Scandinavian Journal of Infectious Diseases, 2014; 46: 479–480
LETTER TO THE EDITOR
Is pulmonary cryptococcosis a unique pathology?
Scand J Infect Dis Downloaded from informahealthcare.com by RMIT University on 08/20/15 For personal use only.
BRUNO HOCHHEGGER1,2, EDSON MARCHIORI1, KLAUS IRION3, ALINE BELLO2 & LUIZ CARLOS SEVERO2 From the 1Radiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, 2Chest Radiology Department, Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil, and 3Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
To the Editor, We read with great interest the well-written manuscript by Hu et al. [1], who reported pulmonary cryptococcosis (PC) in China. They reported that solitary cavitary pulmonary nodule may be a common computed tomography finding in AIDSassociated PC. However, we would like highlight some important aspects. Cryptococcus neoformans was first isolated in 1894 from fermented peach juice by the Italian Francesco Sanfelice [2]. Since that time, this organism has been recovered from numerous locations throughout the world, where its main ecological niche is soil, particularly in association with pigeon excreta [3]. Cryptococci grow as unicellular, encapsulated cells in the asexual state, or as basidiomycetous filaments in the sexual state [2]. Infection due to this opportunistic fungus is believed to occur by inhalation and primarily targets the lung, with frequent dissemination to the central nervous system, as well as a variety of other organs [2]. Cryptococcus gattii was first isolated from a leukemic patient in 1970 and described as a variant of C. neoformans [4]. However, C. gattii (formerly Cryptococcus neoformans var. gattii) [2] is a basidiomycetous yeast that is pathogenic to immunocompetent mammals including humans. This relatively uncommon organism differs from the congeneric, more commonly encountered pathogen C. neoformans, with regards to phenotypic characteristics, natural habitat, epidemiology,
ecology, clinical manifestations of disease, and responses to antifungal therapy [5]. Phylogenetic studies have shown that C. gattii and C. neoformans diverged from a common ancestor approximately 40 million years ago [3]. C. gattii has the ability to inhibit polymorphonuclear leukocyte (PMN) migration to the site of the organism [2,3], which may promote survival of the extracellular organisms, and can multiply locally to form cryptococcomas that can potentially be misdiagnosed as malignancies [1–4]. Compared to C. neoformans, C. gattii infections more often cause granulomatous lesions (cryptococcomas) in the lung and brain, with more associated neurological sequelae and morbidity [6–9]. Because of these data, we do not believe that pulmonary cryptococcosis can only be regarded as a unique pathology. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References [1] Hu Z, Xu C, Wei H, Zhong Y, Bo C, Chi Y, et al. Solitary cavitary pulmonary nodule may be a common CT finding in AIDS-associated pulmonary cryptococcosis. Scand J Infect Dis 2013;45:378–89. [2] Mitchell DH, Sorrell TC, Allworth AM, Heath CH, McGregor AR, Papanaoum K, et al. Cryptococcal disease of the CNS in immunocompetent hosts: influence of cryptococcal variety on clinical manifestations and outcome. Clin Infect Dis 1995;20:611–6.
Correspondence: B. Hochhegger, Chest Radiology Department, Santa Casa de Porto Alegre, Rua 24 de outubro 925/903, Bairro Moinhos de Vento, 90510002, Porto Alegre, RS, Brazil. Tel/Fax: ⫹ 55 51 3213 7164. E-mail: [email protected] (Received 24 April 2013 ; accepted 29 April 2013) ISSN 0036-5548 print/ISSN 1651-1980 online © 2014 Informa Healthcare DOI: 10.3109/00365548.2013.803294
480
B. Hochhegger et al.
Scand J Infect Dis Downloaded from informahealthcare.com by RMIT University on 08/20/15 For personal use only.
[3] Kwon-Chung KJ, Bennett JE. Medical mycology. Philadelphia, PA: Lea and Febiger; 1992. [4] Vanbreuseghem R, Takashio M. An atypical strain of Cryptococcus neoformans (San Felice) Vuillemin 1894. II. Cryptococcus neoformans var. gattii var. nov. Ann Soc Belges Med Trop Parasitol Mycol 1970;50:695–702. [5] Sorrell TC. Cryptococcus neoformans variety gattii. Med Mycol 2001;39:155–68. [6] Campbell LT, Fraser JA, Nichols CB, Dietrich FS, Carter D, Heitman J. Clinical and environmental isolates of
Cryptococcus gattii from Australia that retain sexual fecundity. Eukaryotic Cell 2005;4:1410–9. [7] Chen S, Sorrell T, Nimmo G, Speed B, Currie B, Ellis D, et al. Epidemiology and host- and variety-dependent characteristics of infection due to Cryptococcus neoformans in Australia and New Zealand. Australasian Cryptococcal Study Group. Clin Infect Dis 2000;31:499–508. [8] Dixit A, Carroll SF, Qureshi ST. Cryptococcus gattii: an emerging cause of fungal disease in North America. Interdiscip Perspect Infect Dis 2009;2009:840452.
