[Cryptococcus neoformans infection in hematologic malignancies].
OBJECTIVE
Cryptococcus is an opportunistic infection that affects immunodepressed patients and is a classical complication of AIDS-stage HIV infection. The aim of this study was to investigate Cryptococcus neoformans infections in patients with hematological malignancies.


METHODS
Six cases have been described of cryptococcosis detected in Nantes, France over the past 10 years in patients with hematological malignancies.


RESULTS
This infection has been found particularly in the context of lymphoproliferative disorders (chronic lymphocytic leukemia, Waldenström macroglobulinemia, Hodgkin's disease, and non-Hodgkin's lymphoma), and also following cytotoxic therapy. In four cases, the patients were treated with fludarabine, which rapidly caused long-duration marked lymphocytopenia, notably in CD4 cells. Cell-mediated immunity plays a major role in systemic defense against C. neoformans. It therefore seems that fludarabine favors the spread of cryptococcal infections.


CONCLUSIONS
In the context of lymphoproliferative syndromes treated with cytotoxic drugs, in particular fludarabine, it appears important to take into account the possible presence of cryptococcal infection in the presence of respiratory, neurological or cutaneous disorders, so that a correct diagnosis can be made and the appropriate treatment administered.
Vigouroux
S
S
Service d'hématologie clinique, Hôtel-Dieu, CHU, Nantes, France.
Morin
O
O
Milpied
N
N
Mahé
B
B
Rapp
M J
MJ
Harousseau
J L
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D003453:Cryptococcosis / Q000188:drug therapy / Q000453:epidemiology*; D003455:Cryptococcus neoformans; D005260:Female; D005602:France; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007111:Immunity, Cellular; D008232:Lymphoproliferative Disorders / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology*; D012189:Retrospective Studies; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives
D000935:Antifungal Agents; D000970:Antineoplastic Agents; D014740:Vidarabine; C024352:fludarabine