Neglected disease, neglected populations: the fight against Cryptococcus and cryptococcosis
Neglected disease, neglected populations: the fight against Cryptococcus and cryptococcosis
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被忽视的疾病，被忽视的人群：对抗隐球菌和隐球菌病
DOI：
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
M. Rodrigues
中科院分区：
文献类型：
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作者：
M. Rodrigues
最近的估计表明，由真菌病原体新型隐球菌和格特隐球菌引起的疾病每年导致超过 180,000 人死亡（Rajasingham 等人，2017 年），按绝对死亡人数计算，隐球菌病是第五大致命传染病，仅次于艾滋病、结核病、疟疾和腹泻（世界卫生组织 2016 年、世界卫生组织 2017 年、世界卫生组织 2018 年）。隐球菌通过吸入感染人类，并且大多数在免疫抑制的患者中，真菌到达大脑导致高度致命的脑膜炎（Colombo 和 Rodrigues 2015）。最有效的抗隐球菌疗法是在 20 世纪 50 年代开发的，基于使用多烯抗真菌两性霉素 B，这种药物静脉注射有毒（Williamson 2017）。非洲大陆大部分地区都没有两性霉素 B（GAFI 来源：https://http://www.gaffi.org），那里是大多数隐球菌病患者集中的地方（Rajasingham 等，2017）。在非洲，唑类抗真菌药物的耐药性已达到惊人的数字（Mpoza 等，2017）。正如最近指出的那样（Williamson 2017），尽管 2010 年至 2014 年博茨瓦纳的艾滋病毒检出率接近 90%、治疗入组率达到 90%、病毒载量达到 90%，但隐球菌性脑膜炎发病率并未下降（Tenforde 等人，2017 年）。批准用于人类使用的抗真菌疫苗仍然无法获得。预防或对抗隐球菌病的创新工具显然是必要的，但这种疾病目前正处于令人担忧的境地。隐球菌病是世界上资金最匮乏的被忽视疾病之一，获得的相关研究和开发资金不到 0.5%（Rodrigues 2016）。世界卫生组织甚至没有将这种疾病视为一种被忽视的热带病（Molloy et al. 2017），这破坏了政府和机构研究资助计划的建立。隐球菌和隐球菌病的研究和开发仍然过度集中于基础研究(Albuquerque and Rodrigues 2012, Colombo and Rodrigues 2015)，这可能与该领域面临的资金困境有关。尽管困难重重，而且规模仍然缩小，隐球菌界一直在不断产生高水平的科学知识（Kwon-Chung 等人，2012）。该领域的科学家以建立友好社区而闻名，自 1989 年耶路撒冷（以色列）召开第一届隐球菌和隐球菌病会议 (ICCC) 以来，该领域的科学家一直在积极讨论该领域的进展。随后的会议分别在米兰（意大利，1993 年）、巴黎（法国，1996 年）、伦敦（英国，1999 年）、阿德莱德（澳大利亚，2002 年）、波士顿（美国，2005 年）、长崎（日本，2008 年）、查尔斯顿（美国，2011 年）和阿姆斯特丹（荷兰，2014 年）举行。在第十届（2017 年）ICCC 中，ICCC 首次来到发展中国家，在伊瓜苏（巴西，2017 年）举行。除了在巴西会议期间讨论的不容置疑的科学进展（本期特刊对此进行了详细介绍）之外，第十届 ICCC 的成果也非常令人兴奋：2020 年会议将首次在非洲乌干达举行。隐球菌和隐球菌病背后的情况无疑是复杂的，但隐球菌界一直在积极扩展其潜力，以推动科学和科学政策的进步。隐球菌病最近被提议为一种被忽视的热带疾病（Molloy 等人，2017 年），需要强调类似的积极举措，如法国隐球菌病研究组的早期成立、隐球菌脑膜炎行动小组 (CryptoMAG) 的建立以及巴西和拉丁美洲隐球菌病网络的形成等。然而，决策者和公共卫生当局迫切需要采取具体行动，扭转资金减少和缺乏创新的现状。过去几十年来，成熟而友好的科学界进行了大量的辩论，给该领域带来了乐观情绪，并相信很快就会有对抗和预防隐球菌病的新解决方案。
Recent estimates indicate that the diseases caused by the fungal pathogens Cryptococcus neoformans and C. gattii kill more than 180,000 humans per year (Rajasingham et al. 2017), which ranks cryptococcosis in absolute numbers of deaths as the 5th most lethal infectious disease, behind AIDS, tuberculosis, malaria and diarrhea (WHO 2016, WHO 2017, WHO 2018). Cryptococcus infects humans through inhalation and, mostly in immunosuppressed patients, the fungus reaches the brain to cause a highly lethal meningitis (Colombo and Rodrigues 2015). The most efficient anticryptococcal therapy, developed in the 1950s, is based on the use of the polyene antifungal amphotericin B, which is toxic intravenous (Williamson 2017). Amphotericin B is not available in most of the African continent (GAFFI Available from: https://http://www.gaffi.org), where most of the individuals suffering from cryptococcosis are concentrated (Rajasingham et al. 2017). In Africa, antifungal resistance to azoles has reached alarming numbers (Mpoza et al. 2017). As recently pointed out (Williamson 2017), cryptococcal meningitis rates have shown no reductions over 2010-2014 in Botswana, despite nearly achieving 90% HIV detection, 90% enrolment in therapy, and 90% achievement of undetectable viral loads (Tenforde et al. 2017). Antifungal vaccines approved for human use are still not available. Innovative tools to