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
A criptococose é uma doença sistêmica causada pelo fungo Cryptococcus neoformans, que acomete com mais freqüência os pulmões e o sistema nervoso central e, menos freqüentemente, a pele, o sistema esquelético e a próstata. Até a década de 80, antes do surgimento da AIDS, era relativamente rara. Apesar dela ocorrer com freqüência no hospedeiro imunodeprimido, cerca de um terço dos pacientes com a doença näo apresenta uma condiçäo de base, nem fatores predisponentes evidentes. Relatamos dois casos de pacientes imunocompetentes que apresentaram meningite criptocócica, enfatizando epidemiologia, etiopatogenia, clínica, diagnóstico e conduta terapêutica
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Amphotericin B , Antigens, Fungal/cerebrospinal fluid , Antigens, Fungal/blood , Central Nervous System , Cerebrum/virology , Cryptococcus neoformans , Fluconazole , Flucytosine , Immunocompetence , Mannitol , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/immunology , Meningitis, Cryptococcal/drug therapy , Treatment Outcome , Meningitis, Cryptococcal/cerebrospinal fluidABSTRACT
Foram utilizadas 82 LCR de transplantados renais (24 pacientes), 43 LCR de pacientes com criptococose comprovada (controles positivos), 35 LCR de pacientes com outras doenças (histoplasmose, paracoccidioidomicose e infecçöes bacterianas) como controles negativos. Os primeiros foram cultivados em ágar Sabouraud com sementes de girassol e juntamente com os demais examiando pelo teste de látex para pesquisa de antígeno circulante de C. neoformans, qualitativamente. O teste de Coaglutinaçäo foi realizado qualitativamente e quantitativamente, encontrando-se títulos até a diluiçäo 1:2048. Näo foram detectadas reaçöes falso-positivas ou falso-negativas entre os controles. Como prova de valor diagnóstico demonstrou: sensibilidade - 92,1%; especificidade - 92,6% e eficiência - 92,3%. Provou também ser um teste rápido, exato e econômico, embora sua escolha dependa do pré-tratamento de LCR (80-C por 3 a 5 minutos) e soros (diluiçäo ou álcali-precipitaçäo) para evitar autoaglutinaçäo e aumentar a sensibilidade da reaçäo