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Query: UMLS:C0024141 (systemic lupus erythematosus)
 44,322 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three patients with systemic lupus erythematosus (SLE) and deep fungal infection are described. Two patients had disseminated cryptococcal infection and the third disseminated histoplasmosis. Allwere receiving corticosteroids at the time fungal infection developed. One patient with disseminated cryptococcosis improved after treatment with amphotericin B and 5-fluorocytosine. The other patient with disseminated cryptococcosis died before adequate therapy could be given. The patient with histoplasmosis responded satisfactorily to amphotericin B. A survey of the literature revealed 30 additional cases of deep fungal infection in patients with SLE, most of whom were on corticosteroid therapy. The majority of the patients had candidiasis (14 patients); 11 patients had severe cryptococcal infection. Other fungal infections reported were histoplasmosis, aspergillois, coccidioidomycosis, and maduromycosis caused by Allerscheria boydii. Twenty-seven patients died; in 22 death was related to the fungal infection. The fungal infection was not diagnosed until necropsy in at least 11 persons. Deep fungal infections should be considered whenever patients with SLE have fever of unknown origin, diffuse pulmonary infiltrates, or unexplained CNS symptoms.
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PMID:Deep fungal infection in systemic lupus erythematosus - three cases reported, literature reviewed. 118 36

Fourteen cases of systemic cryptococcosis were admitted to Siriraj Hospital during 1987 to 1989. These included 5 male and 9 female patients aged 4-65 years. The most significant manifestation was cryptococcal meningitis and systemic lupus erythematosus was the most common underlying disease. Culture test for C. neoformans was negative after 28 days of treatment and the latex agglutination test decreased to 1+ agglutination within 49 days of treatment. The latex agglutination test may also be positive in other bacterial, fungal, connective tissue and malignant diseases. A definite diagnosis must, therefore, rely on conventional methods (finding organisms in specimens, culture for the organism). The latex agglutination test is valuable for monitoring patients (decreasing titer indicates a good response). The disease recurred in 4 cases. In cases of cryptococcal meningitis, lumbar puncture should periodically be performed to obtain cerebrospinal fluid for mycological study. In addition the patients should be observed for symptoms and signs.
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PMID:Latex agglutination test for diagnosing cryptococcosis. 179 55

Cryptococcosis is a known opportunistic infection in immunosuppressed hosts. We report our experience of all cases presenting to our Department between December 1975 and September 1988. Eight post-renal transplant patients and three systemic lupus erythematosus (SLE) patients were affected. All were receiving treatment with steroids, in association with either azathioprine or cyclosporin. The diagnosis of cryptococcal meningitis was initially based on a positive cerebrospinal fluid (CSF) cryptococcal antigen, by latex agglutination test, and subsequently confirmed by cultures. Common clinical presentations, in descending order of frequency, included headaches, fever, mental confusion, epilepsy and papilloedema. Meningism was not a prominent feature. CT brain scans were obtained in eight patients and one showed a focal lesion and one showed cerebral atrophy. Four patients also had an abnormal chest X-ray (CXR) and one had disseminated cryptococcosis. Amphotericin and 5-fluorocytosine were the mainstay of therapy, although ketoconazole alone was subsequently used in three selected patients with cure. Four early deaths occurred in patients with delayed diagnosis and treatment, usually in association with other severe concurrent infections. We conclude that awareness of cryptococcosis is essential in immunocompromised hosts presenting with headache with, or without, mental confusion or fever.
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PMID:Cryptococcosis in a renal unit. 228 81

Cryptococcus neoformans was isolated from 13 patients (7 females and 6 males) suffering from systemic cryptococcosis. Eight patients were suffering from central nervous system cryptococcosis and 5 were suffering from disseminated cryptococcosis. Systemic lupus erythematosus was found to be the common underlying disease in 3 patients. The results of treatment depended on the underlying diseases (7 improved, 6 died). Also, 13 isolates of C. neoformans were obtained from feces of 30 pet birds. All 26 isolates of C. neoformans were cultured in glycine cycloheximide medium and were found to be of serotypes A and D.
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PMID:Clinical and environmental isolates of Cryptococcus neoformans in Bangkok (Thailand). 269 67

Peritonitis is an unusual complication of infections caused by Cryptococcus neoformans and has rarely been reported in patients with end-stage renal disease who are maintained on peritoneal dialysis. We report two patients on chronic peritoneal dialysis in whom the first known manifestation of cryptococcal infection was dialysate cultures positive for Cryptococcus neoformans. One patient was on prednisone for systemic lupus erythematosis. The other patient was severely malnourished with type I diabetes mellitus. Both patients were found to have cryptococcal meningitis. Both patients were treated with intravenous (IV) amphotericin B and removal of the dialysis catheter. Evaluation and care of peritoneal dialysis patients with cryptococcal peritonitis include serial cryptococcal cultures and antigen titers, investigation for cryptococcal meningitis, removal of the peritoneal dialysis catheter, and IV amphotericin B.
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PMID:Cryptococcal peritonitis in patients on peritoneal dialysis. 328 71

