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Systemic Review of Published Reports on Primary Cutaneous Cryptococcosis in Immunocompetent Patients

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Abstract

Primary cutaneous cryptococcosis (PCC) has been confirmed as a distinct clinical entity with secondary cutaneous cryptococcosis from systematic infection since 2003. Although it has been confirmed as a distinct clinical entity, little has progressed on PCC in immunocompetent hosts compared to their immunocompromised counterpart. We reviewed the literature on cases of PCC in immunocompetent patients from 2004 to 2014, and 21 cases from 16 reports were identified. Males are more likely to develop PCC infections, with a ratio of 17:4 male to female. These patients were found to be almost all senior population except for patients from Asia. Asymptomatic or moderate itching manifesting in a painful nodule is the most common presentation, although there is no typical clinical manifestation recorded. Upper limbs are the most common site of infection, accounting for 71.4 % of all patients. Of the 12 identified isolates, 6 strains are identified as C. neoformans, 5 as C. gattii, and 1 as C.laurentii. Fluconazole was used in 10 cases; however, only 80 % of the 10 cases could confirm that fluconazole was effective in clearing the infections. Interestingly although not approved as a treatment option, Itraconazole was effective in the seven cases it was used to treat cryptococcosis, with a dosage range of 100–400 mg/d and duration from 3 to 6 months. Even though the prognosis of these patients was generally good, more data are need to determine which antifungal azole is the better treatment option and whether primary skin infections could disseminate to systematic infection.

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References

  1. Sanfelice F. Contributo alle morfologia e biologia dei blastomiceti che si sviluppano nei succhi di alcuni frutti. Ann Isto Igiene R Univ Roma. 1894;4:463–95.

    Google Scholar 

  2. Ricardo M, La Hoz La, Pappas PG. Cryptococcal infections: changing epidemiology and implications for therapy. Drugs. 2013;73(6):495–504.

    Article  Google Scholar 

  3. Neuville S, Dromer F, Morin O, et al. Primary cutaneous cryptococcosis: a distinct clinical entity. Clin Infect Dis. 2003;36(3):337–47.

    Article  PubMed  Google Scholar 

  4. Christianson JC, Engber W, Andes D. Primary cutaneous cryptococcosis in immunocompetent and immunocompromised hosts. Med Mycol. 2003;41(3):177–88.

    Article  PubMed  Google Scholar 

  5. Lu HC, Yang YY, Huang YL, et al. Disseminated cryptococcosis initially presenting as cellulitis in a rheumatoid arthritis patient. J Chin Med Assoc. 2007;70(6):249–52.

    Article  PubMed  Google Scholar 

  6. Rerolle JP, Szelag JC, Diaconita M, et al. Intracranial granuloma and skull osteolysis: complication of a primary cutaneous cryptococcosis in a kidney transplant recipient. Am J Kidney Dis. 2005;46(6):e113–7.

    Article  PubMed  Google Scholar 

  7. Hafner C, Linde HJ, Vogt T, et al. Primary cutaneous cryptococcosis and secondary antigenemia in a patient with long-term corticosteroid therapy. Infection. 2005;33(2):86–9.

    Article  CAS  PubMed  Google Scholar 

  8. Biancheri D, Kanitakis J, Bienvenu AL, et al. Cutaneous cryptococcosis in solid organ transplant recipients: epidemiological, clinical, diagnostic and therapeutic features. Eur J Dermatol. 2012;22(5):651–7.

    PubMed  Google Scholar 

  9. Sun HY, Alexander BD, Lortholary O, et al. Cutaneous cryptococcosis in solid organ transplant recipients. Med Mycol. 2010;48(6):785–91.

    Article  PubMed  Google Scholar 

  10. Kronstad JW, Attarian R, Cadieux B, et al. Expanding fungal pathogenesis: Cryptococcus breaks out of the opportunistic box. Nat Rev Microbiol. 2011;9(3):193–203.

    Article  CAS  PubMed  Google Scholar 

  11. Molina-Leyva A, Ruiz-Carrascosa JC, Leyva-Garcia A, et al. Cutaneous Cryptococcus laurentii infection in an immunocompetent child. Int J Infect Dis. 2013;17(12):e1232–3.

    Article  PubMed  Google Scholar 

  12. Narváez-Moreno B, Bernabeu-Wittel J, Zulueta-Dorado T, et al. Primary cutaneous cryptococcosis of the penis. Sex Transm Dis. 2012;39(10):792–3.

    Article  PubMed  Google Scholar 

  13. Leão CA, Ferreira-Paim K, Andrade-Silva L, et al. Primary cutaneous cryptococcosis caused by Cryptococcus gattii in an immunocompetent host. Med Mycol. 2011;49(4):352–5.

    Article  PubMed  Google Scholar 

  14. Spiliopoulou A, Anastassiou ED, Christofidou M. Primary cutaneous cryptococcosis in immunocompetent hosts. Mycoses. 2012;55(2):e45–7.

