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Pulmonary Cryptococcosis

Pathophysiological and Clinical Characteristics
  • Miriam L. Cameron
  • John R. Perfect
Chapter
  • 66 Downloads
Part of the Infectious Agents and Pathogenesis book series (IAPA)

Abstract

Cryptococcus neoformans is an encapsulated yeast that has become a significant human pathogen in our enlarging population of immunocompromised hosts. The yeast was originally isolated by Sanfelice in 1894 from peach juice,1 but its role as a human pathogen was described soon after in 1894–1895 (Buschke and Busse) from a bone lesion.2,3 C. neoformans may also be a pulmonary pathogen in other mammals and even the bottle-nosed dolphin is not safe from a pulmonary infection.4 Since its discovery, C. neoformans has been a consistent cause of invasive mycoses, but with the advent of iatrogenic immunosuppression (glucocorticoids, cancer chemotherapeutic agents, anti—transplant rejection therapeutics),56 and with the appearance of the acquired immunodeficiency syndrome (AIDS) during the past 10 years,7–10 this particular fungal infection has mushroomed into a common clinical problem.

Keywords

Alveolar Macrophage Pulmonary Infection Acquire Immunodeficiency Syndrome Cryptococcus Neoformans Adult Respiratory Distress Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Sanfelice, F., 1894, Contributo alla morfologia e biologia dei blastomiceti che si sviluppano nei succhi di alcuni frutti, Ann. igiene 4:463.Google Scholar
  2. 2.
    Buschke, A., 1895, Ueber, eine durch coccidien hemorgerufene krankheit des menschen, Dtsch. Med. Wochenschr. 21:14.CrossRefGoogle Scholar
  3. 3.
    Busse, O., 1894, Ueber parasitare zelleinschulusse and ihre zuchtung, Centralbl f Bakt 16:175.Google Scholar
  4. 4.
    Migaki, G., Gunnels, R. D., and Casey, H. W., 1978, Pulmonary cryptococcosis in an Atlantic bottlenosed dolphin (TURSIOPS TRUNCATUS), Lab. Anim. Sci. 28:603–606.PubMedGoogle Scholar
  5. 5.
    Perfect, J. R., Durack, D. T., and Gallis, H. A., 1983, Cryptococcemia, Medicine 62: 98–109.PubMedCrossRefGoogle Scholar
  6. 6.
    Perfect, J. R., 1989, Cryptococcosis, Infect. Dis. Clin. North Am. 3:77–102.PubMedGoogle Scholar
  7. 7.
    Zuger, A., Louie, E., Holzman, R. S., Simberkoff, M. S., and Rahal, J. J., 1986, Cryptococcal disease in patients with acquired immunodeficiency syndrome: Diagnostic features and outcome of treatment, Ann. Intern. Med. 104:234–240.PubMedCrossRefGoogle Scholar
  8. 8.
    Kovacs, J. A., Kovacs, A. A., Polis, M., Wright, W. C., Gill, V.J., Tuazon, C. U., Gelmann, E. P., Lane, H. C., Longfield, R., Overturf, G., Macher, A. M., Fauci, A. S., Parrillo, J. E., Bennett, J. E., and Masur, H., 1985, Cryptococcosis in the Acquired Immunodeficiency Syndrome, Ann. Intern. Med. 103:533–538.PubMedCrossRefGoogle Scholar
  9. 9.
    Chuck, S. L. and Sande, M. A., 1989, Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome, N. Engl. J. Med. 321:794–799.PubMedCrossRefGoogle Scholar
  10. 10.
    Clark, R. A., Greer, D., Atkinson, W., Valainis, G. T., and Hyslop, N., 1990, Spectrum of Cryptococcus neoformans infection in 68 patients infected with acquired immunodeficiency virus, Rev. Infect Dis. 12:768–777.PubMedCrossRefGoogle Scholar
  11. 11.
    Edwards, V. E., Sutherland, J. M., and Tyrer, J. H., 1970, Cryptococcosis of the central nervous system, J.Neurol. Neurosurg. Psychiatry 33:415–425.PubMedCrossRefGoogle Scholar
  12. 12.
    Newberry, W. M., Jr., Walter, J. E., Chandler, J. W., Jr., and Tosh, F. E., 1967, Epidemiologic study of Cryptococcus neoformans, Ann. Intern. Med. 67:724–732.CrossRefGoogle Scholar
  13. 13.
    Falconer, H., Terry, S. I., and Spencer, H., 1980, Cryptococcosis in the West Indies, West Indian Med. J. 29:142.PubMedGoogle Scholar
  14. 14.
    Slobodniuk, R. and Naraqi, S., 1980, Cryptococcal meningitis in the central province of Papua New Guinea, New Guinea Med. J. 23:111.Google Scholar
  15. 15.
    Misha, S. K., Staib, F., Folkens, V., and Fromtling, R. A. 1981, Serotypes of Cryptococcus neoformans strains isolated in Germany, J. Clin. Microbiol. 14:106.Google Scholar
  16. 16.
    Bisseru, B., Bajaj, A., Carruthers, R. H., and Chhabra, H. N., 1983, Pulmonary and bilateral retinochoroidal cryptococcosis, Br. J. Ophthalmol. 67:157–161.PubMedCrossRefGoogle Scholar
  17. 17.
    Randhawa, H. S. and Paliwal, D. K., 1979, Survey of Cryptococcus neoformans in the respiratory tract of patients with bronchopulmonary disorders and in the air, Sabouraudia 17:399–404.PubMedCrossRefGoogle Scholar
  18. 18.
    Fink, J. N., Barboriak, J. J., and Kaufman, L., 1968, Cryptococcal antibodies in pigeon Breeder’s disease, J. Allergy Clin. Immunol. 41:297–301.Google Scholar
  19. 19.
    Cobcroft, R., Kronenberg, H., and Wilkinson, I., 1978, Cryptococcus in bagpipes, Lancet 1:1368–1369.PubMedCrossRefGoogle Scholar
  20. 20.
    Powell, K. E., Dahl, B. A., Weeks, R. J., and Tosh, F. E., 1972, Airborne Cryptococcus neoformans: Particles from pigeon excreta compatible with alveolar deposition, J.Infect. Dis. 126:412–415.CrossRefGoogle Scholar
  21. 21.
    Smith, C. D., Ritter, R., Larsh, H. W., and Furculow, M. L., 1964, Infections of white mice with airborne Cryptococcus neoformans, J. Bacteriol. 87:1363–1368.Google Scholar
  22. 22.
    Neilson, J. B., Fromtling, R. A., and Bulmer, G. S., 1977, Cryptococcus neoformans: Size range of infectious particles from aerosolized soil, Infect. Immun. 17:634–638.PubMedGoogle Scholar
  23. 23.
    Emmons, C. W., 1951, Isolation of Cryptococcus neoformans from soil, J. Bacteriol. 62: 685–690.PubMedGoogle Scholar
  24. 24.
    Ruiz, A., Fromtling, R. A., and Bulmur, G. S., 1981, Distribution of Cryptococcus neoformans in a natural site, Infect. Immun. 31:560–563.PubMedGoogle Scholar
  25. 25.
    Ellis, D. H. and Pfeiffer, T. J., 1990, Ecology, life cycle, and infectious propagule of Cryptococcus neoformans, Lancet 336:923–925.PubMedCrossRefGoogle Scholar
  26. 26.
    Ellis, D. H. and Pfeiffer, T. J., 1990, Natural habitat of Cryptococcus neoformans var gattii, J. Clin. Microbiol. 28:1642–1644.PubMedGoogle Scholar
  27. 27.
    Duperval, R., Hermans, P. E., Brewer, N. S., and Roberts, G. D., 1977, Cryptococcosis, with emphasis on the significance of isolation of Cryptococcus neoformans from the respiratory tract, Chest 72:13–19.PubMedCrossRefGoogle Scholar
  28. 28.
    Levitz, S. M., 1991, The etiology of Cryptococcus neoformans and the epidemiology of cryptococcosis, Rev. Infect. Dis. 13:1163–1169.PubMedCrossRefGoogle Scholar
  29. 29.
