Cryptococcus and Coccidioides in Sarcoidosis

Cryptococcus and Coccidioides in Sarcoidosis Open Forum Infectious Diseases CORRESPONDENCE References Cryptococcus and Coccidioides immunosupressants were commenced. in Sarcoidosis 1. Kuberski T, Yourison I. Coccidioidomycosis: a This association may be due to the low cause of sarcoidosis. Open Forum Infect Dis 2017; CD4 T-cell count associated with s -ar 4:ofw117. To the Editor—We read with great 2. Duréault A, Chapelon C, Biard L, et  al. Severe coidosis [4], but it may also reflect indi- infections in sarcoidosis: incidence, predictors and interest Kuberski and Yourison’s hypoth- viduals whose dysregulated immune long-term outcome in a cohort of 585 patients. esis that Coccidioides spp. and other Medicine (Baltimore) 2017; 96:e8846. response to Cryptococcu r s esulted in dimorphic fungi may be the precipitants 3. Bernard C, Maucort-Boulch D, Varron L, sarcoid. As Kuberski et al. note, negative et  al; French Cryptococcosis Study Group. of sarcoidosis in a proportion of cases [1]. fungal polymerase chain reactions of f-or Cryptococcosis in sarcoidosis: cryptOsarc, We would like to suggest additional ways a comparative study of 18 cases. QJM 2013; malin-fixed sarcoid tissue biopsies would 106:523–39. to test this hypothesis, as well as suggest- not rule out these fungi as precipitants in 4. Williamson PR, Jarvis JN, Panackal AA, et  al. ing that Cryptococcu s s pp. be included Cryptococcal meningitis: epidemiology, immunol- the sarcoid. ogy, diagnosis and therapy. Nat Rev Neurol 2017; in the list of fungi considered possible If a dysregulated immune response to 13:13–24. precipitants. various fungi (and other antigens) were A single-center study of severe infec- responsible for sarcoid, then assessing tions in 585 patients with sarcoidosis from the antibody and cell-mediated immune France found that fungi were the most responses to a panel of fungi in patients common cause of severe infections aer ft with a new diagnosis of sarcoid would be mycobacteria []. 2 Ten of the 16 severe instructive. Finding enhanced responses infections were fungal, and Cryptococcus to specific fungi in sarcoid cases vs con- Received 17 December 2017; editorial decision 1 January neoformans and Pneumocytis jirovecii 2018; accepted 12 January 2018. trols would constitute evidence support- Correspondence: Chris Kenyon, PhD, HIV/STI Unit, Institute were the most common causes. While ive of the fungi-sarcoid hypothesis. of Tropical Medicine, Nationalestraat 155, Antwerp 2000, the P.  jirovecii infections are likely the Belgium (ckenyon@itg.be). result of the immunosuppressants used Acknowledgments Open Forum Infectious Diseases to treat sarcoidosis, this is not as clearly Potential conifl cts of interest. All authors: © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is the case for Cryptococcu. A  s study of all no reported conflicts of interest. All authors an Open Access article distributed under the terms of the have submitted the ICMJE Form for Disclosure cases of cryptococcosis in the French Creative Commons Attribution-NonCommercial-NoDerivs of Potential Conflicts of Interest. Conflicts that national mycosis registry, for example, licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), the editors consider relevant to the content of the which permits non-commercial reproduction and distribution found 18 cases where the individual manuscript have been disclosed. of the work, in any medium, provided the original work is had preexisiting or contemporaneous not altered or transformed in any way, and that the work is Chris R. Kenyon properly cited. For commercial re-use, please contact journals. sarcoidosis [3 ]. In 6 cases, the diagno- HIV/STI Unit,  Nationalestraat 155, Institute of Tropical permissions@oup.com sis of cryptococcosis was made before Medicine, Antwerp, Belgium DOI: 10.1093/ofid/ofy019 CORRESPONDENCE • OFID • 1 Downloaded from https://academic.oup.com/ofid/article-abstract/5/2/ofy019/4812467 by Ed 'DeepDyve' Gillespie user on 16 March 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Open Forum Infectious Diseases Oxford University Press