    CAS  PubMed  Google Scholar 

  15. Pasa CR, Chang MR, Hans-Filho G. Post-trauma primary cutaneous cryptococcosis in an immunocompetent host by Cryptococcus gattii VGII. Mycoses. 2012;55(2):e1–3.

    PubMed  Google Scholar 

  16. Nasser N, Nasser Filho N, Vieira AG. Primay cutaneous cryptococcosis in an immunocompetent patient. An Bras Dermatol. 2011;86(6):1178–80.

    Article  PubMed  Google Scholar 

  17. Lingegowda BP, Koh TH, Ong HS, et al. Primary cutaneous cryptococcosis due to Cryptococcus gattii in Singapore. Singap Med J. 2011;52(7):e160–2.

    CAS  Google Scholar 

  18. Pau M, Lallai C, Aste N, et al. Primary cutaneous cryptococcosis in an immunocompetent host. Mycoses. 2010;53(3):256–8.

    Article  PubMed  Google Scholar 

  19. Allegue F, de Lis MP, Pérez-Alvarez R. Primary cutaneous cryptococcosis presenting as a whitlow. Acta Derm Venereol. 2007;87(5):443–4.

    Article  PubMed  Google Scholar 

  20. Yuge S, Bastazini Júnior I, Coelho MC, et al. Cutaneous cryptococcosis in an immunocompetent host. Acta Derm Venereol. 2006;86(2):165–6.

    PubMed  Google Scholar 

  21. Xiujiao X, Ai’e X. Two cases of cutaneous cryptococcosis. Mycoses. 2005;48(4):238–41.

    Article  PubMed  Google Scholar 

  22. Al-Marzooq YM, Chopra R, Al-Mommatten MI, et al. Fine-needle aspiration diagnosis of primary cutaneous cryptococcosis in an immunocompetent patient: a case report. Diagn Cytopathol. 2005;32(4):219–21.

    Article  PubMed  Google Scholar 

  23. Kumar P, Saran RK, Gondal R, et al. Smear morphology of cryptococcosis presenting as a subcutaneous swelling in healthy adults: a report of three cases. Cytopathology. 2005;16(3):143–6.

    Article  CAS  PubMed  Google Scholar 

  24. Werchniak AE, Baughman RD. Primary cutaneous cryptococcosis in an elderly man. Clin Exp Dermatol. 2004;29(2):159–60.

    Article  CAS  PubMed  Google Scholar 

  25. Marques SA, Bastazini I Jr, Martins AL, et al. Primary cutaneous cryptococcosis in Brazil: report of 11 cases in immunocompetent and immunosuppressed patients. Int J Dermatol. 2012;51(7):780–4.

    Article  PubMed  Google Scholar 

  26. Tilak R, Prakash P, Nigam C, et al. Cryptococcal meningitis with an antecedent cutaneous Cryptococcal lesion. Dermatol Online J. 2009;15(9):12.

    PubMed  Google Scholar 

  27. Chen J, Varma A. Diaz MR, Cryptococcus neoformans strains and infection in apparently immunocompetent patients China. Emerg Infect Dis. 2008;14:755–62.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Chau TT, Mai NH, Phu NH, et al. A prospective descriptive study of cryptococcal meningitis in HIV uninfected patients in Vietnam-high prevalence of Cryptococcus neoformans var grubii in the absence of underlying disease. BMC Infect Dis. 2010;9(10):199.

    Article  Google Scholar 

  29. Lee SJ, Choi HK, Son J, et al. Cryptococcal meningitis in patients with or without human immunodeficiency virus: experience in a tertiary hospital. Yonsei Med J. 2011;52(3):482–7.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Kronstad JW, Attarian R, Cadieux B, et al. Expanding fungal pathogenesis: Cryptococcus breaks out of the opportunistic box. Nat Rev Microbiol. 2011;9(3):193–203.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

Part of this work was supported by China National Nature and Science Foundation (Number: 30600540). We would like to acknowledge Dr Shu Hui Chen from NIAID, NIH, who has contributed scientific discussions, English and proper grammar, and syntax for this paper.

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Authors and Affiliations

  1. Department of Dermatology and Mycology Center, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China

    Lin Du, Yali Yang, Julin Gu, Jianghan Chen, Wanqing Liao & Yuanjie Zhu

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  1. Lin Du
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  2. Yali Yang
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  3. Julin Gu
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  4. Jianghan Chen
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  5. Wanqing Liao
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  6. Yuanjie Zhu
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Correspondence to Yuanjie Zhu.

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Du, L., Yang, Y., Gu, J. et al. Systemic Review of Published Reports on Primary Cutaneous Cryptococcosis in Immunocompetent Patients. Mycopathologia 180, 19–25 (2015). https://doi.org/10.1007/s11046-015-9880-7

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  • DOI: https://doi.org/10.1007/s11046-015-9880-7

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