LETTER TO THE EDITOR
Is pulmonary cryptococcosis a unique pathology?
Scand J Infect Dis Downloaded from informahealthcare.com by RMIT University on 08/20/15 For personal use only.
BRUNO HOCHHEGGER1,2, EDSON MARCHIORI1, KLAUS IRION3, ALINE BELLO2 & LUIZ CARLOS SEVERO2 From the 1Radiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, 2Chest Radiology Department, Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil, and 3Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
To the Editor, We read with great interest the well-written manuscript by Hu et al. [1], who reported pulmonary cryptococcosis (PC) in China. They reported that solitary cavitary pulmonary nodule may be a common computed tomography finding in AIDSassociated PC. However, we would like highlight some important aspects. Cryptococcus neoformans was first isolated in 1894 from fermented peach juice by the Italian Francesco Sanfelice [2]. Since that time, this organism has been recovered from numerous locations throughout the world, where its main ecological niche is soil, particularly in association with pigeon excreta [3]. Cryptococci grow as unicellular, encapsulated cells in the asexual state, or as basidiomycetous filaments in the sexual state [2]. Infection due to this opportunistic fungus is believed to occur by inhalation and primarily targets the lung, with frequent dissemination to the central nervous system, as well as a variety of other organs [2]. Cryptococcus gattii was first isolated from a leukemic patient in 1970 and described as a variant of C. neoformans [4]. However, C. gattii (formerly Cryptococcus neoformans var. gattii) [2] is a basidiomycetous yeast that is pathogenic to immunocompetent mammals including humans. This relatively uncommon organism differs from the congeneric, more commonly encountered pathogen C. neoformans, with regards to phenotypic characteristics, natural habitat, epidemiology,
ecology, clinical manifestations of disease, and responses to antifungal therapy [5]. Phylogenetic studies have shown that C. gattii and C. neoformans diverged from a common ancestor approximately 40 million years ago [3]. C. gattii has the ability to inhibit polymorphonuclear leukocyte (PMN) migration to the site of the organism [2,3], which may promote survival of the extracellular organisms, and can multiply locally to form cryptococcomas that can potentially be misdiagnosed as malignancies [1–4]. Compared to C. neoformans, C. gattii infections more often cause granulomatous lesions (cryptococcomas) in the lung and brain, with more associated neurological sequelae and morbidity [6–9]. Because of these data, we do not believe that pulmonary cryptococcosis can only be regarded as a unique pathology. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References [1] Hu Z, Xu C, Wei H, Zhong Y, Bo C, Chi Y, et al. Solitary cavitary pulmonary nodule may be a common CT finding in AIDS-associated pulmonary cryptococcosis. Scand J Infect Dis 2013;45:378–89. [2] Mitchell DH, Sorrell TC, Allworth AM, Heath CH, McGregor AR, Papanaoum K, et al. Cryptococcal disease of the CNS in immunocompetent hosts: influence of cryptococcal variety on clinical manifestations and outcome. Clin Infect Dis 1995;20:611–6.
Correspondence: B. Hochhegger, Chest Radiology Department, Santa Casa de Porto Alegre, Rua 24 de outubro 925/903, Bairro Moinhos de Vento, 90510002, Porto Alegre, RS, Brazil. Tel/Fax: ⫹ 55 51 3213 7164. E-mail: [email protected] (Received 24 April 2013 ; accepted 29 April 2013) ISSN 0036-5548 print/ISSN 1651-1980 online © 2014 Informa Healthcare DOI: 10.3109/00365548.2013.803294
480
B. Hochhegger et al.
Scand J Infect Dis Downloaded from informahealthcare.com by RMIT University on 08/20/15 For personal use only.
[3] Kwon-Chung KJ, Bennett JE. Medical mycology. Philadelphia, PA: Lea and Febiger; 1992. [4] Vanbreuseghem R, Takashio M. An atypical strain of Cryptococcus neoformans (San Felice) Vuillemin 1894. II. Cryptococcus neoformans var. gattii var. nov. Ann Soc Belges Med Trop Parasitol Mycol 1970;50:695–702. [5] Sorrell TC. Cryptococcus neoformans variety gattii. Med Mycol 2001;39:155–68. [6] Campbell LT, Fraser JA, Nichols CB, Dietrich FS, Carter D, Heitman J. Clinical and environmental isolates of
Cryptococcus gattii from Australia that retain sexual fecundity. Eukaryotic Cell 2005;4:1410–9. [7] Chen S, Sorrell T, Nimmo G, Speed B, Currie B, Ellis D, et al. Epidemiology and host- and variety-dependent characteristics of infection due to Cryptococcus neoformans in Australia and New Zealand. Australasian Cryptococcal Study Group. Clin Infect Dis 2000;31:499–508. [8] Dixit A, Carroll SF, Qureshi ST. Cryptococcus gattii: an emerging cause of fungal disease in North America. Interdiscip Perspect Infect Dis 2009;2009:840452.
