Aislamiento presuntivo y caracterización de cryptococcus neoformans y cryptococcus gattii desde árboles en la región de O’Higgins y Maule, Chile / Presumptive isolation and characterization of cryptococcus neoformans and cryptococcus gattii from trees in the region of O’Higgins and Maule, Chile

Introducción: la criptocococis es una micosis sistémica causada por C. neoformans y C. gattii, es frecuente y oportunista en inmunocomprometidos y patógeno primario en personas inmunocompetentes. C. neoformans tiene una distribución mundial y se ha aislado desde las excretas de palomas. C. gattii se considera restringida a regiones con clima tropical, subtropical, y templadas, se encuentra asociada frecuentemente a detritos de especies de Eucalyptus sp. La virulencia de estas levaduras le permite desarrollar patogénesis en mamíferos y supervivencia en el ambiente. Objetivo: Identificar y determinar la actividad de proteinasas y fosfolipasas, de C. neoformans y C. gattii aisladas desde las oquedades de árboles en lugares con alta afluencia de público. Materiales y Métodos: Se tomaron 200 muestras de hisopado desde distintas especies de árboles desde sectores de la región de O’Higgins y el Maule. Se siembran en ASG, se aíslan y mantienen en ASD. Identificación con tinta china, Urea de Christensen, crecimiento a 37°C, asimilación y fermentación de azucares, y siembra en medio CGB. Se mide índice de actividad enzimática Prz de proteinasas y fofolipasas. Resultados y Conclusiones: Se obtuvieron 109 cepas de C. neoformans aisladas desde las oquedades de diferentes especies arbóreas y 3 cepas presuntivas de C. gattii desde Eucalyptus sp. y Prunus cerasifera artropurpurea. El 88,1 por ciento de las cepas C. neoformans y 100 por ciento de C. gattii, presentaron alta actividad proteolítica, El 49,5 por ciento de las cepas de C. neoformans y 33,3 por ciento de C. gattii mostraron alta actividad de fosfolipasas.

Introduction: criptocococis is a systemic mycosis caused by C. neoformans and C. gattii, frequent and opportunistic in immunocompromised and primary pathogen in immunocompetent persons. C. neoformans has a worldwide distribution and has been isolated from the excreta of pigeons. C. gattii is considered restricted to regions with tropical, subtropical, and temperate, is often associated with species of Eucalyptus sp. The virulence of these yeasts develop pathogenesis allows survival in mammals and the environment. Objective: To identify and determine the activity of proteinases and phospholipases of C. neoformans and C. gattii isolated from the hollows of trees in places with high turnout. Materials and Methods: 200 swab samples were taken from different species of trees from areas of the region of O’Higgins and Maule. Planted in ASG, they are isolated and kept in ASD. Identification with ink, Urea Christensen, growth at 37 ° C, assimilation and fermentation of sugars, and planting medium CGB. Prz index proteinase enzyme activity is measured and phospholipases. Results and Conclusions: We manage to get 109 strains of C. neoformans isolated from the hollows of different tree species and 3 presumptive strains of C. gattii from Eucalyptus sp. and Prunus cerasifera artropurpurea. 88.1 percent of the strains C. neoformans and C. gattii 100 percent , they showed high proteolytic activity, 49.5 percent of the strains of C. neoformans and C. gattii 33.3 percent showed high activity phospholipases.

Criptococosis pulmonar y meníngea, en paciente inmunocompetente / Pulmonary and meningeal Cryptococcosis in an immunocompetent patient

