Cryptococcus neoformans infection

J.C. Rhodes, I. Polacheck, and K.J. Kwon-Chung, Phenoloxidase activity and virulence in isogenic strains of Cryptococcus neoformans, Infect. Immun., 36, 1175, 1982. 

Amphotericin B In vivo—mice In vivo—mice In vivo—mice Treatment of pulmonary and systemic Cryptococcus neoformans infections Prophylaxis of pulmonary aspergillosis Pharmacokinetics, effect of lipid composition [91] [92] [93]... 

B. E. Gilbert, P. R. Wyde, and S. Z. Wilson, Aerosolized liposomal amphotericin B for treatment of pulmonary and systemic Cryptococcus neoformans infections in mice, Antimicrob. Agents Chemother. 36 1466 (1992). 

La Sorda, M., Torelli, R., Fiori, B., Santangelo, R., Delogu, G., and Fadda, G. (2006) Role of AFRl, an ABC transporterencoding gene, in the in vivo response to fluconazole and virrrlence of Cryptococcus neoformans. Infection and Immunity, 74, 1352-1359. 

Smith CL, Baker CJ, Anderson DC, Edwards MS Role of complement receptors in opsonophago-cytosis of group B streptococci by adult and neonatal neutrophils. J Infect Dis 1990 162 489-495. Vecchiarelli A, Retini C, Casadevall A, Monari C, Pietrella D, Kozel TR Involvement of C3a and C5a in interleukin-8 secretion by human polymorphonuclear cells in response to capsular material of Cryptococcus neoformans. Infect Immun 1998 66 4324--4330. 

A later study in 8 other patients confirmed that itraconazole levels were reduced by rifampicin but the clinical outcome depended on the mycosis being treated. Four out of 5 patients responded to treatment for a Cryptococcus neoformans infection, despite undetectable itraconazole levels, apparently because in vitro there is synergy between the two drugs. In contrast, 2 patients with coccidioidomycosis failed to respond, and 2 others with eryptoeoeeosis suffered a relapse or persistenee of seborrhoeic dermatitis (possibly due to M. furfur) while taking both drugs. In a pa-... 

Traynor TR, Kuziel WA, Toews GB, Huffnagle GB. CCR2 expression determines T1 versus T2 polarization during pulmonary Cryptococcus neoformans infection. J Immunol 2000 164 2021-2027. 

Levitz SM, North EA, Jiang Y, Nong SH, Kornfeld H, Harrison TS. Variables affecting production of monocyte chemotactic factor 1 from human leukocytes stimulated with Cryptococcus neoformans. Infect Immun 1997 65 903-908. 

Pirofski LA. Of mice and men, revisited new insights into an ancient molecule from studies of complement activation by Cryptococcus neoformans. Infect Immun 2006 74 3079-3084. 

R. Cherniak, J.B. Simdstrom, Polysaccharide antigens of the capsule of Cryptococcus neoformans, Infection Immunity, 62 (5), 1507-1512,1994. 

Due to the rapid appearance of resistance, 5FC is only used as a combination partner for the intensive therapy of established severe fungal infections caused by Candida spp., Cryptococcus neoformans and Aspergillus sp. Anorexia, nausea, vomiting, diarrhoea and or abdominal pain occur in 6% of the patients. Of greater concern is the potential for bone marrow depression (seen in 5% of the patients, all with elevated 5FC levels). 

Amphotericin B is particularly effective against systemic infections caused by C. albicans and Cryptococcus neoformans. It is poorly absorbed from the gastrointestinal tract and is thus usually administered by intravenous injection under strict medical supervision. Amphotericin B methyl ester (Fig. 5.15C) is water-soluble, unlike amphotericin B itself, and can be administered intravenously as a solution. The two forms have equal antifungal activity but higher peak serum levels are obtained with the ester. Although the ester is claimed to be less toxic, neurological effects have been observed. An ascorbate salt has recently been described which is water-soluble, of similar activity and less toxic. 

Cryptococcus neoformans HIV-1 infection tobacco smoking as risk 1.3 II... 

Cryptococcosis is a noncontagious, systemic mycotic infection caused by the ubiquitous encapsulated soil yeast Cryptococcus neoformans. 

Amphotericin B is used to treat systemic disseminated fungal infections caused by Candida spp., Cryptococcus neoformans, and the invasive dimorphic fungi Aspergillus spp., Histoplasma capsulatum, Coccidioides immi-tis, Blastomyces dermatitidis, and Sporothrix schenckii). Intravenous amphotericin B remains the treatment of choice for serious invasive fungal infections unresponsive to other agents. 

Nakouzi, A., P. Valadon, J. Nosanchuk, N. Green, and A. CasadevaU, Molecular basis for immunoglobulin M specificity to epitopes in Cryptococcus neoformans polysaccharide that elicit protective and nonprotective antibodies. Infect Immun, 2001. 69(5) 3398-409. 

The spectrum of action of these medications is quite broad, ranging from many Candida species, Cryptococcus neoformans, the endemic mycoses (blastomycosis, coccidioidomycosis, histoplasmosis), the dermatophytes, and, in the case of itraconazole and voriconazole, even aspergillus infections. They are also useful in the treatment of intrinsically amphotericin-resistant organisms such as Pseudallescheria boydii. 

Antifungal spectrum It is the drug of choice for Cryptococcus neoformans. for candidemia, and for coccidioidomycosis. Fluconazole has also been shown to be useful in the treatment of blastomycosis, candidiasis, and histoplasmosis. These infections are characterized by a high rate of relapse, and fluconazole has proved effective in chronic ambulatory treatment. 

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