2008). Prostatic cryptococcosis: a case report. Journal of Venomous Animals and Toxins including Tropical Diseases, 14(2), 378-385. 10.1590/S1678-91992008000200015.
Chaya, R., Padmanabhan, S., Anandaswamy, V., & Moin, A. (2013). Disseminated Cryptococcosis presenting as cellulitis in a renal transplant recipient. Journal of Infection in Developing Countries, 7(1), 60-63. 10.3855/jidc.2479.
Chayakulkeeree, M., & Perfect, J. R. (2006). Cryptococcosis. Infectious Disease Clinics of North America, 20(3), 507-544. 10.1016/j.idc.2006.07.001.
Chen, S. C., Meyer, W., & Sorrell, T. C. (2014). Cryptococcus gattii infections. Clinical Microbiology Reviews, ;27(4), 980-1024. 10.1128/CMR.00126-13.
Choi, H. S. (2022). Pulmonary cryptococcosis after recovery from COVID-19 in an immunocompetent patient: A rare case report. Medicine (Baltimore), 101(32), e30143. 10.1097/MD.0000000000030143.
Corrêa, M. P. S. C. (2001). Neurocriptococose Pediátrica no Estado do Pará: Espectro de achados tomográficos na infecção por Cryptococcus neoformans var. gattii. Dissertação (Pós-graduação em Medicina Tropical) - Núcleo de Medicina Tropical da Universidade Federal do Pará. p. 1-66.
Corrêa, M. P. S. C., Severo, L. C., Oliveira, F. M., Irina, K., & Londero, I. T. (2002). The spectrum of computerized tomography (CT) findings in central nervous system (CNS) infection due to Cryptococcus neoformans var. gattii in immunocompetent children. Revista do Instituto de Medicina Tropical de São Paulo, 44(5), 283-287. 10.1590/S0036-46652002000500010.
Dreyer, R. (2022). Case report: Disseminated cryptococcus gattii in an immunocompetent patient. IDCases, 29, e01537. 10.1016/j.idcr.2022.e01537.
Dromer, F., Mathoulin-Pélissier, S., Fontanet, A., Ronin, O., Dupont, B., Lortholary, O., & French Cryptococcosis Study Group. (2004). Epidemiology of HIV-associated cryptococcosis in France (1985-2001): comparison of the pre- and post-HAART eras. AIDS, 18(3), 555-562. 10.1097/00002030-200402200-00024.
Faganello, J., Arruda, W., Schrank, A., & Vainstein, M. H. (2006). An alternative method to prepare samples of the pathogenic yeast Cryptococcus neoformans for scanning electron microscopy analysis. Journal of Microbiological Methods, 64(3), 416-419. 10.1016/j.mimet.2005.07.003.
Gaiba, R., O’Neill, E., & Lakshmi, S. (2019). Pulmonary cryptococcosis complicating interstitial lung disease in a patient with systemic lupus erythematosus, BMJ Case Reports, 12(8), e229403. 10.1136/bcr-2019-229403.
Govender NP, Meintjes G, Mangena P, Nel J, Potgieter S, Reddy D, Rabie H, Wilson D, Black J, Boulware D, Boyles T, Chiller T, Dawood H, Dlamini S, Harrison TS, Ive P, Jarvis J, Karstaedt A, Madua MC, Menezes C, Moosa MS, Motlekar Z, Shroufi A, Stacey SL, Tsitsi M, van Cutsem G, Variava E, Venter M, Wake R. (2019) Southern African HIV Clinicians Society guideline for the prevention, diagnosis and management of cryptococcal disease among HIV-infected persons: 2019 update. South Afr J HIV Med, 20(1):1030. 10.4102/sajhivmed.v20i1.1030.
Hengeveld, P. J., Jongh, E., Westerweel, P. E., & Levin, M. D. (2020). Disseminated cryptococcal disease during treatment with idelalisib and corticosteroids for follicular lymphoma, BMJ Case Reports, 13(7), e235216. 10.1136/bcr-2020-235216.
Kassaza, K., Wasswa, F., Nielsen, K., & Bazira, J. (2022). Cryptococcus neoformans Genotypic Diversity and Disease Outcome among HIV Patients in Africa. Journal of Fungi, 8(7), 734. 10.3390/jof8070734.
Karnik. K., Wu, Y., Ruddy, S., Quijano-Rondan, B., Urban, C., Turett, G., Yung, L., Prasad, N., Yoon, J., & Segal-Maurer, S. (2022). Fatal case of disseminated cryptococcal infection and meningoencephalitis in the setting of prolonged glucocorticoid use in a Covid-19 positive patient. IDCases, 27, e01380. 10.1016/j.idcr.2022.e01380.
