Utilidad del recuento de unidades formadoras de colonia de Cryptococcus sp. en líquido cefalorraquídeo de pacientes con criptococosis meníngea asociada al sida / Cryptococcus' colony forming unit count usefulness

Antecedentes: El recuento de unidades formadoras de colonia (UFC) de Cryptococcus en el líquido cefalorraquídeo (LCR) sería un marcador fiable para el pronóstico del paciente y una herramienta simple y económica. Objetivo: Evaluar la utilidad del recuento de UFC de Cryptococcus spp. y compararlo con las variaciones de antígeno capsular de Cryptococcus (AgCr) en LCR.Materiales y métodos: Se realizó la revisión de historias clínicas de pacientes con meningoencefalitis por Cryptococcus asociada con el sida en nuestro centro, entre febrero de 2016 y julio de 2020. Se evaluaron los valores de UFC y AgCr en LCR durante la evolución de la micosis. Resultados y discusión: Se analizaron datos de 94 episodios clínicos de 85 pacientes, con un total de 297 observaciones de muestras de LCR. Se evidenció el valor del recuento de UFC por ser un marcador de viabilidad y de carga fúngica. El recuento de UFC bajo no necesariamente coexistió con un nivel bajo de AgCr. Con respecto a la evolución en el tiempo, la mayoría de los pacientes fueron diagnosticados con una alta carga fúngica y su descenso ocurrió más rápido que el del AgCr, por lo que reflejaría la mejora del paciente, permitiendo tomar conductas al respecto.Palabras clave: Criptococosis, carga fúngica, ufc/mL.

Background. The Cryptococcus' colony-forming unit (CFU) count in cerebrospinal fluid (CSF) would be a reliable marker for patient prognosis and a simple and inexpensive tool. Objectives: To evaluate the usefulness of the CFU count of Cryptococcus spp. And to compare it with the variations of Cryptococcus' capsular antigen (CrAg) in CSF.Materials and methods. Clinical records of patients with aids-related meningoencephalitis caused by Cryptococcusassisted in our center between February 2016 and July 2020 were reviewed. CFU count and CrAg values in CSF were evaluated during the evolution of the mycosis.Results and Discussion. Data from 94 clinical episodes of 85 patients with a total of 297 observations of CSF samples were analyzed.The importance of using the CFU count was evidenced as it is a viability and fungal load marker.Low CFU count did not necessarily coexist with low CrAg.Regarding the evolution over time, most of the patients were diagnosed with a high fungal load and its decrease occurred faster than that the one of AgCr. This would reflect the improvement of the patient, allowing behaviors to be taken in this regard

Criptococosis diseminada en paciente HIV con CD4 mayor a 500 / Disseminated cryptococcosis among an HIV-Infected person with CD4 Higher than 500 cel/µ

La criptococosis es la micosis sistémica más frecuente entre los pacientes con HIV SIDA. Su prevalencia oscila entre el 5% y el 25%, de acuerdo con la región geográfica que se considere. La localización habitual de esta micosis en el paciente VIH es el sistema nervioso central (SNC). La diseminación sanguínea del agente causal ocurre ante defectos de la inmunidad mediada por células, asociándose con frecuencia a linfomas, leucemia, enfermedades del sistema retículo endotelial. A partir de la eclosión del HIV se redujo un aumento significativo del número de casos, transformándose esta última condición en la causa favorecedora más importante.

Cryptococcosis is the most frequent systemic mycosis among patients with HIV AIDS. Its prevalence ranges between 5% and 25%, according to the geographical region considered. The usual location of this mycosis in the HIV patient is the central nervous system (CNS). Blood dissemination of the causative agent occurs due to defects of cell-mediated immunity, frequently associated with lymphomas, leukemia, reticuloendothelial system diseases. From the emergence of HIV, there was a significant increase in the number of cases, with the latter condition becoming the most important favorable cause

Variability in innate host immune responses to cryptococcosis

Cryptococcosis is an invasive fungal disease caused by Cryptococcus neoformans and the closely related species C. gattii. The severe form of the disease, cryptococcal meningitis (CM), is rapidly fatal without treatment. Although typically a disease of immunocompromised (especially HIV-positive) individuals, there is growing awareness of cryptococcal disease amongst non-immunocompromised patients. Whilst substantial progress has been made in understanding the pathogenicity of C. neoformans in HIV patients, prospective data on cryptococcosis outside the context of HIV remains lacking. Below we review how innate immune responses vary between hosts depending on immunological status, and discuss risk factors and predictors of disease outcome in different groups.

