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Cryptococcus gattii in Patients with Lymphoid Neoplasms: An Illustration of Evolutive Host-Fungus Interactions

Olivier Paccoud1, Marie-Elisabeth Bougnoux2, Marie Desnos-Ollivier3

  • 1University of Paris, Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75015 Paris, France.

Journal of Fungi (Basel, Switzerland)
|April 3, 2021
PubMed

Insights

Cryptococcus gattii (CG) meningitis is rare in lymphoid neoplasms. This case highlights the need for awareness and careful antifungal management in immunocompromised patients, especially those on targeted therapies.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Hematology

Background:

  • Cryptococcus gattii (CG) outbreaks in North America reveal distinct virulence and epidemiology compared to Cryptococcus neoformans.
  • CG infections are increasingly reported in diverse patient groups, yet remain uncommon in lymphoid neoplasms.
  • Limited data exists on CG epidemiology and management within the context of hematological malignancies.

Purpose of the Study:

  • To report a case of autochthonous CG meningitis in a patient with chronic lymphocytic leukemia (CLL) treated with ibrutinib.
  • To review the clinical epidemiology of CG infections in patients with lymphoid neoplasms.
  • To summarize host responses to CG and potential treatment challenges in the hematological setting.

Main Methods:

  • Case report of a patient with CLL and CG meningitis.
  • Literature review of clinical epidemiology of CG infections in lymphoid neoplasms.
  • Summary of current knowledge on host responses and antifungal management in immunocompromised patients.

Main Results:

  • A rare case of CG meningitis occurred in a patient with CLL on ibrutinib therapy in France.
  • CG infections in lymphoid neoplasms are infrequent but potentially severe.
  • Management involves complex interactions between pathogen, host immunity, and potential drug-drug interactions with cancer therapies.

Conclusions:

  • CG meningitis is an emerging concern in patients with lymphoid neoplasms, particularly those on targeted therapies like ibrutinib.
  • Enhanced clinical vigilance and tailored antifungal strategies are crucial for managing CG in this vulnerable population.
  • Future guidelines must address the complexities of antifungal treatment and drug interactions in the onco-hematological setting.
Keywords:
Cryptococcus gattiichronic lymphocytic leukemiacryptococcosishaematological malignancyibrutiniblymphoid neoplasms

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