    Littman, M. L. and Zimmerman, L. E., 1956, Cryptococcosis, torulosis or European blastomycosis, Grune and Stratton, New York.Google Scholar
  30. 30.
    Glaser, J. B. and Garden, A., 1985, Inoculation of cryptococcosis without transmission of the acquired immunodeficiency syndrome, N. Engl. J. Med. 313:264.CrossRefGoogle Scholar
  31. 31.
    Shuttleworth, D., Philpot, C. M., and Knight, A. G., 1989, Cutaneous cryptococcosis treatment with oral fluconazole, Br. J. Dermatol. 120:683–687.PubMedCrossRefGoogle Scholar
  32. 32.
    Kwon-Chung, K. J., 1975, A new genus, Filobasidiella, the perfect state of Cryptococcus neoformans, Mycologia 67:1197.PubMedCrossRefGoogle Scholar
  33. 33.
    Still, C. N. and Jacobson, E. S., 1983, Recombinational mapping of capsule mutations in Cryptococcus neoformans, J. Bacteriol. 156:460–462.PubMedGoogle Scholar
  34. 34.
    Cohen, J., Perfect, J. R., and Durack, D. T., 1982, Cryptococcosis and basidiospores, Lancet 1:1301.PubMedCrossRefGoogle Scholar
  35. 35.
    Kwon-Chung, K.J. and Bennett, J. E., 1978, Distribution of “a” and “alpha” mating types of Cryptococcus neoformans among natural and clinical isolates, Am. J. Epidemiol. 108:337.PubMedGoogle Scholar
  36. 36.
    Kwon-Chung, K.J., Edman, J. C., and Wickes, B. L., 1992, Genetic association of mating types and virulence in Cryptococcus neoformans, Infect. Immun. 60:602–605.PubMedGoogle Scholar
  37. 37.
    Dykstra, M. A., Friedman, L., and Murphy, J. W., 1977, Capsule size of Cryptococcus neoformans: Control and relationship to virulence, Infect. Immun. 16:129.PubMedGoogle Scholar
  38. 38.
    Gal, A. A., Evans, S., and Meyer, P. R., 1987, The clinical laboratory evaluation of cryptococcal infections in the Acquired Immunodeficiency Syndrome, Diagn. Microbiol. Infect. Dis. 7:249–254.PubMedCrossRefGoogle Scholar
  39. 39.
    Bottone, E. J. and Wormser, G. P., 1985, Capsule-deficient cryptococci in AIDS, Lancet 2:553.PubMedCrossRefGoogle Scholar
  40. 40.
    Kozel, T. R., 1989, Antigenic structure of Cryptococcus neoformans capsular polysaccharides, in: Immunology of Fungal Diseases, (E. Kurstak, ed.), Marcel Dekker, Inc., New York, pp. 63–86.Google Scholar
  41. 41.
    Cherniak, R., Reiss, E., Slodki, M. E., Plattner, R. D., and Blumer, S. O., 1980, Structure and antigenic activity of the capsular polysaccharide of Cryptococcus neoformans serotype A, Mol. Immunol. 17:1025–1032.PubMedCrossRefGoogle Scholar
  42. 42.
    Cherniak, R., Reiss, E., and Turner, S. H., 1982, A galactoxylomannan antigen of Cryptococcus neoformans serotype A, Carbohydr. Res. 103:239–250.CrossRefGoogle Scholar
  43. 43.
    Bhattacharjee, A. K., Bennett, J. E., and Glaudemans, C. P. J., 1984, Capsular polysaccharides of Cryptococcus neoformans, Rev. Infect. Dis. 6:619–624.PubMedCrossRefGoogle Scholar
  44. 44.
    Erke, K. H. and Schneidau, J. D., 1973, Relationship of some Cryptococcus neoformans hypha-forming strains to standard strains and to other species of yeasts as determined by deoxyribonucleic acid base ratios and homologies, Infect. Immun. 7:941–948.PubMedGoogle Scholar
  45. 45.
    Perfect, J. R., Magee, B. B., and Magee, P. T. 1989, Separation of chromosomes of Cryptococcus neoformans by pulsed field gel electrophoresis, Infect. Immun. 57:2624–2627.PubMedGoogle Scholar
  46. 46.
    Bottone, E. J., Salkin, I. F., Hurd, N.J., and Wormser, G. P., 1987, Serogroup distribution of Cryptococcus neoformans in patients with AIDS, J. Infect. Dis. 156:242.PubMedCrossRefGoogle Scholar
  47. 47.
    Shimizu, R. Y., Howard, D. H., and Claney, M. N., 1986, The variety of Cryptococcus neoformans in patients with AIDS, J.Infect. Dis. 159:1042.CrossRefGoogle Scholar
  48. 48.
    Rinaldi, M. G., Drutz, D. J., Howell, A., Sande, M. A., Wofsky, C.B., and Hadley, W. K., 1986, Serotypes of Cryptococcus neoformans in patients with AIDS, J.Infect. Dis. 153:642.PubMedCrossRefGoogle Scholar
  49. 49.
    Bennett, J. E., Kwon-Chung, K. J., and Howard, D. H., 1977, Epidemiology differences among serotypes of Cryptococcus neoformans, Am. J. Epidemiol. 105:582.PubMedGoogle Scholar
  50. 50.
    Kwon-Chung, K. J., and Bennett, J. E., 1984, Epidemiologic differences between the two varieties of Cryptococcus neoformans, Am. J. Epidemiol. 120:123–140.PubMedGoogle Scholar
  51. 51.
    Lehmann, P. E., Morgan, R. J., and Freimer, E. H., 1984, Infection with Cryptococcus neoformans var. gattii leading to a pulmonary cryptococcoma and meningitis, J. Infect. 9:301–306.PubMedCrossRefGoogle Scholar
  52. 52.
    Bottone, E. J., Kirschner, P. A., and Salkin, I. F., 1986, Isolation of highly encapsulated Cryptococcus neoformans serotype B from a patient in New York City, J. Clin. Microbiol. 23:186–188.PubMedGoogle Scholar
  53. 53.
    Henderson, D. K., Edwards, J. E., Dismukes, W. E., and Bennett, J. E., 1981, Meningitis produced by different serotypes of Cryptococcus neoformans, in: Proceedings of the 81st annual meeting of the American Society for Microbiology, American Society of Microbiology Proceedings (Abstract).Google Scholar
  54. 54.
    Bulmer, G. S. and Tacker, J. R., 1975, Phagocytosis of Cryptococcus neoformans by alveolar macrophages, Infect. Immun. 11:73–79.PubMedGoogle Scholar
  55. 55.
    Bottone, E. J., Johnasson, B. E., Toma, M., and Wormser, G. P., 1986, Poorly encapsulated Cryptococcus neoformans from patients with AIDS. I: preliminary observations, AIDS Res. Hum. Retroviruses 2:221.Google Scholar
  56. 56.
    Ro, J. Y., Lee, S. S., and Ayala, A. G., 1987, Advantage of Fontana-Masson stain in capsule-deficient cryptococcal infection, Arch. Pathol. Lab. Med. 111:53–57.PubMedGoogle Scholar
  57. 57.
    Moser, S. A., Friedman, L., and Varraux, A. R., 1978, Atypical isolate of Cryptococcus neoformans cultured from sputum of a patient with pulmonary cancer and blastomycosis, J.Clin. Microbiol. 7:316–318.PubMedGoogle Scholar
  58. 58.
    Harding, S. A., Scheid, W. M., Feldman, P. S., and Sande, M. A., 1979, Pulmonary infection with capsule-deficient Cryptococcus neoformans, Virchows Arch [A] 182:113–118.CrossRefGoogle Scholar
  59. 59.
    Brueske, C. H., 1986, Proteolytic activity of a clinical isolate of Cryptococcus neoformans, J. Clin. Microbiol. 23:631.PubMedGoogle Scholar
  60. 60.
