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1.
Braz. j. med. biol. res ; 53(11): e9056, 2020. tab, graf
Article in English | LILACS, ColecionaSUS | ID: biblio-1132484

ABSTRACT

Cryptococcal meningitis affects normal hosts and immunocompromised patients exhibiting high mortality rates. The objective of this study was to design two molecular assays, visible microarray platforms and loop-mediated isothermal amplification (LAMP), to identify Cryptococcus spp. and the species neoformans and gattii from the cerebral spinal fluid (CSF). To identify Cryptococcus and the two species, we designed two microarrays DNA platforms based on the internal transcribed spacer (ITS) region and CAP59 gene and LAMP assays specific for Cryptococcus species. The assays were tested using CSF from patients with cryptococcal meningitis. CSF from patients with cryptococcal meningitis was cultured in Sabouraud culture medium, and the Cryptococcus spp. grown in the culture medium were also tested for LAMP and microarray platforms. The results were compared to DNA sequencing of the same genetic regions. A total of 133 CSF samples were studied. Eleven CSFs were positive for Cryptococcus (9 C. neoformans and 2 C. gattii), 15 were positive for bacteria, and 107 were negative. The CAP59 platform correctly identified 73% of the CSF samples, while the ITS platform identified 45.5%. CAP59 platform correctly identified 100% of the Cryptococcus isolates, and ITS platform identified 70%. The two sets of LAMP primers correctly identified 100% of the Cryptococcus isolates. However, for CSF samples, the amplification occurred only in 55.5% of C. neoformans. The methodologies were reliable in the identification of Cryptococcus species, mainly for isolates from culture medium, and they might be applied as adjunctive tests to identify Cryptococcus species.


Subject(s)
Humans , Meningitis, Cryptococcal/diagnosis , Cryptococcus neoformans/genetics , Sequence Analysis, DNA , Oligonucleotide Array Sequence Analysis , Nucleic Acid Amplification Techniques
2.
Mem. Inst. Oswaldo Cruz ; 113(7): e180050, 2018.
Article in English | LILACS | ID: biblio-894943

ABSTRACT

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.


Subject(s)
Humans , Meningitis, Cryptococcal/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Cryptococcosis/drug therapy , Immunologic Tests , Drug Therapy, Combination
3.
Rev. chil. infectol ; 35(6): 716-721, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-990857

ABSTRACT

Resumen La criptococosis es una enfermedad fúngica de distribución global con una mayor incidencia en países en vía de desarrollo, donde constituye una de las principales causas de meningitis, asociado a una alta morbi-mortalidad. Afecta principalmente a pacientes con inmunosupresión (por infección por VIH, tratamiento con glucocorticoides, sometidos a trasplantes, cáncer, etc). Sin embargo, en los últimos años se ha presentado un incremento de casos en inmunocompetentes, siendo tanto o más grave que en inmunocomprometidos. Presentamos dos casos de meningitis criptocóccica. Un varón de 48 años, en quien se descartó una infección por VIH u otra causa de inmunosupresión y una mujer de 67 años con antecedentes de cirrosis hepática. Debe considerarse Cryptococcus spp. como posible agente causal de meningitis, tanto en pacientes inmunocomprometidos como inmunocompetentes.


Cryptococcosis is a fungal disease of global distribution with a higher incidence in developing countries, where it represents one of the main causes of meningitis, associated with high morbidity and mortality. It mainly occurs in patients with immunosuppression (due to HIV infection, glucocorticoid treatment, transplants, cancer, etc.). However, in recent years there has been an increase in cases in immunocompetent, which is as serious or more severe than in immunocompromised. We report two cases of cryptococcal meningitis. A 48-year-old male with no pathological history, in whom HIV infection or another cause of immunosuppression was ruled out, and a 67-year-old woman with a previous diagnosis of liver cirrhosis. The above mentioned highlights the importance of always considering Cryptococcus spp. as possible causative agent of meningitis, in both immunocompromised and immunocompetent patients.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Meningitis, Cryptococcal/diagnosis , Cryptococcus neoformans/genetics , Tomography, X-Ray Computed , Polymerase Chain Reaction , Immunocompromised Host
4.
Med. Afr. noire (En ligne) ; 63(7): 397-400, 2016.
Article in French | AIM | ID: biblio-1266200

ABSTRACT

Introduction : La cryptococcose neuro-méningée est la plus commune des affections mortelles du Système Nerveux Central chez les patients immuno-déprimés en Afrique Subsaharienne. Il s'agit alors d'une véritable urgence diagnostique et thérapeutique, d'où la mise en œuvre des tests diagnostiques rapides et efficace. Le Crag-Test serum (Antigénémie cryptococcique) pourrait alors se révéler utile sur ces terrains particuliers en milieu rural africain. Observation : Nous rapportons deux cas de cryptococcose neuro-méningée chez deux patientes âgées respectivement de 48 et 38 ans au regard du terrain d'immuno-dépression acquis, la présence de levure encapsulée à l'examen du liquide cérébro-spinal à l'encre de Chine dans un cas et la positivité du Crag-test serum dans les deux cas. La présence d'emblée de facteurs de mauvais pronostic expliquaient l'issue fatale. Conclusion : Compte tenu de la gravité potentielle de cette affection, le Crag-test serum devrait être facilement accessible et disponible pour un diagnostic rapide et une prise en charge précoce et efficace afin de limiter la morbi-mortalité


