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Metataxonomics of Internal Transcribed Spacer amplicons in cerebrospinal fluid for diagnosing and genotyping of cryptococcal meningitis

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Chinese Medical Journal 2019年第23期132卷 2827-2834页

作者： Ji-Ting Zhu Han Lin Xuan Wu Zhi-Wen Li Ai-Yu Lin Department of Neurology and Institute of Neurology First Affiliated HospitalFujian Medical UniversityFuzhouFujian 350005China School of Postgraduate Education Fujian Medical UniversityFuzhouFujian 350122China

Background:cryptococcal meningitis is a severe infectious disease associated with high morbidity and *** and accuracy of diagnosis contribute to better prognosis,but readily available tools,such as microscopy,culture,and antigens do not perform well all the *** study attempted to diagnose and genotype cryptococcus in the cerebrospinal fluid(CSF)samples from patients with cryptococcal meningitis using the approach of metataxonomics of Internal Transcribed Spacer(ITS)***:The CSF samples were collected from 11 clinically suspected cryptococcal meningitis patients and four non-infectious *** were recruited from the First Affiliated Hospital of Fujian Medical University Hospital,Fuzhou Fourth Hospital and the 476th Hospital of Chinese People's Liberation Army from December 2017 to December ***1 ribosomal deoxyribonucleic acid(rDNA)genes of 15 whole samples were amplified by universal forward primer ITS1(CTTGGTCATTTAGAGGAAGTAA)and reverse primer ITS2(GCTGCGTTCTTCATCGATGC),sequenced by Illumina MiSeq Benchtop *** results were confirmed by sanger sequencing of ITS1 region and partial CAP59 gene of microbial isolates from 11 meningitic ***-wise comparison between infectious group and control group was conducted through permutational multivariate analysis(PERMANOVA)in R ***:The 30,000 to 340,000 high-quality clean reads were obtained from each of the positively stained or cultured CSF samples and 8 to 60 reads from each *** samples from 11 infected patients yielded detectable cryptococcal-specific ITS1 DNA with top abundance(from 95.90%to 99.97%),followed by many other fungal groups(each<1.41%).ITS genotype was defined in 11 CSF samples,corresponding to ITS type 1,and confirmed by Sanger sequencing.A statistically significant difference(r2=0.65869,P=0.0014)between infectious group and control group was ***:The metataxonomics of ITS amplicons facilitates the diagnosis a

关键词： Metataxonomics Internal transcribed spacer amplicons Cerebrospinal fluid Diagnosis Genotype cryptococcal meningitis

Clinical features and treatment outcomes of human immunodeficiency virus-associated cryptococcal meningitis:a 2-year retrospective analysis

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Chinese Medical Journal 2020年第23期133卷 2787-2795页

作者： Wei Song Yin-Zhong Shen Zhen-Yan Wang Tang-Kai Qi Li Liu Ren-Fang Zhang Jiang-Rong Wang Yang Tang Jun Chen Jian-Jun Sun Hong-Zhou Lu Department of Infection and Immunity Shanghai Public Health Clinical CenterFudan UniversityShanghai 201508China

Background:cryptococcal meningitis(CM)is one of the most common opportunistic infections caused by Cryptococcus neoformans in human immunodeficiency virus(HIV)-infected patients,and is complicated with significant morbidity and *** study retrospectively analyzed the clinical features,characteristics,treatment,and outcomes of first-diagnosed HIV-associated CM after 2-years of ***:Data from all patients(n=101)of HIV-associated CM hospitalized in Shanghai Public Health Clinical Center from September 2013 to December 2016 were collected and analyzed using logistic regression to identify clinical and microbiological factors associated with ***:Of the 101 patients,86/99(86.9%)of patients had CD4 countcryptococcal pneumonia,50/74(67.6%)had abnormalities shown on intracranial imaging,amongst whom 24/50(48.0%)had more than one *** median time to negative CSF Indian ink staining was 8.50 months(interquartile range,3.25-12.00 months).Patients who initiated antiretroviral therapy(ART)before admission had a shorter time to negative CSF Indian ink compared with ART-naïve patients(7 vs.12 months,χ^2=15.53,P<0.001).All-cause mortality at 2 weeks,8 weeks,and 2 years was 10.1%(10/99),18.9%(18/95),and 20.7%(19/92),*** with PCP on admission(adjusted odds ratio[AOR],3.933;95%confidence interval[CI],1.166-13.269,P=0.027)and altered mental status(AOR,9.574;95%CI,2.548-35.974,P=0.001)were associated with higher mortality at 8 ***:This study described the clinical features and outcomes of first diagnosed HIV-associated CM with 2-year follow-up *** mental status and coinfection with PCP predicted mortality in HIV-ass