    Rhodes, J. C., Polacheck, I., and Kwon-Chung, K. J., 1982, Phenoloxidase activity and virulence in isogenic strains of Cryptococcus neoformans, Infect. Immun. 36:1175–1184.PubMedGoogle Scholar
  61. 61.
    Kwon-Chung, K. J. and Rhodes, J. C., 1986, Encapsulation and melanin formation as indicators of virulence in Cryptococcus neoformans, Infect. Immun. 51:218–223.PubMedGoogle Scholar
  62. 62.
    Restrepo, B. I. and Barbour, A. G., 1989, Cloning of the 18s and 25s ribosomal DNA from the pathogenic fungus, Cryptococcus neoformans, J. Bacteriol. 171:5596–5600.PubMedGoogle Scholar
  63. 63.
    Vilgalys, R. and Hester, M., 1990, Rapid genetic identification and mapping of en-zymatically amplified ribosomal DNA from several Cryptococcus species, J. Bacteriol. 172:4238–4246.PubMedGoogle Scholar
  64. 64.
    Varma, A. and Kwon-Chung, K. J., 1989, Restriction fragment polymorphism in mitochondrial DNA of Cryptococcus neoformans, J. Gen. Microb. 135:3353–3362.Google Scholar
  65. 65.
    Edman, J. C. and Kwon-Chung, K.J., 1990, Isolation of the URA5 gene from Cryptococcus neoformans var. neoformans and its use as a selective marker for transformation, Mol. Cell. Biol. 10:4538–4544.PubMedGoogle Scholar
  66. 66.
    Toffaletti, D. L., Rude, T. H., Johnston, S. A., and Durack, D. T., 1993, Gene transfer in Cryptococcus neoformans using biolistic delivery of DNA, J. Bacteriol. 175:1405–1411.PubMedGoogle Scholar
  67. 67.
    Perfect, J. R., Rude, T. H., Penning, L. M., and Johnston, S. A., 1992, Cloning of the Cryptococcus neoformans TRP 1 gene by complementation in Saccharomyces cerevisiae, Gene 122:213–217.PubMedCrossRefGoogle Scholar
  68. 68.
    Perfect, J. R., Rude, T., Penning, L., and Wong, B., 1991, Cloning of a Cryptococcus neoformans mannitol dehydrogenase gene, Internat. Soc. Human Animal Mycol. PS 1.45. (Abstract).Google Scholar
  69. 69.
    Chaskes, S. and Tyndall, R. L., 1975, Pigment production by Cryptococcus neoformans from para- and ortho-diphenols: Effect of the nitrogen source, J. Clin. Microbiol. 1:509–514.PubMedGoogle Scholar
  70. 70.
    Krumholz, R. A., 1972, Pulmonary cryptococcosis: A case due to Cryptococcus albidus, Am. Rev. Respir. Dis. 105:421–424.PubMedGoogle Scholar
  71. 71.
    Lynch, J. P., III, Schaberg, D. R., Kissner, D. G., and Kauffman, C. A., 1981, Cryptococcus laurentii lung abscess, Am. Rev. Respir. Dis. 123:135–138.PubMedGoogle Scholar
  72. 72.
    Krajden, S., Summerbell, R.C., Kane, J., Salkin, I. E., Kemna, M. E., Rinaldi, M. G., Fuksa, M., Spratt, E., Rodriques, C., and Choe, J., 1991, Normally saprobic cryptococci isolated from Cryptococcus neoformans infections, J. Clin. Microbiol. 29:1883–1887.PubMedGoogle Scholar
  73. 73.
    Gupta, R. K., 1985, Diagnosis of unsuspected pulmonary cryptococcosis with sputum cytology, Acta Cytol. 29:154–156.PubMedGoogle Scholar
  74. 74.
    Gal, A. A., Koss, M. N., Hawkins, J., Evans, S., and Einstein, H., 1986, The pathology of pulmonary cryptococcal infections in the acquired immunodeficiency syndrome, Arch. Pathol. Lab. Med. 110:502–507.PubMedGoogle Scholar
  75. 75.
    Gal, A. A., Kos, M. N., and Hawkins, J., 1986, The pathology of pulmonary cryptococcal infections in the acquired immunodeficiency syndrome, Arch. Pathol. Lab. Med. 110:502.PubMedGoogle Scholar
  76. 76.
    Anderson, D. A. and Sagha, H. M., 1988, Persistence of infection in mice inoculated intranasally with Cryptococcus neoformans, Mycopathologia 104:161–169.CrossRefGoogle Scholar
  77. 77.
    Mody, C. H., Tyler, C. L., Sitrin, R. G., Jackson, C., and Toews, G. B., 1991, Interferon-gamma activates rat alveolar macrophages for anticryptococcal activity, Am. J. Resp. Cell. Mol. Biol. 5:19–26.CrossRefGoogle Scholar
  78. 78.
    Granger, D. L., Perfect, J. R., and Durack, D. T., 1985, Virulence of Cryptococcus neoformans: Regulation of capsule synthesis by carbon dioxide, J.Clin. Invest. 76:508–516.PubMedCrossRefGoogle Scholar
  79. 79.
    Levitz, S. M. and DiBenedetto, D. J., 1989, Paradoxical role of capsule in murine broncho-alveolar macrophage-mediated killing of Cryptococcus neoformans, J. Immunol. 142:659–665.PubMedGoogle Scholar
  80. 80.
    Salyer, W. R., Salyer, D. C., and Baker, R. D., 1974, Primary complex of Cryptococcus and pulmonary lymph nodes, J. Infect. Dis. 130:74–77.PubMedCrossRefGoogle Scholar
  81. 81.
    Baker, R. D., 1976, The primary pulmonary lymph node complex of cryptococcosis, Am. J. Clin. Pathol. 65:83–92.PubMedGoogle Scholar
  82. 82.
    Granger, D. L., Perfect, J. R., and Durack, D. T., 1986, Macrophage-mediated fungistasis in vitro: Requirements for intracellular and extracellular cytotoxicity, J. Immunol. 136:672–680.PubMedGoogle Scholar
  83. 83.
    Flesch, I. E. A., Amberger, G., and Kaufmann, S. H. E., 1989, Fungicidal activity of IFN-gamma activated macrophages. Extracellular killing of Cryptococcus neoformans, J. Immunol. 142:3219–3224.PubMedGoogle Scholar
  84. 84.
    Granger, D. L., Hibbs, J. B., Perfect, J. R., and Durack, D. T., 1988, Specific amino acid (L-Arginine) requirement for the microbiostatic activity of murine macrophages, J. Clin. Invest. 81:1129–1136.PubMedCrossRefGoogle Scholar
  85. 85.
    Weinberg, P. B., Becker, S., Granger, D. L., and Koren, H. S., 1987, Growth inhibition of Cryptococcus neoformans by human alveolar macrophages, Am. Rev. Respir. Dis. 136:1242–1247.PubMedCrossRefGoogle Scholar
  86. 86.
    Cameron, M. L., Granger, D. L., Weinberg, J. B., Kozumbo, W. J., and Koren, H. S., 1990, Human alveolar and peritoneal macrophages mediate fungistasis independently of L-ar-ginine oxidation to nitrite or nitrate, Am. Rev. Respir. Dis. 142:1313–1319.PubMedCrossRefGoogle Scholar
  87. 87.
    Becker, S. and Koren, H. S., 1989, Dual effects of interferon-gamma on the interaction between human alveolar macrophages and Cryptococcus neoformans, Chest 95:S172-S174.CrossRefGoogle Scholar
  88. 88.
    Newman, S. L. and Mikus, L. K., 1985, Deposition of C3b and iC3b onto particulate activators of the human complement system. Quantitation with monoclonal antibodies to human C3, J. Exp. Med. 161:1414–1431.PubMedCrossRefGoogle Scholar
  89. 89.
    Kozel, T. R., Wilson, M. A. Pfrommer, G. S. T., and Schlageter, A. M., 1989, Activation and binding of opsonic fragments of C3 on encapsulated Cryptococcus neoformans by using an alternative complement pathway reconstituted from six isolated proteins, Infect. Immun. 57:1922–1927.PubMedGoogle Scholar
  90. 90.
