ABSTRACT
Despite highly active anti-retroviral therapy, cryptococcal meningoencephalitis is the second most prevalent neurological disease in Brazilian AIDS patients, being frequently a defining condition with several episodes. As knowledge of Cryptococcus neoformans isolates in the same episode is critical for understanding why some patients develop several episodes, we investigated the genotype characteristics of C. neoformans isolates in two different situations. By pulsed field gel electrophoresis and random amplifield polymorphic DNA analysis, 54 isolates from 12 patients with AIDS and cryptococcosis were analyzed. Group 1 comprised 39 isolates from nine patients with a single episode and hospitalization. Group 2 comprised 15 isolates from three patients with two episodes and hospitalizations. Except for three patients from group 1 probably infected with a single C. neoformans isolate, the other nine patients probably were infected with multiple isolates selected in different collection periods, or the infecting isolate might have underwent mutation to adapt and survive the host immune system and/or the antifungal therapy. However, the three patients from group 2 presented genetic diversity among isolates collected in both hospitalizations, possibly having hosted the initial isolate in both periods. These data, emphasize that Cryptococcus diversity in infection can contribute to strategies of treatment and prevention of cryptococcosis.
Subject(s)
Humans , AIDS-Related Opportunistic Infections/microbiology , Cryptococcus neoformans/genetics , Genetic Variation , Meningoencephalitis/microbiology , Acute Disease , Brazil , Cryptococcus neoformans/isolation & purification , DNA, Fungal/genetics , Electrophoresis, Gel, Pulsed-Field , Genotype , Mycological Typing Techniques , Random Amplified Polymorphic DNA TechniqueABSTRACT
Cryptococcus neoformans é uma levedura capsulada que apresenta tropismo pelo sistema nervoso central causando meningoencefalite. É a micose mais freqüente em pacientes com AIDS, e é responsável pela alta morbidade e mortalidade. Há duas variedades: var. neoformans e var. gattii. C. neoformans var.neoformans está distribuído mundialmente e é comumente encontrado em fezes de aves, principalmente de pombo. C. neoformans var. gattii está geograficamente limitado a regiões tropicais e subtropicais e está associado a algumas espécies de árvores, principalmente, Eucalyptus sp. A proposta desse estudo foi de avaliar a prevalência das variedades de Cryptococcus neoformans isoladas de 452 amostras de líquido cefalorraquiano (LCR) provenientes de 183 pacientes com AIDS, internados no Instituto de Infectologia Emílio Ribas São Paulo-SP, de 1996 a...
Cryptococcus neoformans is an encapsulated yeast that presents tropism for central nervous system, and causes meningoencephalitis. Cryptococcosis is the most frequent mycosis in patients with AIDS, and itis the cause of high morbidity and mortality. C. neoformans presents two varieties var. neoformans andvar. gattii. Cryptococcus neoformans var. neoformans has been world-wide isolated from avian feces, especially pigeon excreta. C. neoformans var. gattii is geographically restricted to tropical and subtropical regions, and it is associated with some trees species, mainly Eucalyptus sp. The proposal of this study was to evaluate the prevalence of Cryptococcus neoformans varieties isolated from 452 cerebrospinalfluid (CSF) samples from 183 patients with AIDS referred to the Instituto de Infectologia Emilio Ribas- São Paulo-SP, from 1996 to 1999. CSF samples were cultured on canavanine-glycine-bromothymolblue...
Subject(s)
Cryptococcus neoformans/isolation & purification , Cerebrospinal Fluid , Acquired Immunodeficiency SyndromeABSTRACT
Paciente portador de leucemia mieloide cronica, com irma HLA-compativel foi submetido a transplante alogenico de medula ossea. No dia +90 pos-TMO foi diagnosticado doenca do enxerto contra o hospedeiro (DECH) extensa e iniciado protocolo alternado de imunossupressao com altas doses de ciclosporina A e prednisona. O seguimento ambulatorial foi complicado, com granulocitopenia intermitente e quadros frequentes de sinusite e pneumonia. Um ano apos o transplante, o paciente apresentou rouquidao e voz anasalada. Foi realizada uma biopsia de corda vocal mas nenhum agente infeccioso pode ser identificado. Na diminuicao das doses das drogas imunossupressoras, houve piora da DECH cronica e foi reiniciado esquema de doses altas no dia +550. Tres meses apos, permanecendo o quadro de DECH fora do controle, foi tentado imunossupressao com azatioprina sem sucesso...