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Braz. j. infect. dis ; 24(1): 7-12, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1089323


ABSTRACT Background: This study aims to explore the epidemiology, clinical profile and strain characteristics of cryptococcosis from 2013 to 2017 in a major teaching hospital in China. Methods: Trends in antifungal drug susceptibility of 217 consecutive non-repetitive cryptococcal isolates collected from patients of an university hospital in China were analyzed between 2013 and 2017. Of those, 98 isolates were conserved for identification by internal transcribed spacer (ITS) sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system. Multilocus sequence typing (MLST) was used to designate molecular types. Clinical characteristics of the 98 patients with cryptococcosis during the period of 2013-2017 were retrospectively evaluated. Results: There was a trend for gradual increase in the MIC range of fluconazole was from 2013 to 2017. The conserved 98 clinical cryptococcal isolates included 97 C. neoformans and one C. gattii, and 90 (91.8%) isolates belonged to ST5 genotype VNI. Out of the 98 patients with cryptococcosis, 28 (28.6%) were HIV-infected and 32 (32.7%) had no underlying diseases. HIV-infected patients had higher mortality than HIV-uninfected patients (28.6% vs 14.3%, p = 0.147). Conclusions: Most of the patients with cryptococcosis were not HIV-infected in this study, while patients with HIV had a higher mortality. Reduced susceptibility to fluconazole was observed among C. neoformans isolates, most of them belonged to ST5 genotype VNI having an impact on the effective dose of fluconazole.

Humans , Male , Female , Adult , Middle Aged , Cryptococcosis/microbiology , Cryptococcosis/epidemiology , Hospitals, University/statistics & numerical data , Time Factors , Microbial Sensitivity Tests , China/epidemiology , Cross-Sectional Studies , Retrospective Studies , Statistics, Nonparametric , Cryptococcosis/drug therapy , Cryptococcus neoformans/isolation & purification , Cryptococcus neoformans/drug effects , Cryptococcus neoformans/genetics , Cryptococcus gattii/isolation & purification , Cryptococcus gattii/drug effects , Cryptococcus gattii/genetics , Multilocus Sequence Typing , Genotype , Antifungal Agents/therapeutic use
An. bras. dermatol ; 94(6): 744-746, Nov.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1054899


Abstract This report describes a case of unusual deep skin ulcers with tortuous sinus tract formation in an immunocompetent woman. She was initially diagnosed with a Staphylococcus aureus skin infection and histopathologically diagnosed with pyoderma gangrenosum. However, culture from the deep end of ribbon gauze inserted into the subcutaneous sinus tract revealed shiny, light-yellow mucoid colonies, which were identified as Cryptococcus neoformans var. grubii. She was treated with fluconazole for nine months and completely healed. Cryptococcosis is an opportunistic infection caused by variants of C. neoformans species. Cutaneous manifestations of cryptococcosis are quite divergent, rarely occurring as deep skin ulcers with sinus formation.

Humans , Female , Adult , Skin Ulcer/microbiology , Skin Ulcer/pathology , Cryptococcosis/pathology , Cryptococcus neoformans/isolation & purification , Dermatomycoses/pathology , Immunocompetence , Skin Ulcer/drug therapy , Fluconazole/therapeutic use , Immunocompromised Host , Cryptococcosis/microbiology , Cryptococcosis/drug therapy , Dermatomycoses/microbiology , Dermatomycoses/drug therapy , Antifungal Agents/therapeutic use
Rev. chil. infectol ; 35(4): 420-423, ago. 2018.
Article in Spanish | LILACS | ID: biblio-978053