Subject(s)
Gabon , Meningitis, Cryptococcal/diagnosis , Meningitis, Listeria , Rural Population
5.
Rev. Inst. Med. Trop. Säo Paulo ; 57(supl.19): 38-45, Sept. 2015. tab, graf
Article in English | LILACS, SESSP-IIERPROD, SES-SP | ID: lil-762056

ABSTRACT

SUMMARYAIDS-related cryptococcal meningitis continues to cause a substantial burden of death in low and middle income countries. The diagnostic use for detection of cryptococcal capsular polysaccharide antigen (CrAg) in serum and cerebrospinal fluid by latex agglutination test (CrAg-latex) or enzyme-linked immunoassay (EIA) has been available for over decades. Better diagnostics in asymptomatic and symptomatic phases of cryptococcosis are key components to reduce mortality. Recently, the cryptococcal antigen lateral flow assay (CrAg LFA) was included in the armamentarium for diagnosis. Unlike the other tests, the CrAg LFA is a dipstick immunochromatographic assay, in a format similar to the home pregnancy test, and requires little or no lab infrastructure. This test meets all of the World Health Organization ASSURED criteria (Affordable, Sensitive, Specific, User friendly, Rapid/robust, Equipment-free, and Delivered). CrAg LFA in serum, plasma, whole blood, or cerebrospinal fluid is useful for the diagnosis of disease caused by Cryptococcusspecies. The CrAg LFA has better analytical sensitivity for C. gattii than CrAg-latex or EIA. Prevention of cryptococcal disease is new application of CrAg LFA via screening of blood for subclinical infection in asymptomatic HIV-infected persons with CD4 counts < 100 cells/mL who are not receiving effective antiretroviral therapy. CrAg screening of leftover plasma specimens after CD4 testing can identify persons with asymptomatic infection who urgently require pre-emptive fluconazole, who will otherwise progress to symptomatic infection and/or die.


RESUMOA meningite criptocócica continua causando um substancial índice de óbitos em pacientes infectados por HIV em países de baixa e média renda. Ferramentas diagnósticas para detecção do antígeno capsular polissacarídico criptocócico (CrAg) em soro e líquor tais como o teste de aglutinação de látex (latex-CrAg) ou o imunoensaio (EIE) têm sido utilizadas por muitos anos. Técnicas diagnósticas mais aprimoradas seriam cruciais nas fases assintomática e sintomática da criptococose para reduzir a mortalidade. Recentemente, o ensaio de fluxo lateral para detecção do antígeno criptocócico (LFA CrAg) foi incluído no arsenal diagnóstico. Contrariamente aos outros testes, LFA CrAg é um ensaio imunocromatográfico em formato similar ao teste de gravidez, e requer pouca ou nenhuma infraestrutura laboratorial. Este teste preenche os critérios ASSURED (Affordable, Sensitive,Specific, User friendly,Rapid/ robust,Equipment-free,Delivered) da Organização Mundial da Saúde e pode ser utilizado em soro, plasma, sangue total ou líquor para o diagnóstico da criptococose. LFA CrAg tem melhor sensibilidade analítica para o C. gattii que o teste de látex-CrAg ou EIE. A prevenção da doença criptocócica constituiria uma nova aplicação do LFA CrAg, mediante a triagem de amostras de sangue para a identificação de infecção sub-clínica em pacientes infectados pelo HIV que não apresentam sintomas, possuem contagem de CD4 < 100 células/mL e não recebem terapia antirretroviral eficaz. A triagem de CrgA em amostras de plasma remanescente da contagem de CD4 pode identificar pacientes com infecção assintomática que precisam urgentemente de tratamento preemptivo com fluconazol, evitando assim a progressão para doença sintomática e/ou óbito.


Subject(s)
Humans , AIDS-Related Opportunistic Infections/diagnosis , Antigens, Fungal/immunology , Cryptococcus/immunology , Meningitis, Cryptococcal/diagnosis , AIDS-Related Opportunistic Infections/blood , AIDS-Related Opportunistic Infections/mortality , Antigens, Fungal/blood , Chromatography, Affinity , Meningitis, Cryptococcal/blood , Meningitis, Cryptococcal/mortality , Point-of-Care Systems , Sensitivity and Specificity
6.
Braz. j. infect. dis ; 19(1): 62-67, Jan-Feb/2015. tab, graf
Article in English | LILACS | ID: lil-741236