La criptococosis es una enfermedad micótica oportunista, grave, causada por Cryptococcus neoformans. un hongo levaduriforme y encapsulado. Sus dos variedades; Cryptococcus neoformans variedad. neoformans (serotipos A y D) y Cryptococcus neoformans variedad. gattii (serotipos B y C) son responsables de enfermedad en el hombre. La infección ocurre por inhalación del microorganismo presente en el excremento principalmente de las palomas. Produce una infección pulmonar inicial desde donde se disemina a otros órganos sobre todo meninges y sistema nervioso central causando una meningoencefalitis; puede diseminarse a piel y vísceras. La criptococosis afecta con mayor frecuencia a personas inmunosuprimidas, en especial pacientes con SIDA. Presentamos el caso de una mujer de 40 años edad, sin antecedentes personales conocidos, a quien no se le conoce ningún estado de inmunosupresion, con serologías negativas para HIV; consultó al servicio de emergencia del Hospital General del Este, Dr Domingo Luciani, en la ciudad de Caracas, Venezuela. por clínica respiratoria de un mes de evolución, tos seca, cefalea, náuseas y vómitos. En el estudio radiológico de tórax se observó una imagen homogénea, radiopaca, que ocupaba el lóbulo superior de pulmón izquierdo. se le realizó fibrobroncoscopia con biopsia y lavado bronquial y los con hallazgos fueron sugestivos de criptococosis pulmonar. Además se realiza punción lumbar por sintomatología neurológíca, con reporte de criptolatex y tinta china positivo en LCR, demostrando el compromiso neurológico. Se planteó una criptococosis pulmonar con compromiso meníngeo(AU)

Cryptococcosis is a serious opportunistic fungal disease caused by Cryptococcus neoformans . There are two varieties; Cryptococcus neoformans var. neoformans (serotypes A and D) and Cryptococcus neoformans var. gattii (serotypes B and C) and they are responsible for human disease. Infection occurs by inhalation of microorganisms present in the feces mainly of pigeons. An initial pulmonary infection occurs and then it can spreads to other organs especially meninges and central nervous system causing meningoencephalitis; also to skin and vísceras. Cryptococcosis most often affects immunosuppressed people, especially AIDS patients. We present the case of a 40 year-old woman who consulted to the Emergency Service of the Hospital Dr Domingo Luciani, in Caracas, Venezuela. She had respiratory symptoms for a month as well as nausea and vomits; The chest radiograph showed a radiopaque homogeneous image in the left upper lobe of the lung. A bronchoscopy plus biopsy and washing was suggestive of pulmonary cryptococcosis . Because some neurological symptoms were present, a lumbar punction was performed and criptolatex reported positive in the CSF, diagnosing a disseminated cryptococcosis with meningeal involvement(AU)

Meningoencefalitis por cryptococcus neoformans en un paciente con lupus eritematoso sistémico tratado con rituximab y micofenolato mofetilo: [revisión] / Meningoencephalitis due to cryptococcus neoformans in systemic lupus erythematosus patient treated with rituximab and mycophenolate mofetil: [review]

Presentamos un paciente con Lupus Eritematoso Sistémico (LES) tratado previamente con Rituximab y Micofenolato Mofetilo que desarrolló una criptococosis meníngea. Los pacientes con LES presentan múltiples defectos en su sistema inmune (SI) que, sumados a los producidos por los tratamientos inmunosupresores, predisponen a infecciones, entre ellas, a las causadas por gérmenes oportunistas. La meningitis por criptococo es una rara y severa complicación en estos pacientes. Rituximab produce una serie de cambios en el SI actuando sobre los linfocitos B, mientras que micofenolato actúa tanto sobre las células T como B. Las alteraciones inmunológicas presentes en nuestro paciente serían producto de la sumatoria de efectos de ambas drogas que explicarían la infección por Criptococcus neoformans.

We presented a systemic lupus erythematosus (SLE) patient previously treated with rituximab and mycophenolate who developed cryptococcal meningitis. SLE patients have multiple defects in the immunity system in addition to the additive effects of immunosuppressive treatments, which predispose to opportunistic infections. Cryptococcal meningitis is a rare and severe complication in SLE patients. Rituximab produces a series of changes in the immune system by acting on B cells, while mycophenolate produces its actions by acting on T and B cells. The immunology system defects in our patient could be done because the additive effects of two drugs that could explain the Cryptococcus neoformans infection.