Resumen Introducción: La criptococcosis es una infección micótica oportunista grave, Cryptococcus neoformans es la principal especie de importancia médica, pudiendo manifestarse como meningitis, neumonía o criptococcemia. Objetivo: Caracterizar a los pacientes con infección por Cryptococcus sp. entre el 01/01/13 y 30/06/16, en el HCVB. Materiales y Métodos: Se identificaron los cultivos con desarrollo de Cryptococcus sp., y a partir de éstos se obtuvo los registros de los pacientes, los que fueron analizados por dos revisores independientes. Resultados: Se recopiló la información de 13 pacientes, que presentaron 15 casos de infección por C. neoformans. De los 13 pacientes, 11 (84,6%) eran de sexo masculino, con una mediana de edad de 35 años. 11 pacientes (84,6%) padecían infección por VIH, uno (7,7%) tenía el antecedente de leucemia linfática crónica, y uno (7,7%) de etilismo crónico. De los 15 casos, nueve (60%) presentaron infección meníngea; cinco (33,3%) presentaron criptococcemia sin compromiso del LCR; y uno (6,6%) presentó infección pulmonar. De los 13 pacientes, ocho (53,3%) se encontraban fallecidos al año de seguimiento. Conclusiones: La infección por Cryptococcus sp. es una patología que debe ser sospechada en pacientes con inmunodeficiencia de predominio celular. La infección meníngea fue la forma más frecuente de presentación. Persiste presentando una elevada mortalidad.

Background: Cryptococcosis is a severe opportunistic mycotic infection, caused mainly by Cryptococcus neoformans. It can present as meningitis, pneumonia or cryptococcemia. Aim: To characterize patients with Cryptococcus infection between January 1°, 2013 and June 30, 2016, in Hospital Carlos van Buren, Valparaíso, Chile. Methods: We identified retrospectively those cultures with Cryptococcus sp. growth, and then obtained their clinical files which were analyzed by two independent reviewers. Results: We were able to obtain data from 13 of 15 patients who presented with Cryptococcus neoformans infection. Out of all, 11 (84.6%) were males, with a median age of 35 years old. 11 (84,6%) were HIV positive, 1 (7,7%) had chronic lymphocytic leukemia, and 1 (7,7%) refered alcohol abuse. Out of the 15 episodes, 9 (60%) had meningeal infection; 5 (33.3%) were cryptococcemia without meningeal involvement and 1 (6.6%) presented as a pulmonary infection. Eight patients were deceased at one year follow up. Conclusions: Cryptococcus sp. infection must be suspected in patients with cellular immunodeficiencies. Meningeal involvement is the most frequent form of clinical presentation. It still has a high mortality rate.

Humans , Male , Female , Adult , Cryptococcosis/diagnosis , CD4-Positive T-Lymphocytes , Fluconazole/therapeutic use , Chile , Retrospective Studies , Cryptococcosis/drug therapy , Cryptococcus neoformans/isolation & purification , Deoxycholic Acid/therapeutic use
Braz. j. infect. dis ; 22(1): 11-15, Jan.-feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-951617


ABSTRACT Fluconazole is extensively used for the treatment of candidiasis and cryptococcosis. Among other factors, successful treatment is related to appropriate fluconazole levels in blood and cerebrospinal fluid. In the present study, fluconazole levels were determined in 15 patients, 14 of whom had AIDS and 13 had neurocryptococcosis. The only selection criterion was treatment with fluconazole, which was performed with a generic or similar form of the drug. Fluconazole level was determined by high performance liquid chromatography and the susceptibility profile of Cryptococcus spp. isolated from the patients was assessed by broth microdilution. Blood and cerebrospinal fluid fluconazole levels were found to be related to the fluconazole daily dose, and exceeded the minimum inhibitory concentration of this antifungal for the Cryptococcus spp. isolates. A good correlation was observed between serum and cerebrospinal fluid drug concentration. In conclusion, treatment with non-original fluconazole under usual medical practice conditions results in appropriate blood and cerebrospinal fluid levels of the drug for inhibiting Cryptococcus spp. susceptible to this antifungal drug. The relatively common failures of neurocryptococcosis treatment appear not to be due to insufficient fluconazole levels in the cerebrospinal fluid, especially with the use of daily doses of 400-800 mg.

Humans , Adult , Middle Aged , Fluconazole/cerebrospinal fluid , Fluconazole/blood , Cryptococcosis/drug therapy , Antifungal Agents/cerebrospinal fluid , Antifungal Agents/blood , Reference Values , Candidiasis/cerebrospinal fluid , Candidiasis/drug therapy , Candidiasis/blood , Microbial Sensitivity Tests , Fluconazole/administration & dosage , Chromatography, High Pressure Liquid , Treatment Outcome , AIDS-Related Opportunistic Infections/drug therapy , Statistics, Nonparametric , Cryptococcosis/cerebrospinal fluid , Cryptococcosis/blood , Cryptococcus/isolation & purification , Cryptococcus/drug effects , Dose-Response Relationship, Drug , Histoplasmosis/cerebrospinal fluid , Histoplasmosis/drug therapy , Histoplasmosis/blood , Antifungal Agents/administration & dosage
Mem. Inst. Oswaldo Cruz ; 113(7): e170391, 2018.
Article in English | LILACS | ID: biblio-894941


