Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep;13(3):99-108.
doi: 10.1007/s12281-019-00345-7. Epub 2019 Jul 22.

Clinical Aspects of Immune Damage in Cryptococcosis

Seher Anjum  1 , Peter R Williamson  1
Affiliations

Clinical Aspects of Immune Damage in Cryptococcosis

Seher Anjum et al. Curr Fungal Infect Rep. 2019 Sep.

Abstract

Purpose of review: To perform an extensive review of recent literature and provide an update on the current epidemiology, clinical features and management of cryptococcal disease with a focus on the differences between patients depending on their immune status.

Recent findings: Emerging literature has highlighted the inflammatory pathophysiology and varied manifestations of cryptococcal infections in patients who are apparently healthy but paradoxically have a more critical clinical course compared to their immunosuppressed counterparts.

Summary: Non-HIV cryptococcal meningitis has greater mortality compared to that seen in HIV patients. Basic science experiments closely analyzing the underlying pathophysiological response to this infection have demonstrated the predominant role of T cell-mediated inflammatory injury in causing worse clinical outcomes. Further studies are needed to define the need for immunosuppressive agents in the treatment of this illness.

Keywords: Cryptococcus; HIV; immunity; meningitis; steroids; ventricular shunt.

PubMed Disclaimer

Conflict of interest statement

Compliance with Ethics Guidelines Conflict of Interest Seher Anjum and Peter Williamson declare no conflicts of interest relevant to this manuscript.

Figures

Figure 1 –
Figure 1 –
An algorithmic approach to diagnose patients with inflammatory response syndromes (c-IRIS and PIIRS) after acute cryptococcal meningitis has been successfully treated. CrAg=cryptococcal antigen, ART=antiretroviral therapy, VL= viral load
See this image and copyright information in PMC

References

    1. Lui G, et al., Cryptococcosis in apparently immunocompetent patients. QJM, 2006. 99(3): p. 143–51.DOI: 10.1093/qjmed/hcl014. - DOI - PubMed
    1. Bennett JE, et al., A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptoccal meningitis. N Engl J Med, 1979. 301(3): p. 126–31.DOI: 10.1056/NEJM197907193010303. - DOI - PubMed
    1. Mirza SA, et al., The changing epidemiology of cryptococcosis: an update from population-based active surveillance in 2 large metropolitan areas, 1992–2000. Clin Infect Dis, 2003. 36(6): p. 789–94.DOI: 10.1086/368091. - DOI - PubMed
    1. Rajasingham R, et al., Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis, 2017. 17(8): p. 873–881.DOI: 10.1016/S1473-3099(17)30243-8. - DOI - PMC - PubMed
    1. Kwon-Chung KJ, et al., Cryptococcus neoformans and Cryptococcus gattii, the etiologic agents of cryptococcosis. Cold Spring Harb Perspect Med, 2014. 4(7): p. a019760DOI: 10.1101/cshperspect.a019760. - DOI - PMC - PubMed