Cutaneous manifestations in renal failure patients: a case series.

Cutaneous involvement in renal disease is due to a host of factors ranging from metabolic disturbances to immunosuppressive drugs. Herein we report a series of six cases of renal failure with varied cutaneous manifestations ranging from infections to neoplasms due to prolonged immunosuppression. Our first case had cutaneous cryptococcosis where skin lesions gave a clue to the diagnosis of altered sensorium and underlying meningitis. The second case initially presented with florid warts and was treated successfully but later presented with an explosive recurrence of skin lesions due to malignant transformation. Our third case had basal cell carcinoma over the presternal region that was successfully treated with liquid nitrogen cryotherapy. Our fourth case had diabetic nephropathy that presented with septicemia and purpura fulminans. The last case had cutaneous manifestations of drug therapy because of heparin infusion. To conclude, cutaneous manifestations in patients with renal failure are varied and a high degree of suspicion is needed for early diagnosis and aggressive treatment to effectively combat mortality and morbidity.

Intraabdominal Cryptococcal Lymphadenitis in a Patient with Systemic Lupus Erythematosus

Cryptococcal infection is a rare, yet well recognized complication of systemic lupus erythematosus (SLE). We present a case of mesenteric and retroperitoneal cryptococcal lymphadenitis resulting in the obstruction of the stomach and proximal duodenum in a patient suffering from SLE, while recently she did not receive any immunosuppressive treatment. A 42-yr-old woman was admitted due to high fever and diffuse abdominal pain for three weeks. Abdominal computed tomography (CT) scan showed multiple conglomerated lymphadenopathies in the retroperitoneum and the mesentery resulting in luminal narrowing of the third portion of the duodenum. Cryptococcal lymphadenitis was proven by needle biopsy and she was treated with intravenous liposomal amphotericin B, followed by oral fluconazole. After fourteen-month antifungal therapies, the clinical symptoms and follow-up images improved. This case emphasize that the intrinsic immunological defects of SLE may be directly responsible for the predisposition to fungal infections.

Cryptococcal lymphadenitis and meningitis in human immunodeficiency virus infection--a case report.

Cryptococcal meningitis (CM) is the commonest life threatening opportunistic fungal disease in Human Immunodeficiency Virus (HIV) infected individuals. But there are very little reports of lymphadenopathy along with cryptococcal meningitis, although cases of pulmonary, Intestinal, Bone marrow and retinal involvement have been described earlier. Here we report a case of cryptococcal meningitis associated with generalized lymphadenopathy and hepatosplenomegaly.

Occurrence and significance of Cryptococcus neoformans in vegetables and fruits.

Cryptococcus neoformans was isolated from three of 437 (0.6%) samples of a wide variety of vegetables collected from a number of markets in Delhi. The vegetables yielding C. neoformans were tomato, Lycopersicon esculentum (1/70), 'vegetable sponge', Luffa cylindrica (1/56) and brinjal, Solanum melongena (1/55). Only solitary samples of these three vegetables were found to be positive. In vitro studies at 25 degrees C revealed that a reference C. neoformans isolate readily colonized, as did Candida albicans and Candida viswanathii (controls), sterilized slices of almost all the test vegetables and fruits (cut or uncut surface) which included tomato, 'vegetable sponge', brinjal, potato, carrot, radish, apple, guava, pineapple, pear, papaya, banana and mango. Sterilized juices of the same vegetables and fruits also supported adequate growth of the reference C. neoformans isolate as well as of C. albicans and C. viswanathii. However, the growth of C. neoformans on the afore-mentioned vegetables and fruits was rapidly masked by miscellaneous molds and bacteria if the test samples had not been sterilized prior to inoculation. Cryptococcus neoformans was not found in any of the 275 fruit samples investigated from the same markets. The results indicate that vegetables and fruits are unsuitable as natural habitats for C. neoformans although it may be sporadically isolated from these sources.