    Kozel, T. R. and Pfrommer, G. S. T., 1986, Activation of the complement system by Cryptococcus neoformans leads to binding of iC3b to the yeast, Infect. Immun. 52:1–5.PubMedGoogle Scholar
  91. 91.
    Lehrer, R. I. and Ladra, K. M., 1972, Fungicidal components of mammalian granulocytes active against Cryptococcus neoformans, J. Infect. Dis. 136:96.CrossRefGoogle Scholar
  92. 92.
    Cameron, M. L., Granger, D. L., Matthews, T. J., Haney, A. F., and Weinberg, J. B., 1991, Peritoneal macrophages infected in vitro with HIV-1 have decreased anticryptococcal activity, ICAAC (Abstract).Google Scholar
  93. 93.
    Cameron, M. L., Granger, D. L., Weinberg, J. B., and Matthews, T. J., 1990, Human monocytes infected with HIV-1 have reduced anti-cryptococcal activity (abstract 362A), Clin. Res. 38: (Abstract).Google Scholar
  94. 94.
    Cameron, M. L., Granger, D. L., Matthews, T. J., and Weinberg, J. B., 1991, Alveolar macrophages infected in vitro with HIV-1 retain normal cryptococcal activity, VII International AIDS Conference, Florence, Italy (Abstract).Google Scholar
  95. 95.
    Meltzer, M. S., Skillman, D. R., Gomatos, P. J., Kalter, D. C., and Gendelman, H. E., 1990, Role of mononuclear phagocytes in the pathogenesis of Human Immunodeficiency Virus infection, Annu. Rev. Immunol. 8:169–194.PubMedCrossRefGoogle Scholar
  96. 96.
    Mann, D. L., Gartner, S., Le Sane, F., Buchow, H., and Popovi C. M., 1990, HIV-1 transmission and function of virus-infected monocytes/macrophages, J.Immunol. 144:2152–2158.PubMedGoogle Scholar
  97. 97.
    Pauza, C. D., 1988, HIV persistence in monocytes leads to pathogenesis and AIDS, Cell. Immunol. 112:414–424.PubMedCrossRefGoogle Scholar
  98. 98.
    Landay, A., Kessler, H. A., Benson, C. A., Pottage, J. C., Jr., Murphy, R., Urbanski, P., Kucik, S., and Phair, J., 1990, Isolation of HIV-1 from monocytes of individuals negative by conventional culture, J.Infect. Dis. 161:706–710.PubMedCrossRefGoogle Scholar
  99. 99.
    Gartner, S., Markovits, P., Markovitz, D. M., Kaplan, M. H., Gallo, R. C., and Popovic, M., 1986, The role of mononuclear phagocytes in HTLV-III/LAV infection, Science 233: 215–219.PubMedCrossRefGoogle Scholar
  100. 100.
    Murphy, J. W. and McDaniel, D. D., 1982, In vitro reactivity of natural killer (NK) cells against Cryptococcus neoformans, J. Immunol. 128:1577.PubMedGoogle Scholar
  101. 101.
    Mody, C. H., Lipscomb, M. F., Street, N. E., and Toews, G. B., 1990, Depletion of CD4+ (L3T4+) lymphocytes in vivo impairs murine host defenses to Cryptococcus neoformans, J. Immunol. 144:1472–1477.PubMedGoogle Scholar
  102. 102.
    Diamond, R. D., Root, R. K., and Bennett, J. E., 1972, Factors influencing killing of Cryptococcus neoformans by human leukocytes in vitro, J. Infect. Dis. 125:267–276.CrossRefGoogle Scholar
  103. 103.
    Masur, H., Ognibene, F. P., Yarchoan, R., Shelhamer, J. H., Baird, B. F., Travis, W., Suffredini, A. F., Deyton, L., Kovacs, J. A., Falloon, J., Davey, R., Polis, M., Metcalf, J., Baseler, M., Wesley, R., Gill, V. J., Fauci, A. S. and Lane, H. C., 1989, CD4 counts as predictors of opportunistic pneumonias in human immunodeficiency virus (HIV) infection, Ann. Intern. Med. 111:223–231.PubMedCrossRefGoogle Scholar
  104. 104.
    Plata, F., Autran, B. Martins, L. P., Wain-Hobson, S., Raphael, M., Mayaud, C., Denis, M., Guillon, J., and Debre, P., 1987, AIDS virus-specific cytotoxic T lymphocytes in lung disorders, Nature 328:348–351.PubMedCrossRefGoogle Scholar
  105. 105.
    Mackewicz, C. E., Ortega, H. W., and Levy, J. A., 1991, CD8+ cell anti-HIV activity correlates with the clinical state of the infected individual, J. Clin. Invest. 87:1462–1466.PubMedCrossRefGoogle Scholar
  106. 106.
    Olafsson, K., Smith, M. S., Marshburn, P., Carter, S. G., and Haskill, S., 1991, Variation of HIV infectibility of macrophages as a function of donor, stage of differentiation, and site of origin, J. Acquir. Immune Defic. Syndr. 4:154–164.PubMedGoogle Scholar
  107. 107.
    Diamond, R. D. and Bennett, J. E. 1974, Prognostic factors in cryptococcal meningitis: A study of 111 cases, Ann. Intern. Med. 80:176–181.PubMedCrossRefGoogle Scholar
  108. 108.
    Dismukes, W. E., Cloud, G., Gallis, H. A., Kerkering, T. M., Medoff, G., Craven, P. L., Kaplowitz, L. G., Fisher, J.E., Gregg, C. R., and Bowles, C. A., 1987, Treatment of Cryptococcal meningitis with combination amphotericin B and flucytosine for four as compared with six weeks, N. Engl. J. Med. 317:334–341.PubMedCrossRefGoogle Scholar
  109. 109.
    Rhodes, J. C., Wicker, L. S., and Urba, W. J., 1980, Genetic control of susceptibility to Cryptococcus neoformans in mice, Infect. Immun. 29:494.PubMedGoogle Scholar
  110. 110.
    Lipscomb, M. F., Alvarellos, T., Toews, G. B., Tompkins, R., Evans, Z., Koo, G., and Kumar, V., 1987, Role of natural killer cells in resistance to Cryptococcus neoformans infections in mice, Am. J. Pathol. 128:354–361.PubMedGoogle Scholar
  111. 111.
    Miller, M. F., Mitchell, T. G., Storkus, W. J., and Dawson, J. R., 1990, Human natural killer cells do not inhibit growth of Cryptococcus neoformans in the absence of antibody, Infect. Immun. 58:639–645.PubMedGoogle Scholar
  112. 112.
    Hill, J. O. and Harmsen, A. G., 1991, Intrapulmonary growth and dissemination of an avirulent strain of Cryptococcus neoformans in mice depleted of CD4+ or CD8+ T cells, J.Exp. Med. 173:755–758.PubMedCrossRefGoogle Scholar
  113. 113.
    Huffnagle, G. B., Yates, J. L., and Lipscomb, M. F., 1991, Immunity to a pulmonary Cryptococcus neoformans infection requires both CD4+ and CD8+ T cells, J. Exp. Med. 173:793–800.PubMedCrossRefGoogle Scholar
  114. 114.
    Twigg, H. L., III, Lipscomb, M. F., Yoffe, B., Barbara, D. J., and Weissler, J. C., 1989, Enhanced accessory cell function by alveolar macrophages from patients infected with the human immunodeficiency virus: Potential role for depletion of CD4+ cells in the lungs, Am. J. Resp. Cell Mol. Biol. 1:391–400.CrossRefGoogle Scholar
  115. 115.
    Calderone, R. A., 1989, The role of complement in host resistance to systemic fungal infection, in: Immunology of Fungal Diseases, (E. Kurstak, ed.), Marcel Dekker, New York, pp. 225–242.Google Scholar
  116. 116.
    Waldorf, A. R., 1989, Pulmonary defense mechanisms against opportunistic fungal pathogens, in: Immunology of Fungal Diseases, (E. Kurstak, ed.), Marcel Dekker, New York, pp. 243–271.Google Scholar
  117. 117.
