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Published in: Infection 4/2022

24-03-2022 | COVID-19 | Brief Report

COVID-19-associated Cryptococcus infection (CACI): a review of literature and clinical pearls

Authors: Dinesh Regalla, Mollie VanNatta, Mohammad Alam, Alexandre E. Malek

Published in: Infection | Issue 4/2022

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Abstract

Background

Cryptococcal infection has been increasingly reported in patients with COVID-19 infection, but the epidemiological factors, presentation, diagnostic certainty, and outcome have not been well-described.

Methods

We reviewed the published cases of COVID-19-associated Cryptococcus infections (CACI) to shed the light on the burden of this infection.

Results

We identified 13 patients with confirmed cryptococcal infection. Cryptococcus infection was primarily seen in patients with severe COVID-19 disease who received corticosteroids therapy and admitted to the intensive care unit. Pulmonary CACI was the most common reported infection followed by cryptococcal meningitis.

Conclusion

In light of the high mortality rate, clinicians should maintain a high clinical suspicion of CACI in critically ill patients.
Literature
1.
go back to reference Lai C-C, Wang C-Y, Hsueh P-R. Co-infections among patients with COVID-19: the need for combination therapy with non-anti-SARS-CoV-2 agents? J Microbiol Immunol Infect. 2020;53:505–12.CrossRef Lai C-C, Wang C-Y, Hsueh P-R. Co-infections among patients with COVID-19: the need for combination therapy with non-anti-SARS-CoV-2 agents? J Microbiol Immunol Infect. 2020;53:505–12.CrossRef
2.
go back to reference Pemán J, Ruiz-Gaitán A, García-Vidal C, et al. Fungal co-infection in COVID-19 patients: should we be concerned? Rev Iberoam micol. 2020;37:41–6.CrossRef Pemán J, Ruiz-Gaitán A, García-Vidal C, et al. Fungal co-infection in COVID-19 patients: should we be concerned? Rev Iberoam micol. 2020;37:41–6.CrossRef
3.
go back to reference Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475–81.CrossRef Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475–81.CrossRef
4.
go back to reference Bartoletti M, Pascale R, Cricca M, et al. Epidemiology of invasive pulmonary aspergillosis among COVID-19 intubated patients: a prospective study. Clin Infect Dis. 2021;73(11):e3606–14.CrossRef Bartoletti M, Pascale R, Cricca M, et al. Epidemiology of invasive pulmonary aspergillosis among COVID-19 intubated patients: a prospective study. Clin Infect Dis. 2021;73(11):e3606–14.CrossRef
5.
go back to reference Narayanan S, Chua JV, Baddley JW. Coronavirus disease 2019–associated mucormycosis: risk factors and mechanisms of disease. Clin Infect Dis. 2021;22:ciab726. Narayanan S, Chua JV, Baddley JW. Coronavirus disease 2019–associated mucormycosis: risk factors and mechanisms of disease. Clin Infect Dis. 2021;22:ciab726.
6.
go back to reference John TM, Jacob CN, Kontoyiannis DP. When uncontrolled diabetes mellitus and severe COVID-19 converge: the perfect storm for mucormycosis. J Fungi (Basel, Switzerland). 2021;7(4):298. John TM, Jacob CN, Kontoyiannis DP. When uncontrolled diabetes mellitus and severe COVID-19 converge: the perfect storm for mucormycosis. J Fungi (Basel, Switzerland). 2021;7(4):298.
7.
go back to reference Setianingrum F, Rautemaa-Richardson R, Denning DW. Pulmonary cryptococcosis: a review of pathobiology and clinical aspects. Med Mycol. 2019;57:133–50.CrossRef Setianingrum F, Rautemaa-Richardson R, Denning DW. Pulmonary cryptococcosis: a review of pathobiology and clinical aspects. Med Mycol. 2019;57:133–50.CrossRef
8.
go back to reference Maziarz EK, Perfect JR. Cryptococcosis. Infect Dis Clin North Am. 2016;30:179–206.CrossRef Maziarz EK, Perfect JR. Cryptococcosis. Infect Dis Clin North Am. 2016;30:179–206.CrossRef
9.
go back to reference Thyagarajan RV, Mondy KE, Rose DT. Cryptococcus neoformans blood stream infection in severe COVID-19 pneumonia. IDCases. 2021;26:e01274.CrossRef Thyagarajan RV, Mondy KE, Rose DT. Cryptococcus neoformans blood stream infection in severe COVID-19 pneumonia. IDCases. 2021;26:e01274.CrossRef
10.