Khatib, M. Y., Ahmed, A. A., Shaat, S. B., Mohamed, A. S., & Nashwan, A. J. (2020).. Clinical Case Reports, 9(2), 853-855. 10.1002/ccr3.3668.
Kwon-Chung, K. J., Fraser, J. A., Doering, T. L., Wang, Z., Janbon, G., Idnurm, A., & Bahn, Y. S. (2014). Cryptococcus neoformans and Cryptococcus gattii, the etiologic agents of cryptococcosis. Cold Spring Harbor Perspectives Medicine, 4(7), a019760. 10.1101/cshperspect.a019760.
Kwon-Chung, K. J., Polacheck, I., Bennett, J. E. (1982). Improved diagnostic medium for separation of Cryptococcus neoformans var. neoformans (serotypes A and D) and Cryptococcus neoformans var. gattii (serotypes B and C). J Clin Microbiol, 15(3):535-537. 10.1128/jcm.15.3.535-537.
Lacaz, C. S., Heins-Vaccari, E. M., Hernandez-Arriagada, G. L., Martins, E. L., Prearo, C. A., Corim, S. M., & Martins, A. M. (2002). Primary cutaneous cryptococcosis due to Cryptococcus neoformans var. gattii serotype B, in an immunocompetent patient. Revista do Instituto de Medicina Tropical de São Paulo, 44(4), 225-228. 10.1590/s0036-46652002000400008.
Lazera, M. S., Cavalcanti, M. A. S., Londero, A. T., Trilles, L., Nishikawa, M. M., & Wanke, B. (2000). Possible primary ecological niche of Cryptococcus neoformans. Medical Mycology, 38(5), 379-383. 10.1080/mmy.38.5.379.383.
Leal, A. L. (2006). Diferenciação das espécies Cryptococcus neoformans e Cryptococcus gattii utilizando a metodologia de PCR multiplex e determinação do perfil epidemiológico de pacientes com meningite criptocócica. Dissertação de mestrado (Pós-Graduação em Biologia Celular e Molecular) - Centro de Biotecnologia da Universidade Federal do Rio Grande do Sul. p. 1-100.
Leongson, K., Cousineau-Côté, V., Goupil, M., Aumont, F., Sénéchal, S., Gaboury, L., Jolicoeur, P., Kronstad, J. W., & Repentigny, L. (2013). Altered immune response differentially enhances susceptibility to Cryptococcus neoformans and Cryptococcus gattii infection in mice expressing the HIV-1 transgene. Infection and Immunity, 81(4), 1100-1113. 10.1128/IAI.01339-12.
Leonhard, S. E., Fritz, D., Van de Beek, & D., Brouwer, M.. C. (2016). Cryptococcal meningitis complicating sarcoidosis. Medicine (Baltimore), 95(35), e4587. 10.1097/MD.0000000000004587.
Li, A. S., Pan, W. H., Wu, S. X., Hideaki, T., Guo, N. R., Shen, Y. N., Lu, G. X., Pan, R. G., Zhu, M. C., Chen, M., Shi, W. M., & Liao, W. Q. (2012). Ecological surveys of the Cryptococcus species complex in China. Chinese Medical Journal, 125(3), 511-516.
Mansour, A., Nakhla, I., El Sherif, M., Sultan, Y. A., & Frenck, R. W. (2006). Cryptococcus neoformans var. gattii meningitis in Egypt: a case report. Eastern Mediterranean Health Journal, 12(1-2), 241-244. PMID: 17037245.
Melo, N. T., Lacaz, C. S., Charbel, C. E., Pereira, A. D., Heins-Vaccari E. M., França-Netto, A. S., Machado, L. R., & Livramento J. A. (1993). Quimiotipagem do Cryptococcus neoformans. Revisão da literatura. Novos dados epidemiológicos sobre a criptococose. Nossa experiência com o emprego do meio de C.G.B. no estudo daquela levedura. Revista do Instituto de Medicina Tropical de São Paulo, 35(5), 469-478. 10.1590/S0036-46651993000500015.
Moreira, T. A., Ferreira, M. S., Ribas, R. M., & Borges, A. S. (2006). Criptococose: estudo clínico-epidemiológico, laboratorial e das variedades do fungo em 96 pacientes, Revista da Sociedade Brasileira de Medicina Tropical, 39(3), 255-258. 10.1590/S0037-86822006000300005.