    Murphy, J. W., 1989, Immunoregulation in cryptococcosis, in: Immunology of Fungal Diseases, (E. Kurstak, ed.), Marcel Dekker, New York, pp. 319–345.Google Scholar
  118. 118.
    Granger, D. L., Perfect, J. R., and Durack, D. T., 1986, Macrophage-mediated fungistasis: Requirement for a macromolecular component in serum, J. Immunol. 137:693–701.PubMedGoogle Scholar
  119. 119.
    Davies, S. F., Clifford, D. P., Hoidal, J. R., and Repine, J. E., 1982, Opsonic requirements for the uptake of Cryptococcus neoformans by human polymorphonuclear leukocytes and monocytes, J. Infect. Dis. 145:870–874.PubMedCrossRefGoogle Scholar
  120. 120.
    Miller, G. P. G. and Kohl, S., 1983, Antibody-dependent leukocyte killing oï Cryptococcus neoformans, J. Immunol. 131:1455–1459.Google Scholar
  121. 121.
    Hutto, J. O., Bryan, C. S., Greene, F. L., White, C. J., and Gallin, J. I., 1988, Cryptococcosis of the colon resembling Crohn’s disease in a patient with hyperimmunoglobulin E-recur-rent infection (Job’s) syndrome, Gastroenterology 94:808–812.PubMedGoogle Scholar
  122. 122.
    Jacobs, D. H., Macher, A. M., Handler, R., Bennett, J. E., Collern, M. J., and Gallin, J. I., 1984, Esophageal cryptococcosis in a patient with the hyperimmunoglobulin E-recurrent infection (Job’s) syndrome, Gastroenterology 87:201–203.PubMedGoogle Scholar
  123. 123.
    Gupton, S., Ellis, M., Cesario, T., Ruhling, M., and Vayuvegula, B., 1987, Disseminated cryptococcal infection in a patient with hypogammaglobulinemia and normal T cell functions, Am. J. Med. 82:129–131.CrossRefGoogle Scholar
  124. 124.
    Marquis, G., Montplaisir, S., and Pelletier, M., 1985, Genetic resistance to murine cryptococcosis: The beige mutation (Hediak-Higashi syndrome) in mice, Infect. Immun. 47: 288–293.PubMedGoogle Scholar
  125. 125.
    Gadebusch, H. H. and Gikas, P. W., 1965, The effect of cortisone upon experimental pulmonary cryptococcosis, Am. Rev. Respir. Dis. 92:64.Google Scholar
  126. 126.
    Kent, T. H. and Layton, J. M., 1962, Massive pulmonary cryptococcosis, Am. J. Clin. Pathol. 38:596–604.PubMedGoogle Scholar
  127. 127.
    Lambertus, M. W., Goetz, M. B., Murthy, A. R., and Mathisen, G. E., 1990, Complications of corticosteroid therapy in patients with the acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia, Chest 98:38–43.PubMedCrossRefGoogle Scholar
  128. 128.
    Wiest, P. M., Flanigan, T., Salata, R. A., Shlaes, D. M., Katzman, M., and Lederman, M. M., 1989, Serious infectious complications of corticosteroid therapy for COPD, Chest 95:1180–1183.PubMedCrossRefGoogle Scholar
  129. 129.
    Goldstein, E. and Rombo, O. N., 1962, Cryptococcal infection following steroid therapy, Ann. Intern. Med. 56:114.PubMedCrossRefGoogle Scholar
  130. 130.
    Bennington, J. L., Haber, S. L., and Morgenstern, N. L., 1964, Increased susceptibility to cryptococcosis following steroid therapy, Dis. Chest 45:262.PubMedCrossRefGoogle Scholar
  131. 131.
    Zee, C. S., Segall, H. D., Boswell, W., Ahmadi, J., Nelson, M., and Colletti, P., 1988, MR imaging of neurocysticercosis, J. Comput. Assist. Tomogr. 12:927–934.PubMedCrossRefGoogle Scholar
  132. 132.
    Kramer, M., Corrado, M. L., Bacci, V., Carter, A. C., and Landesman, S. H., 1983, Pulmonary cryptococcosis and Cushing’s syndrome, Ann. Intern. Med. 143:2179–2180.CrossRefGoogle Scholar
  133. 133.
    Kerkering, T. M., Duma, R. J., and Shadomy, S., 1981, The evolution of pulmonary cryptococcosis: Clinical implications from a study of 41 patients with and without compromising host factors, Ann. Intern. Med. 94:611–616.PubMedCrossRefGoogle Scholar
  134. 134.
    Finke, R., Strobel, E. S., Kroepelin, T., Guzman, J., Klein, P. J., Schaefer, H. E., Kappe, R., and Muller, J., 1988, Disseminated cryptococcosis in a patient with malignant lymphoma, Mycoses 31:102–108.Google Scholar
  135. 135.
    Okun, E. and Butler, W. T., 1964, Ophthalmologic complications of cryptococcal meningitis, Arch. Ophthalmol. 71:52–57.PubMedCrossRefGoogle Scholar
  136. 136.
    Borton, L. K. and Wintroub, B. U., 1984, Disseminated cryptococcosis presenting as herpetiform lesions in a homosexual man with acquired immunodeficiency syndrome, J. Am. Acad. Dermatol. 10:387–390.PubMedCrossRefGoogle Scholar
  137. 137.
    Mayers, D. L., Martone, W. J., and Mandell, G. L., 1981, Cutaneous cryptococcosis mimicking gram-positive cellulitis in a renal transplant patient, South. Med. J. 74:1032.PubMedCrossRefGoogle Scholar
  138. 138.
    Schupbach, C. W., Wheeler, C. E., and Briggaman, R. A., 1976, Cutaneous manifestations of disseminated cryptococcosis, Arch. Dermatol. 112:1734.PubMedCrossRefGoogle Scholar
  139. 139.
    Rico, M. J. and Penneys, N. S., 1985, Cutaneous cryptococcosis resembling molluscum contagiosum in a patient with AIDS, Arch. Dermatol. 121:901.PubMedCrossRefGoogle Scholar
  140. 140.
    Gosling, H. R. and Gilmer, W. S., 1956, Skeletal cryptococcosis: Report of a case and review of the literature, J.Bone Joint Surg. 38A:660.PubMedGoogle Scholar
  141. 141.
    Lombardo, T. A., Rabson, A. S., and Dodge, H. T., 1957, Mycotic endocarditis, Am. J. Med. 22:664.PubMedCrossRefGoogle Scholar
  142. 142.
    Colmers, R. A., Irniger, W., and Steinberg, D. H., 1967, Cryptococcus neoformans endocarditis cured by amphotericin B, JAMA 199:762.PubMedCrossRefGoogle Scholar
  143. 143.
    Proknow, J. J., Benfield, J. R., and Rippon, J. W., 1965, Cryptococcal hepatitis presenting as a surgical emergency, JAMA 191:269.CrossRefGoogle Scholar
  144. 144.
    Randall, R. E., Jr., Stacy, W. K., and Toone, E. C., 1968, Cryptococcal pyelonephritis, N. Engl. J. Med. 279:60.PubMedCrossRefGoogle Scholar
  145. 145.
    Cohen, I., 1985, Isolated pulmonary cryptococcosis in a young adolescent, Pediatr. Infect. Dis. J.4:416–419.CrossRefGoogle Scholar
  146. 146.
    Allende, M., Pizzo, P. A., and Walsh, T. J., 1992, Pulmonary cryptococcosis presenting as metastatic tumor in children with soft tissue sarcomas, 92nd American Society of Microbiology, New Orleans (Abstract).Google Scholar
  147. 147.
    Paillas, J., Sinico, M., Viellefond, A., and Blaye, N., 1982, Un cas de cryptococcose pulmonaire pseudo-tumorale, Sem. Hop. Paris 58:2402–2404.PubMedGoogle Scholar
  148. 148.