Cryptococcosis in the immunocompromised host with special reference to AIDS.

Cryptococcosis is increasing because of an ever rising population of immunocompromised individuals especially those with acquired immune deficiency syndrome (AIDS). Cryptococcal infection of the central nervous system (CNS) were diagnosed in 149 cases over a period of 19.5 years (January 1978-June 1998). Culture was positive in all cases except three who were already on antifungal therapy. India ink mounts of cerebrospinal fluid (CSF) revealed encapsulated cryptococci in 134, and cryptococcal antigen was detected in 111 of 114 patients tested. A comparison of laboratory and certain clinical parameters in patients with and without associated HIV infection showed that a poor CSF cell response and culture of cryptococci from extra-neural sites was more often associated with HIV infection and was statistically significant. Further, presence of concomitant infection especially tuberculosis, and mortality were higher in the HIV positive group.

Hemicoréia-hemibalismo associado a granuloma criptocócico em paciente com SIDA: relato de caso / Hemichorea-hemiballism associated to cryptococcal granuloma in AIDS: case report

Distúrbios do movimento sao pouco frequentes na síndrome de imunodeficiência adquirida (SIDA). Dentre eles destaca-se a hemicoréia-hemibalismo (HC-HB), relacionada a infecçao oportunística pelo Toxoplasma gondii. Relatamos caso de HC-HB em um paciente de 28 anos portador de SIDA associada a lesao granulomatosa no núcleo sub-talâmico direito. Após insucesso no tratamento para neurotoxoplasmose, com a pesquisa de antígeno criptocóccico positiva no líquor, houve melhora clínica e radiológica com terapia antifúngica, estabelecendo-se o diagnóstico etiológico de granuloma por Cryptococcus neoformans. Discorre-se acerca das causas de HC-HB, com mençao especial ao diagnóstico diferencial deste distúrbio em indivíduos infectados pelo HIV

Criptococose cutânea primária causada por arranhadura de gato em paciente com imunossupressäo iatrogênica / Primary cutaneous criptococosis caused by cat scratching in a iatrogenic immunosupressed pacient

Trata-se de relato de um caso de Criptococose cutânea primária em paciente com bronquite crônica usuário de corticosteróides há 25 anos. A lesäo era nodular em mäo, devido a trauma local por arranhadura de gato. O diagnóstico foi confirmado por histopatologia e cultura. Itraconazol foi a terapêutica instituída e observamos boa evoluçäo da lesäo. Esta infecçäo, oportunista, na forma cutânea é rara e pode preceder comprometimento sistêmico. Em pacientes susceptíveis deve ser sempre suspeitada, já que o diagnóstico näo é fácil e adequada terapia em tempo hábil pode prevenir piores complicaçöes.

Paracoccidioidomicose, histoplasmose e criptococose: envolvimento pulmonar nas três principais micoses profundas existentes no Brasil / Paracococidioidomycosis, histoplasmosis and criptococosis: pulmonary involvment in principal deep micosis in Brasil

Os autores discutem os mecanismos das lesões pulmonares nas três principais micoses profundas existentes no Brasil, todas elas bastante frequentes na prática clínica. Devem, também, ser assinalados aspectos como: as dificuldades diagnósticas, maior conscientização sobre sua importância como patologia, carência de conhecimentos epidemiológicos, bem como das facilidades dos métodos diagnósticos

Criptococose disseminada em paciente com SIDA: relato de caso / Disseminated cryptococcosis in patient with AIDS: case report

Este artigo relata o caso de um paciente HIV positivo de 21 anos, com febre, tosse produtiva, dor pleurítica, sudorese noturna e emagrecimento. Apresentava linfadenopatia cervical, anemia e linfopenia. Exames de imagem mostraram linfadenomegalia mediastinal. A biópsia linfonodal diagnosticou criptococose. A infecção por Cryptococcus neoformans é frequente em pacientes com SIDA em estágio avançado, particularmente naqueles com contagem de linfócitos CD4 menor que 100/mm3. O acometimento de pulmões, fígado e linfonodos é raro, sendo a meningite, muitas vezes assintomática, a forma mais comum de apresentação. Faz-se necessária a investigação do líquor quando se diagnostica infecção criptocóccica em outro órgão ou sistema. O tratamento precoce da criptococose localizada previne a disseminação da doença