关键词： Clinical features cryptococcal meningitis HIV Intracranial lesions Mortality

Voriconazole in an infant with cryptococcal meningitis

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Chinese Medical Journal 2008年第3期121卷 286-288页

作者： SHEN Yin-zhong WANG Jiang-rong LU Hong-zhou Department of Infectious Diseases Shanghai Public HealthClinical Center Fudan University Shanghai 201508 China

Cryptococcus neoformans （C. neoformans） is the most common cause of fungal meningitis worldwide.1 cryptococcal meningitis is an opportunistic infection commonly found in immunocompromised hosts, especially HIV-infected adults. It also occurs in apparently immunocompetent individuals. Rarely has it been reported in children, and it is almost nonexistent in infants. Voriconazole is a member of a second generation of antifungal triazoles with broad spectrum antifungal activity, oral and parenteral bioavailability and a favorable safety profile in adults.3 This patient shows improved in vitro activity against C. neoformans when compared to fluconazole and it has been used successfully in about half the patients with refractory cryptococcosis.4 However, the efficacy and safety of voriconazole as a antifungal agent in children with cryptococcal meningitis have not been well assessed, This report described cryptococcal meningitis in a 13-day-old premature neonate who recovered without overt toxicity after voriconazole was added to an antifungal regimen that included amphotericin B and flucytosine. We focused on the response of this child with cryptococcal meningitis to voriconazole.

关键词： voriconazole cryptococcal meningitis child

Current diagnosis and treatment of cryptococcal meningitis without acquired immunodeficiency syndrome

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Neuroimmunology and Neuroinflammation 2016年第1期3卷 249-256页

作者： Xiao-Su Guo Hui Bu Jun-Ying He Yue-Li Zou Yue Zhao Yuan-Yuan Li Jun-Zhao Cui Ming-Ming Zheng Wei-Xin Han Ze-Yan Zhao Department of Neurology the Second Hospital of Hebei Medical UniversityShijiazhuang 050000HebeiChina

cryptococcal meningitis(CM)is a central nervous system infectious disease caused by *** is the most common fungal infection in the central nervous system,accounting for about 48%of fungal *** disease occurs mainly in acquired immunodeficiency syndrome(AIDS)patients and concentrates in the immunocompromised people without *** are nearly one million new cases of CM each year,and about 70%of them *** China,CM occurs mainly in people without AIDS and there is an increasing trend in recent *** diagnosis and treatment is the key to reducing morbidity and mortality associated with *** diagnosis mainly depends on laboratory examination such as morphological examination,fungal culture and antigen ***,clinical manifestation and imaging examination are the important parts of auxiliary *** initial combined antifungal treatment is emphasized,and the principle of fractional treatment including induction,consolidation and maintenance therapy should be *** high intracranial pressure must be reduced actively at the same *** addition,it is proved that the novel immunotherapy combined with antifungal agents can improve the curative effect and limit the chance of antimicrobial ***-scale clinical trials are needed for further study.