    Warr, W., Bates, J. H., and Stone, A., 1968, The spectrum of pulmonary cryptococcosis, Ann. Intern. Med. 69:1109–1116.PubMedCrossRefGoogle Scholar
  149. 149.
    Campbell, G. D., 1966, Primary pulmonary cryptococcosis, Am. Rev. Respir. Dis. 94:236–243.PubMedGoogle Scholar
  150. 150.
    Rosenheim, S. H. and Schwarz, J. 1975, Cavitary pulmonary cryptococcosis complicated by aspergilloma, Am. Rev. Respir. Dis. 111:549–553.PubMedGoogle Scholar
  151. 151.
    Zlupko, G. M., Fochler, F. J., and Goldschmidt, Z. H., 1980, Pulmonary cryptococcosis presenting with multiple pulmonary nodules, Chest 77:575.PubMedCrossRefGoogle Scholar
  152. 152.
    McDonnell, J. M. and Hutchins, G. M., 1985, Pulmonary cryptococcosis, Hum. Pathol. 16:120–128.CrossRefGoogle Scholar
  153. 153.
    Middleton, F. G. and Prioleau, W. H. 1982, Pulmonary cryptococcosis: Review of eleven cases, J. S.C. Med. Assoc. 78:419–423.PubMedGoogle Scholar
  154. 154.
    Town, G. I., 1985, Pulmonary cryptococcosis: A report of two cases and review of the literature, N.Z. Med. J. 894–895.Google Scholar
  155. 155.
    Hunt, K. K., Jr., Enquist, R. W., and Bowen, T. E., 1976, Multiple pulmonary nodules with central cavitation, Chest 69:529–530.PubMedCrossRefGoogle Scholar
  156. 156.
    Diamond, R. D. and Levitz, S. M., 1988, Cryptococcus neoformans pneumonia, in: Respiratory Infections: Diagnosis and Management, 2nd ed., (J. E. Pennington, ed.), Raven Press, New York, pp. 457–471.Google Scholar
  157. 157.
    McDonnell, J. M. and Hutchins, G. M., 1985, Pulmonary cryptococcosis, Hum. Pathol. 16:121–128.PubMedCrossRefGoogle Scholar
  158. 158.
    Hammerman, K.J., Powell, K. E., Christianson, C. S., Huggin, P. M., Larsh, H. W., Vivas, J. R., and Tosh, F. E., 1973, Pulmonary cryptococcosis: Clinical forms and treatment. A Center for Disease Control Cooperative Mycoses Study, Am. Rev. Respir. Dis. 108:1116–1123.PubMedGoogle Scholar
  159. 159.
    Henson, D. J. and Hill, A. R., 1984, Cryptococcal pneumonia: A fulminant presentation, Am. J. Med. 228:221.Google Scholar
  160. 160.
    Tynes, B., Mason, K. N., Jennings, A. E., and Bennett, J. E., 1968, Variant forms of pulmonary cryptococcosis, Ann. Intern. Med. 69:1117–1125.PubMedCrossRefGoogle Scholar
  161. 161.
    Warr, W., Bates, J. H., and Stove, A., 1968, The spectrum of pulmonary cryptococcosis, Ann. Intern. Med. 69:1109–1116.PubMedCrossRefGoogle Scholar
  162. 162.
    Menon, A., and Rajamani, R., 1976, Giant ‘cryptococcoma’ of the lung, Br. J. Dis. Chest 70:269–272.PubMedCrossRefGoogle Scholar
  163. 163.
    Gerstenhaber, B. J., Weiner, B., Morecki, R., Bernstein, R., and Luftschein, S., 1977, “Allergic” cryptococcal pneumonia, Lung 154:195–199.PubMedCrossRefGoogle Scholar
  164. 164.
    Mitchell, D. H. and Sorrell, T. C., 1992, Pancoast’s syndrome due to pulmonary infection with Cryptococcus neoformans variety gatti, Clin. Infect. Dis. 14:1142–1144.PubMedCrossRefGoogle Scholar
  165. 165.
    Carey, C. F., Mueller, L., Fotopoulos, C. L., and Dall, L., 1991, Bronchitis obliterans— organizing pneumonia associated with Cryptococcus neoformans infection, Rev. Infect. Dis. 13:1253–1254.PubMedCrossRefGoogle Scholar
  166. 166.
    Kahn, F. W., England, D. M., and Jones, J. M., 1985, Solitary pulmonary nodule due to Cryptococcus neoformans and Mycobacterium tuberculosis, Am. J. Med. 78:677–681.PubMedCrossRefGoogle Scholar
  167. 167.
    Corpe, R. F. and Parr, L. H., 1953, Pulmonary torulosis complicating pulmonary tuberculosis treated by resection, J. Thorac. Cardiovasc. Surg. 27:392–398.Google Scholar
  168. 168.
    Riley, E. and Cahan, W. G., 1972, Pulmonary cryptococcosis followed by pulmonary tuberculosis: A case report, Am. Rev. Respir. Dis. 106:594–599.PubMedGoogle Scholar
  169. 169.
    Dalgleish, A. G., 1981, Concurrent hydatid disease and cryptococcosis in a 16-year-old girl, Med.J.Aust. 2:144–145.PubMedGoogle Scholar
  170. 170.
    Davies, S. F. and Sarosi, G. A., 1987, Role of serodiagnostic tests and skin tests in the diagnosis of fungal disease, Clin. Chest Med. 8:135–146.PubMedGoogle Scholar
  171. 171.
    Bennett, J. E., Hasenclever, H. F., and Baum, G. L., 1965, Evaluation of skin test for cryptococcosis, Am. Rev. Respir. Dis. 91:616.PubMedGoogle Scholar
  172. 172.
    Atkinson, A.J. and Bennett, J. E., 1968, Experience with a new skin test antigen prepared from Cryptococcus neoformans, Am. Rev. Respir. Dis. 97:637–643.PubMedGoogle Scholar
  173. 173.
    Muchmore, H. G., Felton, F. G., Salvin, S. B., and Rhoades, E. R., 1969, Delayed hypersensitivity to cryptococcin in man, Sabouraudia 6:285–288.CrossRefGoogle Scholar
  174. 174.
    Schimpff, S. C. and Bennett, J. E., 1975, Abnormalities in cell-mediated immunity in patients with Cryptococcus neoformans infection, J. Allergy Clin. Immunol. 55:430–441.PubMedCrossRefGoogle Scholar
  175. 175.
    Kauffman, C. A., Bergman, A. G., Severance, P. J., and McClatchey, K. D., 1981, Detection of cryptococcal antigen: Comparison of two latex agglutination tests, Am. J. Clin. Pathol. 75:106–109.PubMedGoogle Scholar
  176. 176.
    Klotz, S. A., Penn, R. L., and George, R. B., 1986, Antigen detection in the diagnosis of fungal respiratory infections, Semin. Respir. Infect. 1:16–21.PubMedGoogle Scholar
  177. 177.
    Davies, S. F., 1988, Diagnosis of pulmonary fungal infections, Semin. Respir. Infect. 3: 162–171.PubMedGoogle Scholar
  178. 178.
    Murata, K., Khan, A., and Herman, P. G., 1989, Pulmonary parenchymal disease: Evaluation with high-resolution CT, Radiology 170:629–635.PubMedGoogle Scholar
  179. 179.
    Silverman, J. F. and Johnsrude, I. S., 1985, Fine needle aspiration cytology of granulomatous cryptococcosis of the lung, Acta Cytol. 29:157–161.PubMedGoogle Scholar
  180. 180.
    Fouret, P., Roux, P., Touboul, J. L., Lancastre, F., and Roland, J., 1985, Diagnostic rapide d’une cryptococcose pulmonaire par examen cytologique du liquide de lavage broncho-alveolaire (LBA), Arch. Anat. Cytol. Pathol. 33:90–92.PubMedGoogle Scholar
  181. 181.
    Feigin, D. S., 1983, Pulmonary cryptococcosis: Radiologic-pathologic correlates of its three forms, AJR 141:1263–1272.CrossRefGoogle Scholar
  182. 182.
