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BACKGROUND: The aim of this study was to investigate the diagnostic value of cryptococcal antigen-lateral flow immunochromatographic assay (CrAg-LFA) in bronchoalveolar lavage fluid (BALF) of patients with pulmonary cryptococcosis (PC). METHODS: A total of 308 patients were divided into the PC group (n = 72) and the non-PC group (n = 236). The clinical data, pathogen detection, radiological imaging, and the detection of the cryptococcal antigen in blood and BALF samples were analyzed. RESULTS: The sensitivity, specificity, positive, and negative predicted values of CrAg-LFA in the serum were 75.0%, 99.6%, 98.2%, and 92.9%, respectively, while those in the BALF were 93.1%, 100.0%, 100.0%, and 97.9%, respectively. The sensitivity of the CrAg-LFA in BALF was significantly higher than that in the serum of the patients in the PC group (P < 0.05). CONCLUSION: CrAg-LFA has a higher diagnostic value for PC when analyzing BALF samples compared to serum samples.

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Resumen Los azoles son fármacos que inhiben la enzima 14α-esteroldemetilasa, impidiendo la unión de ergosterol; esto altera la estructura y función de la pared celular fúngica. Especialmente el grupo de los triazoles: fluconazol, itraconazol, voriconazol, posaconazol e isavuconazol, son una alternativa farmacológica para el tratamiento de la enfermedad fúngica invasora causada por Aspergillus spp, Candida spp, Cryptococcus spp, patógenos emergentes como los Mucorales, y de micosis endémicas como las ocasionadas por Histoplasma spp y Coccidioides spp. Los efectos adversos de los triazoles son menos frecuentes comparados con los ocasionados por anfotericina B, un antifúngico de uso común para estas micosis. Los principales efectos adversos de los triazoles son hepáticos, gastrointestinales y cardiovasculares como la prolongación del intervalo QT. Las interacciones farmacológicas son usuales y se presentan con moléculas que usan sustratos del citocromo CYP3A4, lo que incluye anti-retrovirales, anti-tuberculosos e inmunomoduladores. En este trabajo se revisan la historia, características farmacológicas y los ensayos clínicos que evidencian su eficacia clínica en los diferentes escenarios clínicos.

Abstract The azoles are drugs that inhibit the 14α-sterol-demethylase enzyme preventing the binding of ergosterol, altering the functionality and structure of the fungal cell wall. Especially the group of triazoles: fluconazole, itraconazole, voriconazole, posaconazole and isavuconazole, are a pharmacological alternative for the treatment of the invasive fungal disease, caused by Aspergillus spp, Candida spp, Cryptococcus spp, by emerging pathogens for example, the Mucoral and finally of endemic mycosis as those caused by Histoplasma spp. and Coccidioides spp. The adverse effects of the triazoles are less frequent compared to those caused by amphotericin B, the main ones being hepatics, gastrointestinals and cardiovasculars, such as the prolongation of the QT interval. The pharmacological interactions are common and occur with molecules that use the substrates of the CYP3A4 cytochrome, for example: antiretroviral, anti-tuberculous and immunomodulators. The history, pharmacological characteristics and clinical trials are reviewed.

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Objective To analyze the CT findings of pulmonary cryptococcosis (PC)in patients without HIV infection.Methods CT data of 26 patients with PC proved by pathology were analyzed retrospectively.All cases underwent plain CT scan,8 of whom underwent contrast-enhanced CT scan.Results 26 patients (17 male and 9 female),single lesion on CT was found in 11 cases,multiple nodules or masses in 10 cases,and mixed-type lesions in 5 cases.The lesion was located in left lung in 1 1 cases,in right lung in 7 cases and bilateral lungs in 8 cases.The lesions with burr sign were found in 1 9 cases,with cavities or vacuoles in 10 cases,and with halo sign in 8 cases.Enhanced CT showed marked heterogeneity in 1 case,moderate heterogeneity in 2 cases,slight enhancement in 3 cases and nonenhancement in 2 cases.Conclusion Lesions of PC with various CT findings are easy to be misdiagnosed as lung carcinoma or other lesions.CT-guided percutaneous lung biopsy is an effective method for diagnosis.

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Seven cases of cryptococosis (six cats and one dog) were studied to establish the determining histomorphological and histochemical characteristics in the histopathological diagnosis of this condition. Additional data related to the epidemiology, clinical aspects, sites of the lesions, and gross findings were obtained from the necropsy and biopsy protocols. Histologically, yeasts were observed inside macrophages or free in the parenchyma, associated with scarse to severe lymphohistioplasmacytic inflammatory reaction. In the hematoxylin-eosin (HE) sections, the yeasts were round, with a central cell containing a nucleus, surrounded by a clear halo (usually non-stained capsule). The techniques of periodic Schiff acid (PAS), Groccot (GMS), and Fontana-Masson (FM) were utilized and demonstrated the wall of the yeast cells. The FM stain showed the melanin present in these cells. The Alcian blue and Mayer's mucicarmin stains showed mainly the yeast polysaccharide capsule. The diameter of the cells ranged from 1.67 to 10.00µm and the full diameter of the encapsulated yeasts varied between 4.17 e 34.16µm. Yeast buddings were better observed through the PAS stain and were narrow based, simple or multiple, mainly in the opposite poles of the cells or forming chains. The definitive diagnosis of cryptococosis was established through the histopathological exam, based on the specific morphology of the agent (encapsulated yeast) and on histochemical proprieties, mostly in the cases without fungal culture.

Sete casos de criptococose (seis gatos e um cão) foram estudados para estabelecer as características histomorfológicas e histoquímicas determinantes no diagnóstico histopatológico dessa condição. Os dados complementares relacionados à epidemiologia, aos aspectos clínicos, à localização das lesões e às alterações macroscópicas foram obtidos dos protocolos de necropsias e biópsias. Na histologia, as leveduras foram observadas no interior de macrófagos ou livres no parênquima, associadas à reação inflamatória linfo-histioplasmocítica que variou de escassa a acentuada. Pela técnica de hematoxilina-eosina (HE) as leveduras eram arredondadas, com célula central contendo um núcleo, circundada por um halo claro (cápsula geralmente não corada). As técnicas histoquímicas do ácido periódico de Schiff (PAS), Grocott e Fontana-Masson (FM) foram utilizadas e evidenciaram a parede das células das leveduras. Pelo FM observou-se a melanina presente nessas células. As técnicas do azul Alciano e da mucicarmina de Mayer evidenciaram principalmente a cápsula polissacarídica das leveduras. O diâmetro das células das leveduras variou de 1,67 a 10,00µm e o diâmetro total das leveduras encapsuladas variou entre 4,17 e 34,16µm. Os brotamentos foram melhor visualizados através do PAS e ocorreram em base estreita, de forma única ou múltipla, principalmente em polos opostos das células das leveduras ou formando uma cadeia. O diagnóstico definitivo de criptococose foi estabelecido através do exame histopatológico, baseando-se na morfologia característica do agente (levedura encapsulada) e em suas propriedades tintoriais (histoquímicas), principalmente nos casos em que a cultura micológica não foi realizada.

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