prevent or fight cryptococcosis are clearly necessary, but the disease is currently immersed in worrying circumstances. Cryptococcosis ranks amongst the most poorly funded neglected diseases in the world, receiving less than 0.5% of available relevant research and development funding (Rodrigues 2016). The disease is not even recognised by the World Health Organization as a neglected tropical disease (Molloy et al. 2017), which undermines the establishment of governmental and institutional programs of research funding. Research and development on Cryptococcus and cryptococcosis is still excessively focused on basic research (Albuquerque and Rodrigues 2012, Colombo and Rodrigues 2015), which might be related with the funding adversities faced by the field. Despite all difficulties and still reduced size, the cryptococcal community has been continuously producing highlevel scientific knowledge (Kwon-Chung et al. 2012). Well-known for having constructed a friendly community, scientists in the field have been actively discussing advances in the area since 1989, when Jerusalem (Israel) held the 1st Conference on Cryptococcus and Cryptococcosis (ICCC). Subsequent meetings were held in Milan (Italy, 1993), Paris (France, 1996), London (United Kingdom, 1999), Adelaide (Australia, 2002), Boston (USA, 2005), Nagasaki (Japan, 2008), Charleston (USA, 2011) and Amsterdam (Netherlands, 2014). In its 10th edition (2017), the ICCC has come to the developing world for the first time, being held in Foz do Iguaçu (Brazil, 2017). Besides the unquestionable scientific advances discussed during the meeting in Brazil, which are detailed in this special issue, the outcome of the 10th ICCC could not be more exciting: the 2020 conference will be held for the first time in Africa, in Uganda. The scenario behind Cryptococcus and cryptococcosis is unquestionably complex, but the cryptococcal community has been actively expanding its potential to generate advances in science and scientific policies. Cryptococcosis has been recently proposed as a tropical neglected disease (Molloy et al. 2017) and similarly positive initiatives need to be highlighted, as the early formation of the French Cryptococcosis Study Group, the establishment of the Cryptococcal Meningitis Action Group (CryptoMAG), and the formation of the Brazilian and Latin American networks of Cryptococcosis, among others. However, concrete actions from decision makers and public health authorities are urgent to revert the current situation of reduced funding and lack of innovation. The prolific debates that have been conducted by a mature and friendly scientific community over the last decades bring optimism to the field and the belief that soon novel solutions to combat and prevent cryptococcosis will be available.
影响因子：
3.8
作者：
Molloy SF;Chiller T;Greene GS;Burry J;Govender NP;Kanyama C;Mfinanga S;Lesikari S;Mapoure YN;Kouanfack C;Sini V;Temfack E;Boulware DR;Dromer F;Denning DW;Day J;Stone NRH;Bicanic T;Jarvis JN;Lortholary O;Harrison TS;Jaffar S;Loyse A
通讯作者：
Loyse A
DOI：
10.1016/s1473-3099(17)30243-8
发表时间：
2017-08
期刊：
The Lancet. Infectious diseases
影响因子：
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作者：
Rajasingham R;Smith RM;Park BJ;Jarvis JN;Govender NP;Chiller TM;Denning DW;Loyse A;Boulware DR
通讯作者：
Boulware DR