Endobronchial cryptococcosis in AIDS

Although cryptococcosis is a common thoracic complication among patients with AIDS, endobronchial abnormalities have rarely been reported. A 45-year-old man presented with a productive cough, fever, and headache. His CD4+ cell count was 7/mm3 and testing for antibodies to HIV-1 was positive. Radiological examination revealed consolidation in the left lung, including cavitation. Bronchoscopic examination demonstrated white, slightly raised, plaque-like lesions in the trachea and left bronchi. Histopathological examination of endobronchial biopsy specimens revealed granulation tissue with abundant encapsulated yeast in the tissue. Cryptococcus neoformans was cultured from the bronchial lavage specimen. Cryptococcal infection should be included in the differential diagnosis of endobronchial abnormalities in patients with AIDS.     

Disseminated Cutaneous Cryptococcosis

Summary: A case of primary cutaneous cryptococcosis in a Thai woman with impairment of cellular immunity is reported. The infection later metastasized to different parts of the body resulting in various cutaneous lesions. With the presence of cryptococcus cells in the spinal fluid, there were no neurological manifestations. The infection was successfully treated with the combination of amphotericin B and 5-fluorocytosine.
Zusammenfassung: Bericht über einen Fall einer primären cutanen Cryptococcose bei einer thailändischen Frau mit einer gestörten zellulären Immunität. Später metastasierte die Infektion in verschiedene Körperregionen, wodurch zahlreiche cutane Herde entstanden. Trotz Gegenwart von Cryptococcus-Zellen im Liquor cerebrospinalis bestanden keine neurologischen Symptome. Die Infektion wurde erfolgreich mit einer Kombination von Amphotericin B und 5-Fluorocytosin behandelt.     

Pulmonary Cryptococcosis in a Rhesus Monkey (Macaca Mulatta)

Summary: Pulmonary cryptococcosis was diagnosed in a 5-year-old-male rhesus monkey from Delhi during 1979. The animal undergoing treatment for bacterial pneumonia was admitted to the indoor ward of Veterinary Hospital with a history of low grade fever, dyspnea and cough. Despite treatment with broad-spectrum antibiotics, hydrocostisones and other supportive drugs, the monkey died. Cryptococcus neoformans was cultured from the lungs of the autopsied animal on sunflower agar medium at 28°C. Histological section of the lung tissue showed large monuclear cells proliferation along with cryptococcal cells. Epidemiological investigation established the source of infection in the environment of the monkey.
Zusammenfassung: Eine pulmonale Crytococcose wurde bei einem 5jährigen männlichen Rhesusaffen 1979 in Delhi diagnostiziert Das Tier wurde während einer Behandlung wegen bakterieller Pneumonie in des Veterinärkrankenhaus mit niedrigem Fieber, Dyspnoe und Husten aufgenommen. Der Affe verstarb trotz Behandlung mit Breitspektrumantibiotika, Hydrocortison und anderen Medikamenten. Aus dem Autopsiematerial konnte Cryptococcus neoformans von den Lungen auf Sonnenblumen-Agar bei 28°C isoliert werden. Histologische Lungenschnitte zeigten Proliferation großer mononukleärer Zellen zusammen mit Cryptococ-cus-Zellen. Bei epidemiologischen Untersuchungen konnte die Infektionsquelle in der Umgebung des Affen nachgewiesen werden.     