Cryptococcus and Coccidioides in Sarcoidosis

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© The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
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Abstract

Open Forum Infectious Diseases CORRESPONDENCE References Cryptococcus and Coccidioides immunosupressants were commenced. in Sarcoidosis 1. Kuberski T, Yourison I. Coccidioidomycosis: a This association may be due to the low cause of sarcoidosis. Open Forum Infect Dis 2017; CD4 T-cell count associated with s -ar 4:ofw117. To the Editor—We read with great 2. Duréault A, Chapelon C, Biard L, et  al. Severe coidosis [4], but it may also reflect indi- infections in sarcoidosis: incidence, predictors and interest Kuberski and Yourison’s hypoth- viduals whose dysregulated immune long-term outcome in a cohort of 585 patients. esis that Coccidioides spp. and other Medicine (Baltimore) 2017; 96:e8846. response to Cryptococcu r s esulted in dimorphic fungi may be the precipitants 3. Bernard C, Maucort-Boulch D, Varron L, sarcoid. As Kuberski et al. note, negative et  al; French Cryptococcosis Study Group. of sarcoidosis in a proportion of cases [1]. fungal polymerase chain reactions of f-or Cryptococcosis in sarcoidosis: cryptOsarc, We would like to suggest additional ways a comparative study of 18 cases. QJM 2013; malin-fixed sarcoid tissue biopsies would 106:523–39. to test this hypothesis, as well as suggest- not rule out these fungi as precipitants in 4. Williamson PR, Jarvis JN, Panackal AA, et  al. ing that Cryptococcu s s pp. be included Cryptococcal meningitis: epidemiology, immunol- the sarcoid. ogy, diagnosis and therapy. Nat Rev Neurol 2017; in the list of fungi considered possible If a dysregulated immune response to 13:13–24. precipitants. various fungi (and other antigens) were A single-center study of severe infec- responsible for sarcoid, then assessing tions in 585 patients with sarcoidosis from the antibody and cell-mediated immune France found that fungi were the most responses to a panel of fungi in patients common cause of severe infections aer ft with a new diagnosis of sarcoid would be mycobacteria []. 2 Ten of the 16 severe instructive. Finding enhanced responses infections were fungal, and Cryptococcus to specific fungi in sarcoid cases vs con- Received 17 December 2017; editorial decision 1 January neoformans and Pneumocytis jirovecii 2018; accepted 12 January 2018. trols would constitute evidence support- Correspondence: Chris Kenyon, PhD, HIV/STI Unit, Institute were the most common causes. While ive of the fungi-sarcoid hypothesis. of Tropical Medicine, Nationalestraat 155, Antwerp 2000, the P.  jirovecii infections are likely the Belgium (ckenyon@itg.be). result of the immunosuppressants used Acknowledgments Open Forum Infectious Diseases to treat sarcoidosis, this is not as clearly Potential conifl cts of interest. All authors: © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is the case for Cryptococcu. A  s study of all no reported conflicts of interest. All authors an Open Access article distributed under the terms of the have submitted the ICMJE Form for Disclosure cases of cryptococcosis in the French Creative Commons Attribution-NonCommercial-NoDerivs of Potential Conflicts of Interest. Conflicts that national mycosis registry, for example, licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), the editors consider relevant to the content of the which permits non-commercial reproduction and distribution found 18 cases where the individual manuscript have been disclosed. of the work, in any medium, provided the original work is had preexisiting or contemporaneous not altered or transformed in any way, and that the work is Chris R. Kenyon properly cited. For commercial re-use, please contact journals. sarcoidosis [3 ]. In 6 cases, the diagno- HIV/STI Unit,  Nationalestraat 155, Institute of Tropical permissions@oup.com sis of cryptococcosis was made before Medicine, Antwerp, Belgium DOI: 10.1093/ofid/ofy019 CORRESPONDENCE • OFID • 1 Downloaded from https://academic.oup.com/ofid/article-abstract/5/2/ofy019/4812467 by Ed 'DeepDyve' Gillespie user on 16 March 2018

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Open Forum Infectious DiseasesOxford University Press

Published: Feb 1, 2018

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