ABSTRACT
In the context of HIV infection, cryptococcal meningitis is the most common mycosis threatening the patient's life. We conducted a retrospective evaluation to determine the epidemiological, microbiological, immunological and clinical characteristics of disseminated cryptococcosis in 51 hospitalised HIV seropositive patients. All the individuals (n = 51) presented reactive serology for HIV (ELISA and/or Western blot) and none fulfilled strict HAART treatment, previous to the opportunistic infection. CD4+ lymphocyte T counts showed levels between 361 and 0 cells/microliter (mean = 45). All patients but one had counts lower than 100 cells/microliter. Cryptococcosis presented as unique episode in 35 patients (68.6) and in 16 as relapse (31.3). In all of them we detected central nervous system involvement. The induction treatment was carried out with amphotericin B (AMB), continued with maintenance therapy with fluconazole. Lethality rate was 36.7, slightly superior among patients in relapse (40) compared to those who presented a first episode of the mycosis (35.2). In those individuals for whom data were available, 65.2 of blood cultures, 94.1 of CSF cultures and 79.06 of microscopic CSF examination with India ink were positive. Titers of Cryptococcus neoformans capsular antigen in CSF > or = 1/1000 were found in 36.1 and > or = 1/1000 in 73.6 of serum samples. In conclusion, manifestations and severity of disseminated cryptococcosis continue maintaining the characteristics of half a decade behind, in those patients who are not treated with HAART. Neurological involvement existed in all patients of this cohort. Treatment is not able to modify the parameters of mortality seen in previous communications. Diagnostic methods applied in this study are in accordance with those in the bibliography.
Subject(s)
Humans , Male , Adult , Middle Aged , Cryptococcosis , AIDS-Related Opportunistic Infections/epidemiology , Acute Disease , Amphotericin B , Antigens, Fungal/blood , Antigens, Fungal/cerebrospinal fluid , Antifungal Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Argentina , Cryptococcosis , Cryptococcus neoformans , Fluconazole , HIV Antibodies , HIV-1 , AIDS-Related Opportunistic Infections/immunology , AIDS-Related Opportunistic Infections/microbiology , Inpatients , Meningitis, Cryptococcal/cerebrospinal fluid , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/epidemiology , Meningitis, Cryptococcal/immunology , Meningitis, Cryptococcal/microbiology , Recurrence , Retrospective StudiesABSTRACT
El Strongyloides stercoralis es un nematelminto de distribución universal, que en pacientes con alteraciones de la respuesta inmune celular, puede provocar infecciones diseminadas graves. Las formas extraintestinales de la estrongiloidosis han sido publicadas con poca frecuencia, a pesar de la elevada prevalencia de infección por este parásito en áreas de clima tropical y en países en vías de desarrollo. Existen escasas publicaciones en pacientes con SIDA. La mayoría de los casos presentan compromiso gastrointestinal, respiratorio, cutáneo y del SNC. La radiografía de tóraz revela la existencia de infiltrados intersticiales difusos. El diagnóstico se confirma por el hallazgo de las larvas rhabditoides en las materias fecales o en el esputo e incluso en el LCR. Con frecuencia, las infecciones diseminadas por este helminto se asocian con septicemias o meningitis causadas por bacilos gram negativos, especialmente Escherichia coli. Presentamos 2 casos de estrongiloidosis diseminada en pacientes con SIDA con hallazgo de larvas en materias fecales y esputo.