Nadrous, H. F., Antonios, V. S., Terrell, C. L., & Ryu, J. H. (2003). Pulmonary cryptococcosis in nonimmunocompromised patients. Chest, 124(6), 2143-2147. 10.1016/s0012-3692(15)31671-8.
Nelson R. W., & Couto C. G. (2001). Doenças micóticas polissistêmicas. Medicina Interna de Pequenos Animais, 1023-1030, 2 ed. Elsevier Brasil, São Paulo.
Ngan, N. T. T., Flower, B., & Day, J. N. (2022). Treatment of Cryptococcal Meningitis: How Have We Got Here and Where are We Going? Drugs, 82(12), 1237-1249. 10.1007/s40265-022-01757-5.
Nidhi, A., Meena, A., Sreekumar, A., & Daga, M. K. (2017). Corticosteroid-induced cryptococcal meningitis in patient without HIV, BMJ Case Reports, 2017, bcr2016216496. 10.1136/bcr-2016-216496.
Nigam, C., Gahlot, R., Kumar, V., Chakravarty, J., & Tilak, R. (2012). Central Nervous System Cryptococcosis among a Cohort of HIV Infected Patients from a University Hospital of North India. Journal of Clinical and Diagnostic Research: JCDR, 6(8), 1385-1387. 10.7860/JCDR/2012/4158.2365.
Nocera, V. B., Jr, I. R., Pietrovicz, J., Krebs, C. N. V., & Lopes, G. L. (2010). Osteomielite criptocócica em paciente com mieloma múltiplo, Revista Brasileira de Hematologia e Hemoterapia, 32(3), 265-268. 10.1590/S1516-84842010005000081.
Pappalardo, M. C. S. M., & Melhem, M. S. C. (2003). Cryptococcosis: a review of the brazilian experience for the disease. Revista do Instituto de Medicina Tropical de São Paulo, 45(6), 299-305. 10.1590/S0036-46652003000600001.
Pappas, P. G., Alexander, B. D., Andes, D. R., Hadley, S., Kauffman, C. A., Freifeld, A., Anaissie, E. J., Brumble, L. M., Herwaldt, L., Ito, J., Kontoyiannis, D. P., Lyon, G. M., Marr, K. A., Morrison, V. A., Park, B. J., Patterson, T. F., Perl, T. M., Oster, R. A., Schuster, M. G., Walker, R., Walsh, T. J., Wannemuehler, K. A., & Chiller, T. M. (2010). Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clinical Infectious Diseases, 50(8), 1101-1111. 10.1086/651262.
Pedroso, R. S., & Candido, R. C. (2006). Diagnóstico Laboratorial da Criptococose. NewsLab, 77, 94-102.
Perfect, J. R., Dismukes, W. E., Dromer, F., Goldman, D. L., Graybill, J. R., Hamill, R. J., Harrison, T. S., Larsen, R. A., Lortholary, O., Nguyen, M. H., Pappas, P. G., Powderly, W. G., Singh, N., Sobel, J. D., Sorrell, T. C. (2010). Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis, 50(3), 291-322. 10.1086/649858.
Rajasingham, R., Smith, R. M., Park, B. J., Jarvis, J. N., Govender, N. P., Chiller, T. M., Denning, D. W., Loyse, A., & Boulware, D. R. (2017). Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. The Lancet Infectious Diseases, 17(8), 873-881. 10.1016/S1473-3099(17)30243-8.
Reolon, A., Perez, L. R. R., & Mezzari, A. (2004). Prevalência de Cryptococcus neoformans nos pombos urbanos da cidade de Porto Alegre, Rio Grande do Sul. Jornal Brasileiro de Patologia e Medicina Laboratorial, 40(5), 293-298. 10.1590/S1676-24442004000500003.
Saag M. S., Powderly, W. G., Cloud, G. A., Robinson, P., Grieco, M. H., Sharkey, P. K., Thompson, S. E., Sugar, A. M., Tuazon, C. U., Fisher, J. F., & et al. (1992). Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. New England Journal of Medicine, 326(2), 83-89, 10.1056/NEJM199201093260202.
Sabiiti, W., Robertson, E., Beale, M. A., Johnston, S. A., Brouwer, A. E., Loyse, A., Jarvis, J. N., Gilbert, A. S., Fisher, M. C., Harrison, T. S., May, R. C., & Bicanic, T. (2014). Efficient phagocytosis and laccase activity affect the outcome of HIV-associated cryptococcosis. Journal of Clinical Investigation, 124(5), 2000-2008. 10.1172/JCI72950.