Criptococosis meníngea no asociada con VIH / Cryptococosis meningitis not associated with HIV

Introducción: la criptococosis meníngea se considera una infección oportunista asociada con enfermedades crónicas inmunosupresoras, principalmente sida; sin embargo, existen pacientes que presentan criptococosis meníngea y no tienen padecimiento de fondo ni factor de inmunosupresión. Objetivo: informar las características de los pacientes con criptococosis meníngea no asociada a infección por virus de la inmunodeficiencia humana, y la evolución de la enfermedad. Diseño: estudio retrospectivo y observacional, consistente en la revisión de expedientes clínicos. Ubicación: Hospital de Infectología, Centro Médico Nacional La Raza. Pacientes: se estudiaron nueve pacientes, dos con enfermedad de fondo (uno con lupus eritematoso generalizado y otro con trasplante renal) y siete sin factores predisponentes. Resultados: el cuadro clínico más común fue cefalea crónica asociada con fiebre intermitente. Sólo cinco pacientes presentaron síndrome meníngeo. El estudio citoquímico del líquido cefalorraquídeo fue compatible con meningitis aséptica en siete pacientes, otro presentó pleocitosis con más de 500 leucocitos y el noveno fue normal. Se trataron con anfotericina B o fluconazol, siendo similar la respuesta terapéutica. Cuatro fallecieron; en dos la muerte fue atribuible a la infección micótica. Conclusiones: la criptococosis meníngea es un padecimiento con letalidad elevada, que debe sospecharse en todo paciente con meningitis subaguda o crónica

Cryptococcus neoformans var. gattii isolados em pacientes com AIDS no estado de Goiás / Cryptococcus neofarmans var. gattii isolated from patients with AIDS in Goiás state

A criptocose é uma das importantes complicaçöes nos indivíduos com AIDS. Nestes pacientes tem predominado como agente etiológico C.neoformans var. neoformans e muito raramente relata-se C.neoformans var. gattii, mesmo nas regiöes onde se verifica a sua prevalência. O liquído cefalorraquidiano (LCR) de pacientes com AIDS foram submetidos ao exame direto com tinta nanquim, cultura em ágar Sabouraud dextrose e em ágar Guizotia abyssinica mantidos à temperatura ambiente e à temperatura de 37§C, identificando-se Cryptococcus neiformans pelas suas características macro e microscópicas. O meio L-canavanina-glicina-azul de bromotimol (CGB) foi utilizado para difderenciar as variedades, sendo identificados 42 Cryptococcus neoformans var. neoformans e 3 var. gattii. O trabalho relata a meningite criptocócica causada por C.neoformans var. neoformans e C. neoformans var. gattii e pacientes com AIDS.

Cerebrospinal fluid profiles in acquired immunodeficiency syndrome with and without neurocryptococcosis

A criptococose e uma das infeccoes fungicas mais comuns do sistema nervoso central (SNC) em pacientes com Sindrome da Imunodeficiencia Adquirida (SIDA), sendo meningoencefalite ou meningite manifestacoes frequentemente observadas. Apesar disso, poucos sao os estudos sistematicos sobre a composicao do liquido cefalo-raquidiano (LCR) de pacientes com SIDA e neurocriptococose. No presente estudo, foram analisadas amostras de LCR de 114 pacientes soropositivos para HIV, com queixa clinica sugestiva de envolvimento do SNC, sendo 32 com neurocriptococose (Grupo 1) e 82 sem doenca neurologica identificada (Grupo 2). Considerando os resultados citologicos e bioquimicos, dois perfis liquoricos foram observados...