Cryptococcal meningitis is the most common central nervous system infection in the world today. It occurs primarily, but not exclusively, in immunocompromised individuals and despite substantial improvement in management of clinical events like AIDS, the numbers of cases of cryptococcosis remain very high. Unfortunately, despite several antifungal agents available for treatment, morbidity and mortality rates remain high with this fungal infection. In this Review, we will describe the treatments and strategies for success, identify the failures, and provide insights into the future developments / improvements for management. This sugar-coated yeast can play havoc within the human brain. Our goals must be to either prevent or diagnose disease early and treat aggressively with all our clinical tools when disease is detected.

Humans , Meningitis, Cryptococcal , AIDS-Related Opportunistic Infections/drug therapy , Antifungal Agents/therapeutic use , Cryptococcosis/drug therapy
Mem. Inst. Oswaldo Cruz ; 113(7): e180050, 2018.
Article in English | LILACS | ID: biblio-894943


Cryptococcosis diagnosis has been recently improved by the use of rapid cryptococcal antigen testing with lateral flow assays, which have proved sensitive and specific. Using "test and treat" screening strategies for cryptococcal disease with these tests has been showed effective in reducing cryptococcal meningitis (CM) in HIV-infected patients. Recommended induction, consolidation, and maintenance therapeutic strategy for CM is widely unavailable and/or expensive in low and middle-income settings. New therapeutic strategies, mostly using reduced duration, have recently shown acceptable outcome or are currently tested. Diagnostic and therapeutic guidelines for cryptococcal disease in limited resources countries are undergoing a paradigmatic shift.

Humans , Meningitis, Cryptococcal/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Cryptococcosis/drug therapy , Immunologic Tests , Drug Therapy, Combination
An. bras. dermatol ; 92(5,supl.1): 69-72, 2017. tab, graf
Article in English | LILACS | ID: biblio-887091


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.

Humans , Male , Adult , Middle Aged , Cryptococcosis/pathology , Dermatomycoses/pathology , Skin/pathology , Biopsy , Cryptococcosis/immunology , Cryptococcosis/drug therapy , Dermatomycoses/immunology , Dermatomycoses/drug therapy , Diagnosis, Differential , Immunocompetence , Antifungal Agents/therapeutic use
An. bras. dermatol ; 91(6): 832-834, Nov.-Dec. 2016. graf
Article in English | LILACS | ID: biblio-837990


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.

Humans , Male , Adult , Cryptococcosis/immunology , Cryptococcosis/pathology , Dermatomycoses/immunology , Dermatomycoses/pathology , Cryptococcus gattii/isolation & purification , Immunocompetence , Skin/microbiology , Skin/pathology , Treatment Outcome , Cryptococcosis/drug therapy , Dermatomycoses/drug therapy , Lymphocytosis/complications , Lung/microbiology , Antifungal Agents/therapeutic use
Braz. j. infect. dis ; 20(4): 342-348, July-Aug. 2016. graf
Article in English | LILACS | ID: biblio-828118


Abstract A natural and biocompatible fibrin microsphere is one of the most promising dual delivery vehicle as compared to other traditionally designed delivery modalities. It represents sustained delivery of encapsulated drug and is easily biodegradable in the blood circulation. In the present study, we evaluated the systemic augmentation of the antifungal activity of amphotericin B loaded in fibrin microsphere (AMB-fibrin microsphere) against cryptococcosis in Swiss albino mice. Mice infected with Cryptococcus neoformans were treated with 0.5 mg/kg AMB-fibrin microsphere that was given alternately for 7 days. The antifungal potential of AMB-fibrin microsphere was assessed on the basis of reduction of cfu count in the systemic circulation and various vital organs of infected mice. The formulation was found to be highly effective in reducing intracellular pathogen from the experimental animals where fibrin microsphere significantly controlled the release of amphotericin B for longer time duration. The AMB-fibrin microsphere chemotherapy was significantly more effective than free amphotericin B in reducing the fungal burden and showed better survival efficacy (p < 0.05). The current study demonstrating the use of novel amphotericin B loaded fibrin microsphere not only imparts protection to the encapsulated amphotericin B but also offers an effective strategy to decrease the drug associated toxicities.