Efficacy Evaluation of a Novel Submicron Miconazole Emulsion in a Murine Cryptococcosis Model

Submicron emulsions of miconazole were stabilized by using a combination of three emulsifiers comprising phospholipids, poloxamer, and deoxycholic acid (DCA). The presence of DCA was vital for prolonged emulsion stability owing to its contribution to the elevated zeta potential of the emulsion. Further, the results by the phospholipid surface labelling colorimetric technique clearly suggested that poloxamer molecules interacted with phospholipid polar-head groups of the mixed DCA-phospholipid interfacial film, resulting in the stabilization of the emulsion by a steric enthalpic entropic mechanism. The plain emulsion vehicle was well tolerated up to a dose of 0.6 ml injected i.v. to BALB/c mice. The maximum tolerated dose of miconazole was 80 and 250 mg/kg in Daktarin^® i.v. (a marketed product) and emulsion, respectively, showing an improved safety ratio of 1 to 3 in favor of the emulsion. These results tended to confirm that the adverse effects associated with Daktarin^® i.v. injection should be associated with the vehicle rather than with the miconazole itself. In a murine cryptococcosis model, only one mouse out of ten remained alive by day 15 in the infected group treated with Daktarin^® i.v., while in the miconazole emulsion treated group, mice began to die from day 16 up to day 25 post inoculation. Thus, the multiple-dose treatment with the miconazole emulsions improved the protection offered to the infected mice. However, the therapeutic levels of miconazole that were reached in the target organ (brain) were lower than those required for complete eradication of Cryptococcus neoformans, which is known to multiply preferentially in the brain.     

Incidence of cryptococcosis in and around Chandigarh, India, during the period 1982-91

Summary. The incidence of cryptococcosis was evaluated in and around Chandigarh, India over a period of 10 years (1982-91). Different species of Cryptococcus were isolated from 38 patients. Cryptococcus neoformans was the predominant isolate (26 = 68%) followed by Cr. albidus (2), Cr. laurentii (1) and not precisely identified Cryptococcus species (9 = 24%). Serotyping of the 18 isolates of Cr. neoformans revealed that 13 (72%) were serotype A, two (11%) were serotype AD and three (17%) were serotype B ( Cr. neoformans var. gattii). Cryptococcus species were found to produce infection in 24 patients and were possibly transient colonizers in another 14 patients. In addition, in 11 patients no Cryptococcus species was isolated from any site but the latex agglutination test for antigen (Crypto-LA) was positive in serum and/or cerebrospinal fluid. Response to various antifungal drugs was also studied in these patients.
Zusammenfassung. Über den Zehnjahreszeitraum 1982–1991 wurde in der Region Chandigarh, Indien, die Cryptococcose-Häufigkeit erhoben. Bei 38 Patienten wurde Cryptococcus isoliert. Vorherrschend war mit 26 Isolaten (68%) Cryptococcus neoformans , gefolgt von Cr. albidus (2), Cr. laurentii (1) und nicht näher definierten Cryptococcus -Arten (9 Isolate = 24%). Bei der Serotypisierung von Cr. neoformans erwiesen sich 13 (72%) als zum Serotyp A gehörig, zwei (11%) gehörten zum Serotyp AD und drei (17%) zum Serotyp B ( Cr. neoformans var. gattii). Cryptococcus -Arten führten bei 24 Patienten zu Infektionen und bei weiteren 14 Patienten möglicherweise zu einer Kolonisation. Bei 11 Patienten konnte Cryptococcus nicht nachgewiesen werden, aber der Cryptococcus -Antigennachweis (Crypto-LA Latexagglutination) war im Serum und/oder im Liquor positiv. Das Ansprechen auf unterschiedliche Antimykotika wurde gleichfalls in die Studie einbezogen.     

Clear cell type of renal cell carcinoma with numerous hyaline globules: a diagnostic pitfall

A unique and never-before-published example of clear cell renal cell carcinoma (CRCC) found among 9000 primary renal cell tumors is presented. The tumor contained such a dense concentration of glassy hyaline globules (GHG) in the cytoplasm of the neoplastic cells that it overshadowed the morphology of the neoplasm. The resulting appearance of the tumor was quite misleading and different from the conventional CRCC. The GHG were 7-30 microm in diameter. They were glassy and pale to slightly eosinophilic in color in hematoxylin-eosin. The GHG stained positively with periodic acid-Schiff and negatively with silver and Hale's colloidal iron. Immunohistochemically, they were also negative for anti Mycobacterium bovis antigen. At the ultrastructural level, the GHG were formed by an amorphous mass of stellate shape. The GHG were localized within rough endoplasmic reticulum. Molecular genetically, mutation of the distal part of exon 3 of the VHL gene causing elongation of the VHL protein was found in the tumor, thus confirming the diagnosis of CRCC.     