Sáez, D., Bahamondes, L., Lam, G., Arellano, L., & Lillo, P. (2006). Síndrome de restauración inmune asociado a tratamiento antirretroviral y criptococosis meníngea: Caso clínico. Revista médica de Chile, 134(10), 1310-1314. 10.4067/S0034-98872006001000015.
Severo, L. C., Oliveira, F. M., & Londero, A. T. (1999). Cryptococcosis due to Cryptococcus neoformans var. gattii in Brazilian patients with AIDS. Report of three cases. Revista Iberoamericana de Micología, 16(3), 152-154. PMID: 18473564.
Silva, J. O., & Capuano, D. M. (2008). Ocorrência de Cryptococcus spp e de parasitas de interesse em saúde pública, nos excretas de pombos na cidade de Ribeirão Preto, São Paulo, Brasil. Revista Do Instituto Adolfo Lutz, 67(2), 137–141. 10.53393/rial.2008.v67.32781.
Silveira, F. P., & Husain S. (2007). Fungal infections in solid organ transplantation. Medical Mycology, 45(4), 305-320. 10.1080/13693780701200372.
Snydman, D. R., Singh, N., Dromer, F., Perfect, J. R., & Lortholary, O. (2008). Cryptococcosis in Solid Organ Transplant Recipients: Current State of the Science. Clinical Infectious Diseases, 47(10), 1321–1327. 10.1086/592690.
Sorrell, T. C. (2001). Cryptococcus neoformans variety gattii. Medical Mycology, 39(2), 155-168. 10.1080/MMY.39.2.155.168.
Souza, M. B., Melo, C. S. N., Silva, C. S., Santo, R. M., & Matayoshi, S. (2006). Criptococose palpebral: relato de caso. Arquivos Brasileiros de Oftalmologia, 69(2), 265-267. 10.1590/S0004-27492006000200024.
Souza, M. T., Silva, M. D., & Carvalho, R. (2010). Integrative review: what is it? How to do it? Einstein, 8(1), 102–106. 10.1590/S1679-45082010RW1134.
Souza, R. P. M. (2013). Cryptococcus neoformans e Cryptococcus gattii: Quimiotipagem e correlação com criptococose em hospitais públicos de João Pessoas - PB. Monografia - Departamento de Ciências Farmacêuticas do Centro de Ciências da Saúde da Universidade Federal da Paraíba. p. 1-62.
Sousa, N. S. O., Almeida, J. D. R., Frickmann, H., Lacerda, M. V. G., & Souza, J. V. B. (2023). Searching for new antifungals for the treatment of cryptococcosis. Rev Soc Bras Med Trop, 56:e01212023. 10.1590/0037-8682-0121-2023.
Van der Horst, C. M., Saag, M. S., Cloud, G. A., Hamill, R. J., Graybill, J. R., Sobel, J. D., Johnson, P. C., Tuazon, C.U., Kerkering, T., Moskovitz, B. L., Powderly, W. G., Dismukes, W. E., & National Institute of Allergy and Infectious Diseases Mycoses Study Group and AIDS Clinical Trials Group. (1997). Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. New England Journal of Medicine, 337(1), 15-21, 10.1056/NEJM199707033370103.
Varma, A., & Kwon-Chung, K. J. (1992). DNA probe for strain typing of Cryptococcus neoformans. Journal of Clinical Microbiology, 30(11), 2960-2967. 10.1128/jcm.30.11.2960-2967.
Velegraki, A., Kiosses, V. G., Pitsouni, H., Toukas, D., Daniilidis, V. D., & Legakis, N. J. (2001). First report of Cryptococcus neoformans var. gattii serotype B from Greece. Medical Mycology, 39(5), 419-22. 10.1080/mmy.39.5.419.422.
Vilchez, R. A., Fung, J., &, Kusne, S. (2002). Cryptococcosis in organ transplant recipients: an overview. American Journal of Transplantation, 2(7), 575-580. 10.1034/j.1600-6143.2002.20701.x.
Xue, X., Deng, H., Zhao, L., Zang, X., Asuquo, I. P., Meng, M., Ma, X., Qin, C., Meng, Y., Wu, C., Gao, J., & Pan, L. (2020). Cryptococcosis caused by cryptococcus gattii: 2 case reports and literature review. Medicine, 99(50), e23213. 10.1097/MD.0000000000023213.
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