    Gleason, T. H., Hammar, S. P., Barthas, M., Kasprisin, M., and Bockus, D., 1980, Cytological diagnosis of pulmonary cryptococcosis, Arch. Pathol. Lab. Med. 104:384–387.PubMedGoogle Scholar
  183. 183.
    Smith, F. S., Gibson, P., Nicholls, T. T., and Simpson, J. A., 1976, Pulmonary resection for localized lesions of cryptococcosis (torulosis): A review of eight cases, Thorax 31:121–126.PubMedCrossRefGoogle Scholar
  184. 184.
    Jensen, W. A., Rose, R. M., Hammer, S. M., and Karchmer, A. W., 1985, Serologic diagnosis of focal pneumonia caused by Cryptococcus neoformans ’, Am. Rev. Respir. Dis. 132:189–191.PubMedGoogle Scholar
  185. 185.
    George, R. B., Jenkinson, S. G., and Light, R. W., 1978, Fiberoptic bronchoscopy in the diagnosis of pulmonary fungal and nocardial infections, Chest 73:33–36.PubMedCrossRefGoogle Scholar
  186. 186.
    Subramanian, S., Kherdekar, S. S., Babu, P. G. V., and Christiansen, C. S., 1982, Lipoid pneumonia with Cryptococcus neoformans colonisation, Thorax 37:319–320.PubMedCrossRefGoogle Scholar
  187. 187.
    Lewis, J. L. and Rabinovich, S., 1972, The wide spectrum of cryptococcal infections, Am. J. Med. 53:315–322.PubMedCrossRefGoogle Scholar
  188. 188.
    Spickard, A., 1973, Diagnosis and treatment of cryptococcal disease, South. Med. J. 66: 26–31.PubMedCrossRefGoogle Scholar
  189. 189.
    Khoury, M. B., Godwin, J. D., Ravin, C. E., Gallis, H. A., Halvorsen, R. A., and Putnam, C. E., 1984, Thoracic cryptococcosis: Immunologic competence and radiologic appearance, AJR 141:893–896.CrossRefGoogle Scholar
  190. 190.
    McAllister, K., Ognibene, A. J., Davis, C.D., Jr., and Carpenter, J. L., 1984, Cryptococcal pleuro-pulmonary disease: Infection of the pleural fluid in the absence of disseminated cryptococcosis. Case report, Milit. Med. 149:684–686.Google Scholar
  191. 191.
    Young, E. J., Hirsh, D. D., Fainstein, V., and Williams, T. W., 1980, Pleural effusions due to Cryptococcus neoformans: A review of the literature and report of two cases with cryptococcal antigen determinations Am. Rev. Respir. Dis. 121:743–746.PubMedGoogle Scholar
  192. 192.
    Duvic, M., Lowe, L., Rios, A., MacDonald, E., and Vance, P., 1987, Superficial phaeohypho-mycosis of the scrotum in a patient with the acquired immunodeficiency syndrome, Arch. Dermatol. 123:1597–1599.PubMedCrossRefGoogle Scholar
  193. 193.
    Epstein, R., Cole, R., and Hunt, K. K., 1972, Pleural effusion secondary to pulmonary cryptococcosis, Chest 61:296.PubMedCrossRefGoogle Scholar
  194. 194.
    Salyer, W. R. and Salyer, D. C., 1974, Pleural involvement in cryptococcosis, Chest 66:139.PubMedCrossRefGoogle Scholar
  195. 195.
    Tenholder, M. F., Ewald, F. W., Jr., Khankhanian, N. K., and Crosby, J. H., 1992, Complex cryptococcal empyema, Chest 101:586–588.PubMedCrossRefGoogle Scholar
  196. 196.
    Perkins, W., 1969, Pulmonary cryptococcosis: Report on the treatment of nine cases, Dis. Chest 56:389–394.PubMedCrossRefGoogle Scholar
  197. 197.
    Inoue, N., Uozumi, T., Yamamoto, T., Ohishi, T., Murai, Y., Murakami, M., and Yoshimatsu, H., 1984, Treatment of cryptococcal meningitis with pulmonary granuloma, J. Neurol. 231:109–111.PubMedCrossRefGoogle Scholar
  198. 198.
    Majid, A. A., 1989, Clinical notes: Surgical resection of pulmonary cryptococcomas in the presence of cryptococcal meningitis, J.R. Coll. Surg. Edinb. 34:332–333.PubMedGoogle Scholar
  199. 199.
    Chechani, V. and Kamholz, S. L., 1989, Recommended dosage change for amphotericin B, J.Infect. Dis. 160:555.PubMedCrossRefGoogle Scholar
  200. 200.
    Bennett, J. E., Dismukes, W., Duma, R. J., Medoff, G., Sande, M. A., Gallis, H., Leonard, J., Fields, B. T., Bradshaw, M., Haywood, H., McGee, Z. A., Cate, T. R., Cobbs, C. G., Warner, J. F., and Alling, D. W., 1979, A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptococcal meningitis, N. Engl. J. Med. 301:126–131.PubMedCrossRefGoogle Scholar
  201. 201.
    Schmutzhard, E. and Vejajjiva, A., 1988, Treatment of cryptococcal meningitis with high-dose, long-term combination amphotericin B and flucytosine, Am. J. Med. 85:737–738.PubMedCrossRefGoogle Scholar
  202. 202.
    Stamm, A. M., Diasio, R. B., Dismukes, W. E., Shadomy, S., Cloud, G. A., Bowles, C. A., Karam, G. H., and Espinel-Ingroff, A., 1987, Toxicity of amphotericin B plus flucytosine in 194 patients with cryptococcal meningitis, Am. J. Med. 83:236–242.PubMedCrossRefGoogle Scholar
  203. 203.
    Utz, J. P., Shadomy, S., and McGehee, K. F., 1969, 5-flucytosine: Experience in patients with pulmonary and other forms of cryptococcosis, Am. Rev. Respir. Dis. 99:975.Google Scholar
  204. 204.
    Fass, R.J. and Perkins, R. L., 1971, 5-fluorocytosine in the treatment of cryptococcal and Candida mycoses, Ann. Intern. Med. 74:535.PubMedCrossRefGoogle Scholar
  205. 205.
    Dismukes, W. E., Cloud, G., and Gallis, H. A., 1983, Treatment of systemic mycoses with ketoconazole: Emphasis on toxicity and clinical response in 52 patients, Ann. Intern. Med. 98:13.PubMedCrossRefGoogle Scholar
  206. 206.
    Perfect, J. R., Durack, D. T., Hamilton, J. D., and Gallis, H. A., 1982, Failure of ketoconazole in cryptococcal meningitis, JAMA 247:3349–3351.PubMedCrossRefGoogle Scholar
  207. 207.
    Denning, D. W., Tucker, R. M., Hanson, L. H., Hamilton, J. R., and Stevens, D. A., 1989, Itraconazole therapy for cryptococcal meningitis and cryptococcosis, Arch. Intern. Med. 149:2301–2308.PubMedCrossRefGoogle Scholar
  208. 208.
    Viviani, M. A., Tortorano, A. M., Giani, P. C., Arici, C., Goglio, A., Crocchiolo, P., and Almaviva, M., 1987, Itraconazole for cryptococcal infection in the acquired immunodeficiency syndrome (letter), Ann. Intern. Med. 106:166.PubMedCrossRefGoogle Scholar
  209. 209.
    Viviani, M. A., Tortorano, A. M., Langer, M., Almaviva, M., Negri, E., Christina, S., Soccia, S., De Maria, R., Fiocchi, R., and Ferrazzi, P., 1989, Experience with itraconazole in cryptococcosis and aspergillosis, J.Infect. 18:151–165.PubMedCrossRefGoogle Scholar
  210. 210.
    Saag, M. S., Powderly, W. G., Cloud, G. A., Robinson, P., Grieco, M. H., Sharkey, P. K., Thompson, S. E., Sugar, A., Tuazon, C. U., Fisher, J. F., Hyslop, N., Jacobson, J. M., Hafner, R., and Dismukes, W. F., 1992, Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis, N. Engl. J. Med. 326:83–89.PubMedCrossRefGoogle Scholar
  211. 211.