Disseminated cryptococcosis with skin lesions: report of a case series

Abstract Cryptococcosis is a common fungal infection in immunocompromised patients, caused by genus Cryptococcus, presenting with meningitis, pneumonia, and skin lesions. Cutaneous presentation can be varied, but specifically in solid organ transplant recipients (iatrogenically immunocompromised), cryptococcosis should always be considered in the differential diagnosis of cellulitis-like lesions, since the delay in diagnosis leads to worse prognosis and fatal outcome. We report four cases of cryptococcosis with cutaneous manifestation not only for its rarity, but also to emphasize the important role of the dermatologist in the diagnosis of this disease.

Disseminated cryptococcosis with cutaneous involvement in an immunocompetent patient

Abstract Cryptococcosis is a fungal infection of opportunistic behavior that is unusual in immunocompetent patients. We report a rare case of disseminated cryptococcosis with cutaneous involvement in an immunocompetent individual. During hospitalization, Cryptococcus gattii was isolated from skin lesions, lung and spinal fluid. The diagnosis of disseminated cryptococcosis was confirmed and treatment was established. The patient showed improvement. Due to the probable clinical severity of the disease and the possibility that skin lesions may be the first manifestation of this illness, prompt diagnosis must be established and treatment provided.

Neuroinmunología de la meningoencefalitis por Cryptococcus neoformans. Presentación de un caso / Neuroimmunology of meningoencephalitis by Cryptococcus neoformans. A case report

Introducción: la meningitis/meningoencefalitis criptococócica es una forma infrecuente de infección del sistema nervioso central, producida por Cryptococcus neoformans. Objetivo: mostrar la respuesta neuroinmunológica, a través del reibergrama, en un paciente con meningoencefalitis crónica por Cryptococcus neoformans. Presentación del caso: se cuantificaron los niveles de IgA, IgM, IgG y albúmina en suero y líquido cefalorraquídeo a partir de las cinco punciones lumbares que se le realizó a la paciente y se confeccionó el reibergrama correspondiente. Se comprobó la ocurrencia de síntesis intratecal de, por lo menos, dos clases de inmunoglobulinas mayores, se observó un porciento mayor de síntesis intratecal de IgG. No existió disfunción de la barrera sangre/líquido cefalorraquídeo. Conclusiones: el estudio neuroinmunológico del líquido cefalorraquídeo indica la cronicidad de la entidad. La síntesis intratecal de inmunoglobulinas y el estado de la barrera sangre/líquido cefalorraquídeo constituyen elementos claves en el diagnóstico de la neuroinflamación(AU)

Introduction: Meningitis/meningoencephalitis is a non-frequent central nervous system infection produced by Cryptococcus neoformans. Objective: To show the neuroimmunological response using reibergram in a patient with chronic meningoencephalitis due to Cryptococcus neoformans. Case presentation: Serum and cerebrospinal fluid IgA, IgM, IgG and albumin levels were quantified in a patient suffering from the disease by means of five lumbar punctures during her evolution; the results were plotted in their corresponding reibergram. Syntheses of at least two intrathecal major immunoglobulin were confirmed. A percent bigger of IgG intrathecal synthesis was observed. There is no blood-brain barrier dysfunction. Conclusion: Intrathecal immunoglobulin synthesis and blood-brain barrier situation constitute key element in the neuro-inflammation diagnosis(AU)

Disseminated cryptococcosis manifested as a single tumor in an immunocompetent patient, similar to the cutaneous primary forms

Abstract Cryptococcosis is a fungal infection caused by Cryptococcus neoformans that tends to affect immunocompromised individuals. The fungi are mostly acquired by inhalation, which leads to an initial pulmonary infection. Later, other organs - such as the central nervous system and the skin - can be affected by hematogenous spread. In addition, cutaneous contamination can occur by primary inoculation after injuries (primary cutaneous cryptococcosis), whose diagnosis is defined based on the absence of systemic involvement. The clinical presentation of cutaneous forms typically vary according to the infection mode. We report an unusual case of disseminated cryptococcosis in an immunocompetent patient with cutaneous lesions similar to those caused by primary inoculation. This clinical picture leads us to question the definition of primary cutaneous cryptococcosis established in the literature.