肺内外隐球菌感染病例的临床特征分析

目的 总结肺内外隐球菌感染患者的临床特点,分析肺外隐球菌感染的独立危险因素。方法 分析2014年1月至2019年12月间首都医科大学附属北京朝阳医院隐球菌感染住院患者的基本临床资料、临床表现、实验室检查、诊断治疗及转归,根据是否有肺外累及分为肺隐球菌感染组(pulmonary cryptococcal infection,PC)和肺外隐球菌感染组(extrapulmonary cryptococcal infection,EPC),用统计学方法对两组资料进行分析,用Logistic回归分析法分析隐球菌播散至肺外的危险因素。结果 共收集病例51例,其中男性30例,女性21例,年龄中位数为55(40,64)岁,合并基础疾病者39例。其中PC组41例,EPC组10例。EPC组实体器官移植和慢性肝病的比例(40.0%和40.0%),高于PC组(7.3%和7.3%),差异有统计学意义(P<0.05);EPC组患者出现头痛症状的比例(50.0%),高于PC组(2.4%),差异有统计学意义(P<0.05);EPC组降钙素原、门冬氨酸氨基转移酶、肌酐高于PC组,差异有统计学意义(P<0.05);EPC组白蛋白、外周血CD4⁺T细胞、外周血CD8⁺T细胞低于PC组,差异有统计学意义(P<0.05);EPC组病死率(60.0%)高于PC组(2.4%),差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示实体器官移植(OR=10.470,95%CI为1.089~100.651,P=0.042)和白蛋白降低(OR=0.783,95%CI为0.637~0.962,P=0.020)与出现肺外隐球菌感染独立相关。结论 肺外隐球菌感染患者比肺隐球菌感染患者预后差,实体器官移植和白蛋白降低是肺外隐球菌感染的独立危险因素。     

A Small Solitary Pulmonary Nodule Discovered by 18F-fluorodeoxyglucose Positron Emission Tomography and CT: Rare Infection Instead of Rare Tumor

THE causes of Cushing’s syndrome are mainly divided into adrenocorticotropic hormone (ACTH) dependent and independent. ACTH dependent hypercortisolism represents excess ACTH secreting by the pituitary or tumor outside the pituitary;     

Infective capacity of Cryptococcus neoformans and Cryptococcus gattii in a human astrocytoma cell line

Pathogenesis of cryptococcosis in the central nervous system (CNS) is a topic of ongoing research, including the mechanisms by which this fungus invades and infects the brain. Astrocytes, the most common CNS cells, play a fundamental role in the local immune response. Astrocytes might participate in cryptococcosis either as a host or by responding to fungal antigens. To determine the infectivity of Cryptococcus neoformans var. grubii and Cryptococcus gattii in a human astrocytoma cell line and the induction of major histocompatibility complex (MHC) molecules. A glioblastoma cell line was infected with C. neoformans var. grubii and C. gattii blastoconidia labelled with FUN‐1 fluorescent stain. The percentage of infection and expression of HLA class I and II molecules were determined by flow cytometry. The interactions between the fungi and cells were observed by fluorescence microscopy. There was no difference between C. neoformans var. grubii and C. gattii in the percentage infection, but C. neoformans var. grubii induced higher expression of HLA class II than C. gattii. More blastoconidia were recovered from C. neoformans‐infected cells than from C. gattii infected cells. Cryptococcus neoformans var. grubii may have different virulence mechanisms that allow its survival in human glia‐derived cells.