Animals , Female , Rats , Fibrin/administration & dosage , Amphotericin B/administration & dosage , Cryptococcosis/drug therapy , Cryptococcus neoformans , Antifungal Agents/administration & dosage , Time Factors , Disease Models, Animal , Microspheres
Med. interna (Caracas) ; 31(4): 211-217, 2015. ilus, tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1009669


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)

Humans , Female , Adult , Cryptococcosis/etiology , Cryptococcosis/drug therapy , Lung Diseases, Fungal/etiology , Immunosuppression , Internal Medicine , Mycoses
Mem. Inst. Oswaldo Cruz ; 109(6): 797-804, 09/09/2014. tab, graf
Article in English | LILACS | ID: lil-723985


Cryptococcosis is reported in adults and is often acquired immune deficiency syndrome (AIDS)-associated; however, its frequency in children is low. Based on the National Survey on Cryptococcosis conducted in Colombia, an epidemiological and clinical analysis was performed on cases of the disease observed in children less than 16 years old between 1993-2010. We found 41 affected children (2.6% prevalence) from the 1,578 surveys received. The country mean annual incidence rate was 0.017 cases/100,000 children under 16 years, while in Norte de Santander the incidence rate was 0.122 cases/100,000 (p < 0.0001). The average age of infected children was 8.4 and 58.5% were male. In 46.3% of cases, a risk factor was not identified, while 24.4% had AIDS. The most frequent clinical manifestations were headache (78.1%), fever (68.8%), nausea and vomiting (65.6%), confusion (50%) and meningeal signs (37.5%). Meningitis was the most frequent clinical presentation (87.8%). Amphotericin B was given to 93.5% of patients as an initial treatment. Positive microbiological identification was accomplished by India ink (94.7%), latex in cerebrospinal fluid (100%) and culture (89.5%). Out of 34 isolates studied, Cryptococcus neoformans var. grubii (VNI 85.3%, VNII 8.8%) was isolated in 94.1% of cases and Cryptococcus gattii (VGII) was isolated in 5.9% of cases. These data are complemented by a literature review, which overall suggests that cryptococcosis in children is an unusual event worldwide.

Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Cryptococcosis/epidemiology , Cryptococcus/isolation & purification , Antifungal Agents/therapeutic use , Coinfection , Colombia/epidemiology , Cryptococcosis/diagnosis , Cryptococcosis/drug therapy , Cryptococcus/classification , HIV , HIV Infections/epidemiology , Incidence , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/epidemiology , Meningitis, Cryptococcal/virology , Prevalence , Risk Factors
Journal of the Egyptian Society of Parasitology. 2014; 44 (2): 455-466
in English | IMEMR | ID: emr-166027


Cryptosporidiosis represents a major public health problem which transmitted by contamination of food or water by sporulated Cryptosporidial oocyst. Causing self- limited diarrhea in immuno-competent person and chronic and life threatening diarrhea among immunocompromised individuals. It can be diagnosed by concentration and detection of its Oocyst in different environmental samples and water by microscopic and immunological examination such as enzyme immunoas-say [ELISA] for parasite antigens and nucleic acid amplification assay as well as use of molecular techniques such as Polymerase Chain Reaction [PCR].Treatment is face challenges, Macrolides, Paramomycin, Nitazoxanide and Mirazid. All these drugs have partial efficacy in reducing disease severity in immunocompetent individuals. Nitazoxanide has partial efficacy in immunocompromised individuals. Resolution of Cryptosporidiosis can be maintained with effective Highly Active Antiretroviral Therapy [HAART]

Humans , Cryptococcosis/drug therapy , Diarrhea/diagnosis , Diarrhea/drug therapy , Polymerase Chain Reaction , Treatment Outcome
Rio de Janeiro; s.n; 2013. xiv,137 p. tab, ilus, graf.
Thesis in Portuguese | LILACS | ID: lil-762504