    Larsen, R. A., Leal, M. A. E., and Chan, L. S., 1990, Fluconazole compared with amphotericin B plus flucytosine for cryptococcal meningitis in AIDS, Ann. Intern. Med. 113:183–187.PubMedCrossRefGoogle Scholar
  212. 212.
    Stern, J. J., Hartman, B. J., Sharkey, P., Rowland, V., Squires, K. E., Murray, H.W., and Graybill, J. R., 1988, Oral fluconazole therapy for patients with the acquired immunodeficiency syndrome and cryptococcosis: Experience with 22 patients, Am. J. Med. 85:477–480.PubMedCrossRefGoogle Scholar
  213. 213.
    Bozette, S. A., Larsen, R. A., Chiu, J., Leal, M. A. E., Jacobsen, J., Rothman, P., Robinson, P., Gilbert, G., McCutchan, J. A., Tilles, J., Leedom, J. M., and Richman, D. D., 1991, A placebo-controlled trial of maintenance therapy with fluconazole after treatment of cryptococcal meningitis in the acquired immunodeficiency syndrome, N. Engl. J. Med. 324: 580–584.CrossRefGoogle Scholar
  214. 214.
    Perfect, J. R., 1990, Cryptococcal pulmonary infections, in: Internal Medicine (J. Kassier, ed.), B.C. Decker, Philadelphia, pp. 713–175.Google Scholar
  215. 215.
    Murray, R. J., Becker, P., Furth, P., and Criner, G. J., 1988, Recovery from cryptococcemia and the adult respiratory distress syndrome in the acquired immunodeficiency syndrome, Chest 93:1304–1307.PubMedCrossRefGoogle Scholar
  216. 216.
    Whitley, T. H., Graybill, J. R., and Alford, R. H., 1976, Pulmonary cryptococcosis in chronic lymphocytic leukemia, South. Med. J. 69:33–37.PubMedCrossRefGoogle Scholar
  217. 217.
    Hardy, R. E., Cummings, C., Thomas, F., and Harrison, D., 1986, Cryptococcal pneumonia in a patient with Sickle Cell disease, Chest 89:892–894.PubMedCrossRefGoogle Scholar
  218. 218.
    Christoph, I., 1990, Pulmonary Cryptococcus neoformans and disseminated Nocardia brasiliensis in an immunocompromised host, North Carolina Med. J. 51:219–220.Google Scholar
  219. 219.
    Cameron, M. L., Bartlett, J. A., Gallis, H. A., and Waskin, H. A., 1991, Manifestations of pulmonary cryptococcosis in patients with acquired immunodeficiency syndrome, Rev. Infect. Dis. 13:64–67.PubMedCrossRefGoogle Scholar
  220. 220.
    Blanc, M., Leuenberger, P. H., and Favez, G., 1982, Cryptococcose pulmonaire invasive isolee. Presentation d’un cas, Schweiz. Med. Wochenschr 112:421–424.PubMedGoogle Scholar
  221. 221.
    Eng, R. H., Bishburg, E., and Smith, S. M., 1986, Cryptococcal infections in patients with acquired immune deficiency syndrome, Am. J. Med. 81:19–23.PubMedCrossRefGoogle Scholar
  222. 222.
    Wasser, L. and Talavera, W., 1987, Pulmonary cryptococcosis in AIDS, Chest 92:692–695.PubMedCrossRefGoogle Scholar
  223. 223.
    Clark, R. A., Greer, D. L., Valainis, G. T., and Hyslop, N. E., 1990, Cryptococcus neoformans pulmonary infection in HIV-1-infected patients, J. Acquir. Immune Defic. Syndr. 3:480–485.PubMedGoogle Scholar
  224. 224.
    Chechani, V. and Kamholz, S. L., 1990, Pulmonary manifestations of disseminated cryptococcosis in patients with AIDS, Chest 98:1060–1066.PubMedCrossRefGoogle Scholar
  225. 225.
    Khardori, N., Butt, F., and Rolston, K. V. I., 1988, Pulmonary cryptococcosis in AIDS, Chest 93:1319–1320.PubMedCrossRefGoogle Scholar
  226. 226.
    Suster, B., Akerman, M., Orenstein, M., and Wax, M. R., 1986, Pulmonary manifestations of AIDS: Review of 106 episodes, Radiology 161:86–93.Google Scholar
  227. 227.
    Perla, E. N., Maayan, S., Miller, S. N., Ramaswamy, G., and Eisenberg, H., 1985, Disseminated cryptococcosis presenting as the adult respiratory distress syndrome, N.Y. State J. Med. 85:704–706.PubMedGoogle Scholar
  228. 228.
    Similowski, T., Datry, A., Jais, P., Katlama, C., Rosenheim, M., and Gentilini, M., 1989, AIDS-associated cryptococcosis causing adult respiratory distress syndrome, Respir. Med. 83:513–515.PubMedCrossRefGoogle Scholar
  229. 229.
    Miller, W. T. and Edelman, J. M., 1990, Cryptococcal pulmonary infection in patients with AIDS: Radiographic appearance, Radiology 175:725–728.PubMedGoogle Scholar
  230. 230.
    Loerinc, A. M., Bottone, E. J., Finkel, L. J., and Teirstein, A. S., 1988, Primary cryptococcal pneumonia mimicking Pneumocystis carinii pneumonia in a patient with AIDS, Mt. Sinai J. Med. 55:181–186.PubMedGoogle Scholar
  231. 231.
    Eng, R. H. K., Bishburg, E., Smith, S. M., and Kapila, R., 1986, Cryptococcal infections in patients with acquired immune deficiency syndrome, Am. J. Med. 81:19–23.PubMedCrossRefGoogle Scholar
  232. 232.
    Sobonya, R. E., Barbee, R. A., Wiens, J., and Trego, D., 1990, Detection of fungi and other pathogens in immunocompromised patients by bronchoalveolar lavage in an area endemic for coccidioidomycosis, Chest 97:1349–1355.PubMedCrossRefGoogle Scholar
  233. 233.
    Malabonga, V. M. and Kamholz, S. L., 1991, Utility of bronchoscopic sampling techniques for cryptococcal disease in AIDS, Chest 99:370–373.PubMedCrossRefGoogle Scholar
  234. 234.
    Witt, D., McKay, D., Schwam, L., Goldstein, D., and Gold, J., 1987, Acquired immune deficiency syndrome presenting as bone marrow and mediastinal cryptococcosis, Am. J. Med. 82:149–150.PubMedCrossRefGoogle Scholar
  235. 235.
    Dismukes, W. E., 1988, Cryptococcal meningitis in patients with AIDS, J. Infect. Dis. 157:624–628.PubMedCrossRefGoogle Scholar
  236. 236.
    Sugar, A. M. and Saunders, C., 1988, Oral fluconazole as suppressive therapy of disseminated cryptococcosis in patients with acquired immunodeficiency syndrome, Am. J. Med. 85:481–489.PubMedCrossRefGoogle Scholar
  237. 237.
    Zuger, A., Schuster, M., Simberkoff, M. S., Rahal, J. J., and Holzman, R. S., 1988, Maintenance amphotericin B for cryptococcal meningitis in the acquired immunodeficiency syndrome (AIDS), Ann. Intern. Med. 104:592–593.CrossRefGoogle Scholar
  238. 238.
    King, C., Finley, R., and Chapman, S. W., 1990, Prostatic cryptococcal infection, Ann. Intern. Med. 113:720.PubMedCrossRefGoogle Scholar
  239. 239.
    Larsen, R. A., Bozzette, S., McCutchan, A., Chiu, J., Leal, M. A., and Richman, D. D., 1989, Persistent Cryptococcus neoformans infection of the prostate after successful treatment of meningitis, Ann. Intern. Med. 111:125–128.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • Miriam L. Cameron
    • 1
  • John R. Perfect
    • 1
  1. 1.Division of Infectious DiseasesDuke University Medical CenterDurhamUSA

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