Cryptococcus laurentii fungaemia in a cervical cancer patient

ABSTRACT Infections caused by emerging Cryptococcus non-neoformans species are being reported with increasingly frequency. Here, we present a case of fungaemia byCryptococcus laurentii in a woman receiving aggressive immunosuppressive therapy for cervical neoplasia. Three venous blood samples were aseptically collected on consecutive days and C. laurentiiwas isolated and identified through phenotypic and molecular methods. After central venous catheter removal and appropriate antifungal therapy, the patient showed significant improvement and blood culture became negative. Thus, patients following immunosuppressive therapies and using invasive medical devices are at risk of C. laurentii blood infections.

Criptococosis en pacientes inmunosuprimidos sin infección por VIH/SIDA: un nuevo problema clínico en Chile / Cryptococcal infections in non-HIV infected patients: a new clinical problem in Chile

Cryptococcal infections are classically associated to HIV/AIDS patients without therapy, but its presence among other immunosuppressed patients is less recognized. We report 3 lethal cases in non HIV-patients. Two of them presented with meningitis associated to renal transplant or corticosteroid use and, the third, with a necrotic skin infection in the context of progressive liver cirrhosis. In the former two patients, meningeal infection was suspected late, and in the latter, the diagnosis was established postmortem. Cryptococcal infections in non-HIV immunosupressed patients can affect different sites, are suspected late and have a high case-fatality ratio.

La mayoría de los casos de infecciones criptocócicas se presenta en pacientes con infección por VIH/SIDA con inmunosupresión avanzada. En otro tipo de pacientes inmunosuprimidos es menos conocida, pero ha ido aumentando en frecuencia. Presentamos tres casos de infecciones criptocócicas en pacientes inmunosuprimidos no infectados por VIH, que se manifestaron como meningitis en un receptor de trasplante renal y en un paciente con terapia corticosteroidal y una infección cutánea progresiva necrótica con diseminación secundaria en un paciente con cirrosis hepática avanzada. En todos los casos, la infección fue identificada tardíamente. La infección en el paciente con cirrosis se estableció postmortem. Las infecciones criptocócicas en pacientes sin infección por VIH pueden ocurrir en diferentes sitios, se sospechan tardíamente y tienen alta letalidad.

Screening for cryptococcal antigenemia in anti-retroviral naive AIDS patients in Benin City, Nigeria

Cryptococcus neoformans is the most incriminated fungal pathogen causing meningitis in acquired immune deficiency syndrome [AIDS] patients, and is known to constitute a major cause of deaths in AIDS patients. This study thus aimed to determine the baseline sero-prevalence of Cryptococcus neoformans infection in anti-retroviral naive [ART-naive] AIDS patients using the serum Cryptococcal antigen [crag] detection method. Baseline effect of variation in CD4 counts, as well as sex and age with sero-positivity for crag were also determined. This descriptive cross-sectional study included 150 [61 males and 89 females] ART-naive AIDS patients attending the Human Immunodeficiency Virus clinic [HIV] at the University of Benin Teaching hospital, Benin City, Nigeria, within the period from February 2011- July 2011. Forty [18 males and 22 females] HIV positive outpatients with CD4 counts >200 cells/microl who were ART-naive were recruited and used as controls. The sero-prevalence of crag in the patients and the control group was measured using the cryptococcal antigen latex agglutination system [CALAS] [Meridian Bioscience, Europe] and CD4 counts were measured using flow cytometry [Partec flow cytometer, Germany]. Of the 150 ART-naive AIDS patients with CD4 counts

Criptococcose cutânea primária em paciente imunocompetente / Primay cutaneous cryptococcosis in an immunocompetent patient

Os autores relatam caso de Criptococcose cutânea primária, causada pelo Cryptococcus neoformans, em paciente imunocompetente, fazendeiro que desenvolveu extensivas lesões, no antebraço, após injúria provocada por galináceo, quando fazia limpeza de seu celeiro. Tratamento oral com fluconazol resultou em cura total. A literatura relata raridade de criptococcose cutânea primária em imunocompetentes e sua relativa frequência em imunodeprimidos.