A criptococose é uma micose sistêmica adquirida pela inalação de basidiosporos ou leveduras desidratadas de Cryptococus neoformans e Cryptococus gattii, estas duas espécies podem causar criptococose oportunista e primária respectivamente. C. neoformans está constituído de tipos moleculares VNI-VNIV e C. gattii de VGI-VGIV que apresentam distribuição geográfica diferenciada, como por exemplo, o tipo VNI é cosmopolita e está associado a AIDS e VGI predominando na Austrália e EUA, o tipo VGII predominando no Brasil e America Latina. Este trabalho tem por objetivo realizar estudo comparado dos tipos moleculares VNI de C. neoformans, VGI e VGII de C. gattii analisando diferentes aspectos tais como: 1- Determinar o perfil da suscetibilidade in vitro da concentração inibitória mínima (CIM) de fluconazol (FLZ), itraconazol (ITZ), 5-fluorocitosina (5FC) e anfotericina B (AMB), isoladamente e de forma combinada de AMB com 5FC e AMB com Voriconazol (VRZ); 2- Determinar CIM pela citometria de fluxo (CMF) frente a FLZ, ITZ e AMB; 3- Definir a concentração mínima letal (CML) de AMB e 5FC, isoladamente e em combinação; 4- Avaliar a ação da melanina frente a 5FC e AMB na forma combinada e isolada de 5FC; 5- Induzir a resistência in vitro para FLZ e padronizar os fluorocromos: acetoximetil - calceína (calceina-AM), acetoximetil - 2’, 7’ -bis-(2-carboxietil)-5-(e -6)- carboxifluoresceína (BCECF-AM), rodamina 123 (Rh123) e iodeto de 3, 3’ –dipentiloxacarbocianina (DiOC5) na CMF para verificar a expressão de bombas de efluxo; 6- Comparar a expressão de bombas de efluxo...

Cryptococcosis is a systemic mycosis acquired by inhalation of dried yeasts or basidiospores of Cryptococus neoformans and Cryptococus gattii, these species can cause cryptococcosis opportunistic and primary respectively. C. neoformans is composed of molecular types VNI - VNIV and C. gattii VGI - VGIV they have different geographical distribution, the VNI type is cosmopolitan and is associated with AIDS, VGI type is predominant in Australia and the USA; while VGII type occurs in Brazil and Latin America. This paper aims to conduct a comparative study of the molecular types VNI C. neoformans and VGI, VGII C. gattii analyzing different aspects such as: 1 – The susceptibility profile in vitro of fluconazole ( FLZ ), itraconazole ( ITZ ), 5 - fluorocytosine ( 5FC ) and amphotericin B ( AMB ) alone and in combination with 5FC and AMB with voriconazole ( VRZ ) 2 – The minimum inhibitory concentration ( MIC ) by flow cytometry ( FCM ) comparing MIC of FLZ, ITZ and AMB with CLSI; 3 - The minimum lethal concentration ( MLC ) of AMB and 5FC, alone and in combination; 4 - The action of melanin against 5FC and AMB alone and combined 5FC, 5 – The induced resistance in vitro to FLZ and standardize the fluorochromes: acetoximetil - calceína (calceina-AM), acetoximetil - 2’, 7’ -bis-(2-carboxietil)-5-(e -6)- carboxifluoresceína (BCECF-AM), rodamina 123 (Rh123) e iodeto de 3, 3’ – dipentiloxacarbocianina (DiOC5) in FCM to verify expression of efflux pumps; 6 - The compare the expression of efflux pumps...

Animals , Cryptococcosis/epidemiology , Cryptococcosis/drug therapy , Cryptococcus gattii/classification , Cryptococcus neoformans/classification , Drug Resistance, Fungal , Cell Separation , Flow Cytometry , Molecular Typing , Mycological Typing Techniques
Biomédica (Bogotá) ; 32(3): 386-398, jul.-set. 2012. ilus, graf, mapas, tab
Article in English | LILACS | ID: lil-663709