go back to reference Gamon E, Tammena D, Wattenberg M, Augenstein T. Rare superinfection in a COVID-19 patient-A chronology. Anaesthesist. 2021;24:1–12. Gamon E, Tammena D, Wattenberg M, Augenstein T. Rare superinfection in a COVID-19 patient-A chronology. Anaesthesist. 2021;24:1–12.
11.
go back to reference Ghanem H, Sivasubramanian G. Cryptococcus neoformans meningoencephalitis in an immunocompetent patient after COVID-19 infection. C Rep Infect Dis. 2021;2021:5597473. Ghanem H, Sivasubramanian G. Cryptococcus neoformans meningoencephalitis in an immunocompetent patient after COVID-19 infection. C Rep Infect Dis. 2021;2021:5597473.
12.
go back to reference Khatib MY, Ahmed AA, Shaat SB, Mohamed AS, Nashwan AJ. cryptococcemia in a patient with COVID-19: a case report. Clin C Rep. 2021;9:853–5.CrossRef Khatib MY, Ahmed AA, Shaat SB, Mohamed AS, Nashwan AJ. cryptococcemia in a patient with COVID-19: a case report. Clin C Rep. 2021;9:853–5.CrossRef
13.
go back to reference Heller HM, Gonzalez RG, Edlow BL, Ard KL, Gogakos T. Case 40–2020: a 24-year-old man with headache and COVID-19. N Engl J Med. 2020;383:2572–80.CrossRef Heller HM, Gonzalez RG, Edlow BL, Ard KL, Gogakos T. Case 40–2020: a 24-year-old man with headache and COVID-19. N Engl J Med. 2020;383:2572–80.CrossRef
16.
go back to reference Abohelwa MM, del Rio-Pertuz G, Parmar KN, et al. Pulmonary cryptococcosis in the 2019 novel coronavirus, when the coinfection affects the mortality. Am J Respir Crit Care Med. 2021;203:A2461. Abohelwa MM, del Rio-Pertuz G, Parmar KN, et al. Pulmonary cryptococcosis in the 2019 novel coronavirus, when the coinfection affects the mortality. Am J Respir Crit Care Med. 2021;203:A2461.
17.
go back to reference Alegre-González D, Herrera S, Bernal J, Soriano A, Bodro M. Disseminated cryptococcus neoformans infection associated to COVID-19. Med Mycol C Rep. 2021;34:35–7.CrossRef Alegre-González D, Herrera S, Bernal J, Soriano A, Bodro M. Disseminated cryptococcus neoformans infection associated to COVID-19. Med Mycol C Rep. 2021;34:35–7.CrossRef
18.
go back to reference Traver EC, Malavé SM. Pulmonary aspergillosis and cryptococcosis as a complication of COVID-19. Med Mycol C Rep. 2022;35:22–5.CrossRef Traver EC, Malavé SM. Pulmonary aspergillosis and cryptococcosis as a complication of COVID-19. Med Mycol C Rep. 2022;35:22–5.CrossRef
19.
go back to reference Thota DR, Ray B, Hasan M, Sharma K. Cryptococcal meningoencephalitis during convalescence from severe COVID-19 pneumonia. Neurohospitalist. 2022;12:96–9.CrossRef Thota DR, Ray B, Hasan M, Sharma K. Cryptococcal meningoencephalitis during convalescence from severe COVID-19 pneumonia. Neurohospitalist. 2022;12:96–9.CrossRef
20.
go back to reference Karnik K, Wu Y, Ruddy S, et al. Fatal case of disseminated cryptococcal infection and meningoencephalitis in the setting of prolonged glucocorticoid use in a COVID-19 positive patient. IDCases. 2022;27:e01380.CrossRef Karnik K, Wu Y, Ruddy S, et al. Fatal case of disseminated cryptococcal infection and meningoencephalitis in the setting of prolonged glucocorticoid use in a COVID-19 positive patient. IDCases. 2022;27:e01380.CrossRef
21.
22.
go back to reference Chiappe Gonzalez AJ, Montenegro-Idrogo JJ, Vargas Vadillo AR, Slee Torres M, Vargas Matos I, Resurrección Delgado CP. Hospital-acquired SARS-CoV-2 pneumonia in a person living with HIV. Int J STD AIDS. 2020;31:1320–2.CrossRef Chiappe Gonzalez AJ, Montenegro-Idrogo JJ, Vargas Vadillo AR, Slee Torres M, Vargas Matos I, Resurrección Delgado CP. Hospital-acquired SARS-CoV-2 pneumonia in a person living with HIV. Int J STD AIDS. 2020;31:1320–2.CrossRef
23.
go back to reference Passerini M, Terzi R, Piscaglia M, Passerini S, Piconi S. Disseminated cryptococcosis in a patient with metastatic prostate cancer who died in the coronavirus disease 2019 (COVID-19) Outbreak. Cureus. 2020;2020:12. Passerini M, Terzi R, Piscaglia M, Passerini S, Piconi S. Disseminated cryptococcosis in a patient with metastatic prostate cancer who died in the coronavirus disease 2019 (COVID-19) Outbreak. Cureus. 2020;2020:12.
24.
