Cryptococcosis Associated With Biologic Therapy: A Narrative Review

Area of Science:

• Mycology
• Immunology
• Infectious Diseases

Background:

• Cryptococcus is an opportunistic fungal pathogen causing severe infections, especially in immunocompromised individuals.
• Biologics are widely used for neoplasms, autoimmune diseases, and transplant rejection, potentially impairing immune defenses.
• This increases susceptibility to opportunistic infections like cryptococcosis.

Purpose of the Study:

• To review the association between cryptococcosis and various biologic therapies.
• To highlight infection risks, clinical presentations, and outcomes in patients using biologics.
• To inform clinicians about cryptococcosis risk stratification in this population.

Main Methods:

• Comprehensive literature review.
• Analysis of studies investigating cryptococcosis in patients receiving biologic agents.
• Synthesis of data on risk factors, clinical manifestations, and outcomes.

Main Results:

• Biologics targeting Th1/macrophage activation pathways (e.g., TNFα antagonists, BTK inhibitors, fingolimod, JAK/STAT inhibitors, anti-CD52 antibodies) are associated with increased cryptococcosis risk.
• Clinical manifestations and outcomes vary, with central nervous system involvement being common.
• Concurrent use of immunosuppressants, especially corticosteroids, further elevates risk.

Conclusions:

• Clinicians must be vigilant for cryptococcosis in patients treated with specific biologics.
• Risk stratification should consider the type of biologic, underlying conditions, age, and concomitant immunosuppressive therapies.
• Early recognition and management are essential for improving outcomes in patients at risk.