The authors report a primary cutaneous cryptococcosis, caused by Cryptococcus neoformans in immunocompetent patient, a farmer who developed extensive lesions at the site of an injury caused by one of the chickens on his right forearm, while he was cleaning out his barn. Oral treatment with fluconazole was totally successful. A review of the literature showed the rarity of cutaneous cryptococcosis in immunocompetent patients and in contrast, that skin lesions frequently occur in immunocompromised patients.

Criptococosis en pacientes con SIDA: manifestaciones cutáneas y sistémicas, diagnóstico y terapéutica / Cryptococcosis in aids patients: Cutaneous and systemic manifestations, diagnosis and treatment

El Cryptococcus neoformans es un hongo patógeno que causa infección invasiva del sistema nervioso central, en la era actual del VIH/SIDA. Diversas investigaciones han identificado el amplio espectro de esta patología, que va desde la colonización inofensiva del tracto respiratorio hasta la presentación con meningitis o enfermedad diseminada; el factor crucial que determina el desarrollo de la infección es el estado inmune del huésped; es así como las manifestaciones mas serias ocurren usualmente en pacientes con SIDA. El uso de agentes antifúngicos adecuados disminuye la mortalidad significativamente, pero se requiere de terapia de mantenimiento continua con el fin de prevenir las recaídas.

Cryptococcus neoformans is an important fungal pathogen causing invasive infection, especially of the central nervous ystem in this era of the HIV/AIDS epidemic. Researchers ave identified a diverse spectrum of host responses range rom harmless colonization of the airways to meningitis r disseminated disease; the crucial factor determining he outcome of this infection is the immune status of the ost. The most serious infections usually occur in patients ith AIDS. The use of appropriate antifungal agents ecreases the mortality significantly, but requires ontinued therapy and long-term maintenance to prevente elapses.

Avaliação da fenotipagem leucocitária e da resposta linfoproliferativa de pacientes HIV soronegativos com neurocriptococose / Evaluation of lymphoproliferative response and leucocyte phenotype from HIV seronegative patients with neurocryptococcosis

A criptococose é uma infecção oportunista e está associada à uma pobre resposta inflamatória e a uma queda da resposta T dependente. O objetivo desse trabalho foi avaliar parâmetros imunológicos celulares em pacientes com neurocriptococose. O leucograma dos pacientes evidenciou: linfopenia, monocitopenia, eosinopenia e neutropenia. Observou-se linfopenia TCD4+ e TCD8+ . O GXM do soro mostrou correlação com linfoproliferação e expressão de moléculas em leucócitos. As células de pacientes com elevadas quantidades de GXM proliferaram menos para antígenos e adequadamente para o mitógeno. Tendo em vista o que foi observado, os dados sugerem um defeito de sinalização monócito-linfócito, provavelmente provocado pelo açúcar da cápsula do C. neoformans / Cryptococcosis is an opportunistic fungal disease that can be associated to a poor inflammatory response and to a decreased T cell response, the aim of this study was to evaluate cellular immunological parameters in HIV(-) patients with neurocryptococcosis. Patient´s leukogram showed: lymphopenia, monocytopenia, eosinopenia and neutropenia. NCC group presented CD4+ and CD8+ T lymphopenia. The serum GXM correlated with lymphoproliferative response and the expression of molecules on leucocytes. NCC patients’ cells with high GXM levels proliferated less to specific antigens and adequately to mitogen. In summary data suggest a defect in monocyte-lymphocyte communication probably related to the interference of C. neoformans capsular sugar...

Enzyme-linked immunosorbent assay for detection and quantification of Cryptococcus neoformans antigen

An enzyme-linked immunosorbent assay was standardized for the detection of cryptococcal antigen in serum and cerebrospinal fluid. The system was evaluated in clinical samples from patients infected by human immunodeficiency virus with and without previous cryptococcosis diagnosis. The evaluated system is highly sensitive and specific, and when it was compared with latex agglutination there were not significant differences. A standard curve with purified Cryptococcus neoformans antigen was settled down for the antigen quantification in positive samples

Influencia del tratamiento con zidovudina (AZT) sobre los niveles de antígeno polisacárido capsular de Cryptococcus neoformans en los fluídos biológicos / Influence of zidovudine (AZT) on levels of capsular antigen of Cryptococcus neoformans in body fluids