The ultrastructure of Cryptococcus neoformans in the cerebrospinal fluid, which was obtained from a patient suffering from systemic lupus erythematosus and cryptococcal meningitis, before treatment and on the 10th and 20th day after the start of treatment was studied. Numerous cryptococci were detected in their cerebrospinal fluid before treatment. However, in most of them their biological activity was low and their organelles were not clear. A few yeasts preserved well their organelles. Such cells showed a tendency to develop vesicular membrane structures (lomasomes) touching the internal part of the cell wall. In the cerebrospinal fluid on the 20th day all of the yeasts were dead, even though numerous yeasts were observed by an India-ink method. At this time no colonies were recovered from the fluid.
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PMID:Ultrastructure of Cryptococcus neoformans in the cerebrospinal fluid of a patient with cryptococcal meningitis. 388 42

The histopathological examination was performed in search of cerebral mycosis in autopsy cases at our department during the 6 years from 1976 to 1981. The cerebral mycoses were histopathologically verified in seven cases, although brain tissue was examined in only 46% of 528 autopsy cases. All cases of cerebral mycosis showed underlying diseases which were hematologic diseases (5 cases), SLE (1 case), and myocardial infarction with indwelling deep venous lines (1 case). Among these cerebral mycosis, one had double fungal infections with aspergillus and candida, while others were as follows; aspergillosis (2 cases), mucormycosis (2 cases), candidiasis (1 case) and cryptococcosis (1 case). Six cases were not diagnosed antemortem with exception of a case of cryptococcosis. Systemic fungal infections were seen in six cases, however, a case of mucormycosis was without systemic infection. Each cerebral mycosis showed its own characteristic histopathologic findings, namely, hemorrhagic and necrotic lesions in aspergillosis and mucormycosis, scattered minute abscesses or granulomatous lesions in candidiasis, and gelatinous lesions in leptomeninges in cryptococcosis. Severe lymphocytopenia (less than 500/mm3) was always present in all except a case of rhinocerebral mucormycosis. It is emphasized that cerebral mycosis should be always considered when neurological symptoms were clinically observed in patients who had severe underlying diseases and/or deep venous lines with severe lymphocytopenia.
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PMID:[A pathological study on cerebral mycosis]. 696 26

The first documented cure of cryptococcosis with cryptococcemia is reported. The patient had systemic lupus erythematosis and had received corticosteroids and immunosuppressive drugs for diffuse proliferative nephritis. She had additional poor prognostic factors including high serum cryptococcal antigen titer, low cerebrospinal leukocyte count, and absence of anticryptococcal antibody. Pulmonary tuberculosis was diagnosed concurrently and subsequently she developed disseminated herpes zoster. During amphotericin B therapy, renal function worsened. Cure of cryptococcosis with cryptococcemia was accomplished despite multiple concurrent infections and transient worsening of renal function.
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PMID:Cure of cryptococcemia in an immunocompromised patient with lupus nephritis. 718 Sep 6

In order to clarify the present state of opportunistic fungal infections increasing in incidence in autopsy cases, all autopsy cases from 1966 to 1975 reported in the Annual of Pathological Autopsy Cases in Japan were reviewed. Of the total 233,130 autopsy cases, mycoses were present in 4,340 (1.86%). The incidence of mycoses has strikingly increased during the recent five-year period. In Japan, the mycoses most frequently occurring in autopsy cases were candidiasis (32.28%), aspergillosis (23.08%), cryptococcosis (9.63%), and mucormycosis (2.90%). These occurred more frequently in younger persons and were most commonly secondary and deep-seated infections (95.78%). Among the primary diseases associated with mycoses, aplastic anemia (14.36%), leukemia (9.89%), malignant lymphoma (5.73%), multiple myeloma (4.68%), and systemic lupus erythematosus (4.62%) were most frequent. The incidence of the primary diseases associated with mycoses is increasing extraordinarily, and this seems to be strongly related to the modern therapy of using high doses of anticancer or immunosuppressive agents.
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PMID:Present state of fungal infections in autopsy cases in Japan. 742 23

Central nervous system compromise is a major cause of morbidity and mortality in SLE. The clinical picture of cerebral cryptococcosis is non-specific and can be mistaken for lupic activity. A retrospective study was undertaken with 10 patients with SLE and cryptococcal meningitis compiled in a 23-year period. The most common symptoms were fever and headache. Lymphocyte counts ranged from 169 to 912 cells/mm. An average delay of 13.6 days in diagnosis was observed in patients with cryptococcal meningitis with no complications and an average delay of 52.4 days in patients with complications. Low lymphocyte counts, observed in all patients, was considered a possible risk factor for cerebral cryptococcosis. To note the association between the delay in the correct diagnosis and complications derived from cerebral cryptococcosis.
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PMID:[Central nervous system cryptococcosis in 10 patients with systemic lupus erythematosus]. 787 60


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