关键词： cryptococcal meningitis without AIDS diagnosis treatment

Successful Treatment with Triple Therapy of Amphotericin B, Voriconazole and Flucytosine on an AIDS Patients with Severe cryptococcal meningitis

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国际感染病学（电子版） 2012年第2期1卷 110-113页

作者： Zhi-liang Hu Hong-xia Wei Wen-hu Yao Yong-feng Yang Department of Infectious Diseases the Second Affiliated Hospital of the Southeast University

A 35-year-old man(body weight=63 kg)with AIDS complaining fever and headache after having commenced anti-retroviral therapy(ART)for a week was admitted to our *** lumbar punctures performed during38 days could not confirm a cryptococcal meningitis(CM)based on staining or culture methods for cerebrospinal fluid(CSF).The disease quickly progressed with serious hearing/vision impairment and frequent onset of seizure and coma after being treated with corticosteroids for five days,and then CM was *** lumbar puncture showed elevated intracranial pressure as high as 870 mm H2O,even though treated with standard antifungal regimens for *** disease was finally controlled by a new triple therapy with amphotericin B(0.7mg?kg-1?day-1,intravenously),flucytosine(100 mg/kg perday,orally in four divided doses),and voriconazole(200mg every 12 hours)and ART containing lamivudine(300 mg/day),stavuding(30 mg,twice a day)and efavirenz(300 mg,orally every night).Although it is rare,negative CSF stain or culture for cryptococci in AIDS patients with CM can persist for a long *** should be used cautiously when an effective anti-fungal therapy is not *** therapy with amphotericin B,flucytosine and voriconazole may be selectively applied in severe *** can be co-administered with efavirenz with modified dosing.

关键词： cryptococcal meningitis Anti-retroviral therapy Corticosteroids Voriconazole Efavirenz

Cryptococcus neoformans,a global threat to human health

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Infectious Diseases of Poverty 2023年第2期12卷 1-18页

作者： Youbao Zhao Leixin Ye Fujie Zhao Lanyue Zhang Zhenguo Lu Tianxin Chu Siyu Wang Zhanxiang Liu Yukai Sun Min Chen Guojian Liao Chen Ding Yingchun Xu Wanqing Liao Linqi Wang College of Veterinary Medicine Henan Agricultural UniversityZhengzhou 450046HenanChina State Key Laboratory of Mycology Institute of MicrobiologyChinese Academy of SciencesBeijing 100101China University of Chinese Academy of Sciences Beijing 100039China Department of Dermatology Shanghai Key Laboratory of Molecular Medical MycologyChangzheng HospitalShanghai 200003China The Medical Research Institute College of Pharmaceutical SciencesSouthwest UniversityChongqing 400715China College of Life and Health Sciences Northeastern UniversityShenyang 110819LiaoningChina Department of Laboratory Medicine and Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal DiseasesPeking Union Medical College HospitalChinese Academy of Medical SciencesBeijing 100730China

Background Emerging fungal pathogens pose important threats to global public health. The World Health Organization has responded to the rising threat of traditionally neglected fungal infections by developing a Fungal Priority Pathogens List (FPPL). Taking the highest-ranked fungal pathogen in the FPPL,Cryptococcus neoformans, as a paradigm, we review progress made over the past two decades on its global burden, its clinical manifestation and management of cryptococcal infection, and its antifungal resistance. The purpose of this review is to drive research efforts to improve future diagnoses, therapies, and interventions associated with fungal *** We first reviewed trends in the global burden of HIV-associated cryptococcal infection, mainly based on a series of systematic studies. We next conducted scoping reviews in accordance with the guidelines described in the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews using PubMed and ScienceDirect with the keywordCryptococcus neoformans to identify case reports of cryptococcal infections published since 2000. We then reviewed recent updates on the diagnosis and antifungal treatment of cryptococcal infections. Finally, we summarized knowledge regarding the resistance and tolerance ofC. neoformans to approved antifungal *** There has been a general reduction in the estimated global burden of HIV-associated cryptococcal meningitis since 2009, probably due to improvements in highly active antiretroviral therapies. However, cryptococcal meningitis still accounts for 19% of AIDS-related deaths annually. The incidences of CM in Europe and North America and the Latin America region have increased by approximately two-fold since 2009, while other regions showed either reduced or stable numbers of cases. Unfortunately, diagnostic and treatment options for cryptococcal infections are limited, and emerging antifungal resistance exacerbates the public health bu

关键词： Fungal infections Cryptococcus neoformans cryptococcal meningitis Antifungal resistance Antifungal tolerance

乳胶凝集试验对新型隐球菌性脑膜炎诊断及治疗的意义

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乳胶凝集试验对新型隐球菌性脑膜炎诊断及治疗的意义