go back to reference Donnelly JP, Chen SC, Kauffman CA, et al. Revision and update of the consensus definitions of invasive fungal disease from the European organization for research and treatment of cancer and the mycoses study group education and research consortium. Clin Infect Dis Publ Infect Dis Soc Am. 2020;71:1367–76.CrossRef Donnelly JP, Chen SC, Kauffman CA, et al. Revision and update of the consensus definitions of invasive fungal disease from the European organization for research and treatment of cancer and the mycoses study group education and research consortium. Clin Infect Dis Publ Infect Dis Soc Am. 2020;71:1367–76.CrossRef
25.
go back to reference Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of America. Clin Infect Dis. 2010;50:291–322.CrossRef Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of America. Clin Infect Dis. 2010;50:291–322.CrossRef
28.
go back to reference Fact sheet for healthcare providers: emergency use authorization for Actemra ® (tocilizumab) highlights of emergency use authorization (EUA) these highlights of the EUA do not include all the information needed to use Actemra under the EUA. see the full fact sheet for healthcare providers for Actemra. Actemra ® (tocilizumab) injection, for intravenous use Original EUA Authorized Date: 06/2021. Available at: www.clinicaltrials.gov. Accessed 30 October 2021. Fact sheet for healthcare providers: emergency use authorization for Actemra ® (tocilizumab) highlights of emergency use authorization (EUA) these highlights of the EUA do not include all the information needed to use Actemra under the EUA. see the full fact sheet for healthcare providers for Actemra. Actemra ® (tocilizumab) injection, for intravenous use Original EUA Authorized Date: 06/2021. Available at: www.​clinicaltrials.​gov. Accessed 30 October 2021.
30.
go back to reference Nishioka H, Takegawa H, Kamei H. Disseminated cryptococcosis in a patient taking tocilizumab for Castleman’s disease. J Infect Chemother: official J Japan Soc Chemother. 2018;24:138–41.CrossRef Nishioka H, Takegawa H, Kamei H. Disseminated cryptococcosis in a patient taking tocilizumab for Castleman’s disease. J Infect Chemother: official J Japan Soc Chemother. 2018;24:138–41.CrossRef
31.
32.
go back to reference Winthrop KL, Harigai M, Genovese MC, et al. Infections in baricitinib clinical trials for patients with active rheumatoid arthritis. Ann Rheum Dis. 2020;79:1290–7.CrossRef Winthrop KL, Harigai M, Genovese MC, et al. Infections in baricitinib clinical trials for patients with active rheumatoid arthritis. Ann Rheum Dis. 2020;79:1290–7.CrossRef
33.
go back to reference Kalil AC, Patterson TF, Mehta AK, et al. Baricitinib plus remdesivir for hospitalized adults with COVID-19. N Engl J Med. 2021;384:795–807.CrossRef Kalil AC, Patterson TF, Mehta AK, et al. Baricitinib plus remdesivir for hospitalized adults with COVID-19. N Engl J Med. 2021;384:795–807.CrossRef
34.
go back to reference Oliveira LVN, Costa MC, Magalhães TFF, et al. Influenza a virus as a predisposing factor for cryptococcosis. Front Cell Infect Microbiol. 2017;7:419.CrossRef Oliveira LVN, Costa MC, Magalhães TFF, et al. Influenza a virus as a predisposing factor for cryptococcosis. Front Cell Infect Microbiol. 2017;7:419.CrossRef
35.
go back to reference Huang J, Li H, Lan C, et al. Concomitant severe influenza and cryptococcal infections: a case report and literature review. Medicine. 2019;98:e15544.CrossRef Huang J, Li H, Lan C, et al. Concomitant severe influenza and cryptococcal infections: a case report and literature review. Medicine. 2019;98:e15544.CrossRef
36.
go back to reference Chen D-Y, Khan N, Close BJ, et al. SARS-CoV-2 disrupts proximal elements in the JAK-STAT pathway. J Virol. 2021;95:e0086221.CrossRef Chen D-Y, Khan N, Close BJ, et al. SARS-CoV-2 disrupts proximal elements in the JAK-STAT pathway. J Virol. 2021;95:e0086221.CrossRef
Metadata
Title
COVID-19-associated Cryptococcus infection (CACI): a review of literature and clinical pearls
Authors
Dinesh Regalla
Mollie VanNatta
Mohammad Alam
Alexandre E. Malek
Publication date
24-03-2022
Publisher
Springer Berlin Heidelberg
Published in
Infection / Issue 4/2022
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-022-01805-y

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