Abstract
Cryptococcus has emerged as a significant pathogen in immunocompromised patients. While the diagnostic testing and the antifungal treatment of cryptococcal infections have become firmly established in clinical practice, new developments and areas of ambiguity merit further consideration. These include the potential for donor transmission of Cryptococcus; cirrhosis-associated cryptococcosis, particularly during transplant candidacy; the utility of serum cryptococcal antigen testing of asymptomatic individuals in high-prevalence, poor-resource areas; pathogenesis and treatment of the immune reconstitution syndrome, specifically in relation to antiretroviral therapy and immunosuppressive medications; and new challenges posed by the emerging species of Cryptococcus gatti. In this article, we summarize the literature pertaining to these topics, focusing on recent progress.
Highlights
Cryptococcosis is one of the most common opportunistic infections in immunocompromised hosts.C. neoformans and C. gattii account for ~80% and 20% of cases of human disease, respectively [1].The global burden of cryptococcosis is estimated to be ~1 million cases with nearly 700,000 deaths annually, with most of the cases occurring in sub-Saharan Africa [1]
Cryptococcemia and disseminated disease occur in 50% to 70% and 19% to 76% of patients with cirrhosis-related cryptococcosis, respectively, and are more likely to be associated with septic shock [3,9,10,14]
There does not seem to be a benefit for earlier antiretroviral therapy (ART) in treating tuberculous meningitis, implying that the timing of ART that provides the greatest advantage in patients with central nervous system (CNS) infections may differ from the timing in patients with non-CNS infections [2]
Summary
Cryptococcosis is one of the most common opportunistic infections in immunocompromised hosts. C. neoformans and C. gattii account for ~80% and 20% of cases of human disease, respectively [1]. Cryptococcosis is a major pathogen in solid organ transplant (SOT) recipients with an overall incidence of 2.8% (range 0.2% to 5%) [3,4]. A strong cellular immune response is essential for containment of cryptococcal infections as evidenced by the fact that the vast majority of cryptococcosis occurs in patients with compromised cell-mediated immunity [5]. In addition to human immunodeficiency virus (HIV) infection and organ transplantation, major risk factors for cryptococcosis comprise liver cirrhosis, iatrogenic immunosuppression including corticosteroids and monoclonal antibodies, rheumatologic and other autoimmune diseases, idiopathic CD4+ lymphopenia, and malignancy [1,5,6]. Cryptococcosis occurs infrequently in hematopoietic stem cell transplant (HSCT) recipients [7]. This article, not aimed to be an exhaustive review, focuses on key areas of interest and new developments in our understanding of cryptococcal infections with implications relevant for management
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