Introduction: A survey on cryptococcosis is being conducted regularly in Colombia since 1997. We present hereby the results corresponding to patients diagnosed from 2006 to 2010. Objective: To analyze the data obtained during this period. Materials and methods: Retrospective analysis of the corresponding surveys. Results: A total of 526 surveys originating from 72% of the Colombian political divisions were received during the 5-year period. Most patients (76.6%) were males and 74.9% were 21-50 years old. The most prevalent risk factor was HIV infection (83.5%) with cryptococcosis defining AIDS in 23% of the cases. In the general population the estimated mean annual incidence rate for cryptococcosis was 2.4 x 106 inhabitants while in AIDS patients this rate rose to 3.3 x 103. In 474 surveys stating clinical features, most frequent complaints were headache 84.5%, fever 63.4%, nausea and vomiting 57.5%, mental alterations 46.3%, meningeal signs 33.0%, cough 26.4% and visual alterations 24.5%. Neurocryptococcosis was recorded in 81.8% of the cases. Laboratory diagnosis was based on direct examination, culture and latex in 29.3% cases. From 413 Cryptococcus isolates analyzed, 95.6% were identified as C. neoformans var. grubii, 1% C. neoformans var. neoformans, and 3.4% C. gattii. Treatment was reported for 71.6% of the cases with amphotericin B alone or in combination with fluconazole prescribed in 28%. Conclusions: Surveys done through passive surveillance continue to be sentinel markers for HIV infection and represent a systematic approach to the study of opportunistic problems regularly afflicting AIDS patients since cryptococcosis requires no compulsory notification in Colombia.

Introducción. Desde 1997 se viene realizando un programa nacional de vigilancia sobre la criptococosis en Colombia. Se presentan los resultados correspondientes a los pacientes diagnosticados entre el 2006 y el 2010. Objetivo. Analizar los datos obtenidos durante este periodo. Materiales y métodos. Análisis retrospectivo de las encuestas. Resultados. Durante los cinco años mencionados se recibieron 526 encuestas representativas del 72 % de la división política colombiana. La mayoría de pacientes (76,6 %) eran hombres y 74,9 % estaban entre los 21 y los 50 años. El factor de riesgo prevalente fue la infección por VIH (83,5 %), y la criptococosis definió el sida en 23 % de los casos. La incidencia anual promedio en la población general fue de 2,4 por un millón de habitantes mientras que, en pacientes con sida, aumentó a 3,3 por 1.000. En 474 encuestas se informaron manifestaciones clínicas; las más frecuentes fueron: cefalea (84,5 %), fiebre (63,4 %), náuseas y vómito (57,5 %), alteraciones mentales (46,3 %), signos meníngeos (33 %), tos (26,4 %) y alteraciones visuales (24,5 %). La neurocriptococosis se reportó en 81,8 % de los casos. El diagnóstico se hizo por examen directo, cultivo y antigenemia en 29,3 % de los casos. De 413 aislamientos recuperados, 95,6 % fueron C. neoformans var. grubii, 1 % C. neoformans var. neoformans, y 3,4 % C. gattii. En 71,6 % de los casos para el tratamiento se administró anfotericina B y en 28 % se combinó con fluconazol. Conclusiones. La vigilancia pasiva continúa siendo un marcador centinela para la infección por VIH, y constituye una aproximación sistemática al estudio de infecciones oportunistas en pacientes con sida, debido a que la criptococosis no es de notificación obligatoria en Colombia.

Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Cryptococcosis/epidemiology , AIDS-Related Opportunistic Infections/epidemiology , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Antigens, Fungal/blood , Colombia/epidemiology , Cryptococcosis/diagnosis , Cryptococcosis/drug therapy , Cryptococcosis/microbiology , Cryptococcus gattii/immunology , Cryptococcus gattii/isolation & purification , Cryptococcus neoformans/immunology , Cryptococcus neoformans/isolation & purification , Drug Resistance, Multiple, Fungal , Fluconazole/administration & dosage , Fluconazole/therapeutic use , Health Surveys , Incidence , Population Surveillance , Retrospective Studies , Symptom Assessment
Article in English | IMSEAR | ID: sea-145712


Opportunistic fungal infections in immunocompromised patients are usually caused by candida, aspergillus, cryptococcus or zygomycetes. Rarely, fungal infections may occur in immunocompetent indivivals and are usually caused by cryptococcus or aspergillus. When infected by cryptococcus, the usual sites of infection include respiratory tract, central nervous system, or skin. Uncommon sites are liver, spleen, prostate, and bone marrow. When it involves liver, it can present with micro-abscesses, cholangitis, or hepatitis. Here we report a case of cryptococcal infection of liver in a HIV-negative patient presenting with micro-abscesses.