Fueron investigados los títulos de antígeno polisacárido capsular de Cryptococcus neoformans en el momento del diagnóstico en 25 pacientes con criptococosis asociada al SIDA. Siete pacientes recibirían en el momento del diagnóstico de la micosis 500-600 mg/día de zidovudina (AZT) y otros 18 no recobirían ninguna medicación antirretroviral. Todos ellos recibieron tratamiento antifúngico específico inmediatamente después de realizado el diagnóstico micológico. Los títulos de los pacientes tratados con AZT fueron más bajos que aquellos no tratados con ningún esquema antirretroviral, aunque la diferencia observada careció de significación estadística (p>0,05). El promedio del tiempo de sobrevida (tomando desde el momento del diagnóstico de la micosis hasta la muerte) fue significativamente más largo (504,43 ñ 160 días) (p = 0,002). Tampoco se observaron diferencias significativas entre los recuentos de linfocitos CD4+ y la prevalencia de diferentes infecciones intercurrentes en ambos grupos. Las diferencias observadas entre ambas poblaciones estudiadas puede demostrar indirectamente la eficacia de la terapéutica antirretroviral para retardar el daño inmunológico provocado por el VIH sobre el sistema inmune de los pacientes

Estudio clínico-epidemiológico de 12 pacientes con Criptococosis asociada al SIDA / Clinical and epidemiologic study of 12 patients with cryptococcosis associated with AIDS

Se propone evaluar las caracter{isticas clínico-neurológicas, epidemiológicas, diagnósticas e inmunológicas de 12 pacientes con criptococosis asociada al SIDA que fueron internados en la Sala 20 del Hospital Muñiz entre 1992 y 1995 (Buenos Aires, Argentina), a causa del primero episodio de criptococosis. Los datos se obtuvieron de las historias clínicas de los pacientes -los cuales tuvieron una edad promedio de 29,5 años

Deteccion de antigeno del polisacarido capsular de Cryptococcus neoformans en pacientes con SIDA y neurocriptococosis en Sao Paulo, Brasil / Detection of capsular polysaccharide antigen of Cryptococcus neoformans in patients with AIDS and neurocryptococcosis in Sao Paulo, Brazil

Antigeno del polisacarido capsular (AgPC) de Cryptococcus neoformans fue detectado por la tecnica de aglutinacion de latex (AL) en LCR y suero de pacientes con Sindrome de Inmunodeficiencia Adquirida (SIDA) y primer episodio de neurocriptococosis, usando como patron el examen micologico (examen directo y cultivo) de LCR. Se obtuvo una sensibilidad de 100 por ciento de AL para detectar AgPC de C. neoformans, el cual por su rapidez permite tratamiento especifico precoz. Titulos iniciales de AgPC de la levadura en esos pacientes pueden ser>1.000.000, pareciendo que cuando esos titulos estan presentes en suero, se relacionan con mortalidad durante el tratamiento. En los pacientes que sobrevivieron se observo que el examen micologico directo y AgPC de C. neoformans, en LCR y suero, permanecen positivos aun despues de tratamiento y mejoria clinica del paciente.

Criptococosis por Cryptococcus Albidus / Cryptococcosis by Cryptococcus albidus

Se presentan los datos clínicos de una mujer de 31 años de edad, residente en la ciudad de Buenos Aires, que en 1982 padeció una sarcoidosis con lesiones cutáneas y pulmonares. Fue medicada con 2 series de predinisona hasta abril de 1985. Desde entonces se encontraba en remisión clínica de su afección original. Cursó un embarazo con parto normal a término, entre mayo de 1985 y febrero de 1986. Poco antes del parto presentó trastornos digestivos, adenopatías generalizadas, hepatosplenomegalia e ictericia obstructiva por compresión extrínseca de las vías biliares extrahepáticas. Una biopsia de ganglio supraclavicular mostró granulomas de células gigantes, con elementos levaduriformes capsulados en su interior. Los cultivos del mismo material exhibieron el desarrollo de un hongo del género Cryptococcus en varios tubos incubados a 28-C. Este germen no creció a 37-C y no fue patógeno para el ratón. Los estudios fisiológicos permitieron su identificación revelaron una reducción de los linfocitos T. La paciente fue tratada desde el día 3-5-86 con itraconazol, a razón de 100 mg/día, con buena evolución. Se trata del segundo caso registrado en la literatura mundial