Cryptococcosis/complications , Cryptococcosis/drug therapy , Fatal Outcome , Female , Heart Arrest/etiology , HIV Seronegativity , Humans , Liver Abscess/diagnosis , Liver Abscess/etiology , Liver Abscess/microbiology , Liver Abscess/therapy , Middle Aged
An. bras. dermatol ; 86(6): 1178-1180, nov.-dez. 2011. ilus
Article in Portuguese | LILACS | ID: lil-610424


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.

Aged , Humans , Male , Cryptococcus neoformans , Cryptococcosis/immunology , Immunocompromised Host , Lung Diseases, Fungal/immunology , Antifungal Agents/therapeutic use , Cryptococcosis/drug therapy , Cryptococcosis/pathology , Cryptococcus neoformans/growth & development , Fluconazole/therapeutic use , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/pathology
Rev. Soc. Bras. Med. Trop ; 43(4): 469-471, jul.-ago. 2010. ilus
Article in English | LILACS | ID: lil-556021


We report a case of an immunocompetent Peruvian patient from the Andes with a one-month history of meningoencephalitis. Cryptococcus gattii was identified from a cerebrospinal fluid culture through assimilation of D-proline and D-tryptophan as the single nitrogen source. Initially, the patient received intravenous antifungal therapy with amphotericin B. The patient was discharged 29 days after hospitalization and continued with oral fluconazole treatment for ten weeks. During this period, the patient showed clinical improvement with slight right-side residual weakness. Through this case report, we confirm the existence of this microorganism as an infectious agent in Peru.

Nós reportamos o caso de um paciente peruano immunocompetente proveniente dos Andes com história de um mês com meningoencefalite. Foi identificado o Cryptococcus gattii na cultura de liquido cerebrospinal através da assimilação de D-prolina e D-tryptofano como fonte única de nitrogênio. Inicialmente, o paciente recebeu tratamento antifúngico intravenoso com amfotericina B. O paciente foi liberado 29 dias depois da hospitalização, seguindo tratamento oral durante 10 semanas com fluconazol. Durante este período, o paciente apresentou melhoria clinica e uma leve fraqueza residual direita. Com o reporte do caso, nós confirmamos a existência desse microorganismo como agente infeccioso em nosso país.

Humans , Male , Middle Aged , Cryptococcosis/diagnosis , Cryptococcus gattii/isolation & purification , Meningoencephalitis/microbiology , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Cryptococcosis/drug therapy , Fluconazole/therapeutic use , Meningoencephalitis/drug therapy , Peru
Braz. j. med. biol. res ; 43(4): 345-349, Apr. 2010. graf, ilus, tab
Article in English | LILACS | ID: lil-543576


The in vivo antifungal activity of the naphthoquinone beta-lapachone against disseminated infection by Cryptococcus neoformans was investigated. Swiss mice were immunosuppressed daily with dexamethasone (0.5 mg per mouse) intraperitoneally for 3 days, the procedure was repeated 4 days later, and the animals were then challenged intravenously with C. neoformans (10(6) CFU/mL) 1 week later. Seven days after infection, the mice were divided into groups and treated daily with beta-lapachone (10 mg/kg, iv) for 7 (N = 6) and 14 days (N = 10). Amphotericin B (0.5 mg/kg) was used as comparator drug and an additional group received PBS. Treatment with beta-lapachone cleared the yeast from the spleen and liver, and the fungal burden decreased approximately 10(4) times in the lungs and brain 14 days after infection when compared to the PBS group (P < 0.05). This result was similar to that of the amphotericin B-treated group. Protection was suggestively due to in vivo antifungal activity of this drug and apparently not influenced by activation of the immune response, due to similar leukocyte cell counts among all groups. This study highlights the prospective use of beta-lapachone for treatment of disseminated cryptococcosis.

Animals , Male , Mice , Antifungal Agents/therapeutic use , Cryptococcus neoformans , Cryptococcosis/drug therapy , Immunocompromised Host , Naphthoquinones/therapeutic use , Dexamethasone , Immunosuppressive Agents , Leukocyte Count