ABSTRACT

Aim: This study evaluated the use of polymerase chain reaction for cryptococcal meningitis diagnosis in clinical samples. Materials and methods: The sensitivity and specificity of the methodology were evaluated using eight Cryptococcus neoformans/C. gattii species complex reference strains and 165 cere- brospinal fluid samples from patients with neurological diseases divided into two groups: 96 patients with cryptococcal meningitis and AIDS; and 69 patients with other neurological opportunistic diseases (CRL/AIDS). Two primer sets were tested (CN4-CN5 and the multiplex CNa70S-CNa70A/CNb49S-CNb-49A that amplify a specific product for C. neoformans and another for C. gattii). Results: CN4-CN5 primer set was positive in all Cryptococcus standard strains and in 94.8% in DNA samples from cryptococcal meningitis and AIDS group. With the multiplex, no 448-bp product of C. gattii was observed in the clinical samples of either group. The 695 bp products of C. neoformans were observed only in 64.6% of the cryptococcal meningitis and AIDS group. This primer set was negative for two standard strains. The specificity based on the negative samples from the CTL/AIDS group was 98.5% in both primer sets. Conclusions: These data suggest that the CN4/CN5 primer set was highly sensitive for the identification of C. neoformans/C. gattii species complex in cerebrospinal fluid samples from patients with clinical suspicion of cryptococcal meningitis. .


Subject(s)
Humans , Cryptococcus gattii/genetics , Cryptococcus neoformans/genetics , DNA, Fungal/cerebrospinal fluid , Meningitis, Cryptococcal/diagnosis , AIDS-Related Opportunistic Infections/cerebrospinal fluid , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/microbiology , Cryptococcus gattii/isolation & purification , Cryptococcus neoformans/isolation & purification , DNA Primers/genetics , Genotype , Meningitis, Cryptococcal/cerebrospinal fluid , Meningitis, Cryptococcal/microbiology , Polymerase Chain Reaction , Sensitivity and Specificity
7.
Arq. bras. neurocir ; 34(1): 73-78, 2015. ilus
Article in Portuguese | LILACS | ID: biblio-1029

ABSTRACT

Acriptococose é a principalmicosequeatingeosistemanervosocentral, sendode distribuição mundial, mais prevalente em países em desenvolvimento. Atualmente, são descritas duas subespécies: Cryptococcus neoformans neoformans, associado à imunossupressão, e Cryptococcus neoformans gattii, em pacientes imunocompetentes. A criptococose do sistema nervoso central parenquimatosa em sua forma granulomatosa, ou criptococoma, é extremamente rara, sendo mais frequente a forma meningítica ou meningoencefalítica. Relatamos o caso de um paciente de 35 anos, não portador da síndrome de imunodeficiência adquirida e imunocompetente, com manifestações clínicas iniciais de cefaleia crônica, hemiparesia progressiva, confusão mental aguda e primeiro episódio de crise convulsiva tônico-clônica generalizada. Hipóteses diagnósticas préoperatórias de neoplasia maligna ou abscesso cerebral. Realizado procedimento cirúrgico, remoção completa da lesão maior, diminuindo o efeito de massa. A lesão foi diagnosticada, através de exame anatomopatológico, como criptococoma, o que torna o caso extremamente raro pelo tamanho da lesão e por ser o paciente imunocompetente. Houve melhora completa do déficit neurológico. O paciente encontra-se em seguimento clínico e tratamento medicamentoso com anfotericina-B.


Cryptococcosis is the main mycosis affecting the central nervous system, with worldwide distribution and higher prevalence in developing countries. Currently, two subspecies are described: Cryptococcus neoformans neoformans (associated with immunosuppression) and Cryptococcus neoformans gattii (in immunocompetent patients). Cryptococcosis of the central nervous system as a parenchymal granuloma or cryptococcoma is extremely rare, contrasting to themuchmore frequentmeningitic form. We report a 35 year-old immunocompetent patient with chronic headache, progressive hemiparesis, acute confusion and first episode of tonic-clonic seizures. Preoperative diagnostic hypotheses were malignancy or abscess. A large mass (5.5 cm) was surgically removed from the right parietal lobe relieving the mass effect. This was later diagnosed by pathological examination as cryptococcoma, an extremely rare case in view of lesion size and its occurrence in an immunocompetent subject. The patient evolved with complete resolution of the neurological deficit and is on amphotericin-B treatment.


Subject(s)
Humans , Male , Adult , Cryptococcus neoformans , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/surgery
8.
Mem. Inst. Oswaldo Cruz ; 109(6): 797-804, 09/09/2014. tab, graf
Article in English | LILACS | ID: lil-723985

ABSTRACT

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.


Subject(s)
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
9.
Rev. Soc. Bras. Med. Trop ; 47(2): 254-256, Mar-Apr/2014. graf
Article in English | LILACS | ID: lil-710359

ABSTRACT

Cryptococcus spp. cerebral abscesses are uncommon in immunocompetent subjects. The recommended induction treatment is the administration of amphotericin B plus flucytosine combined with resection for lesions ≥3cm. In this paper, we describe an HIV-negative woman diagnosed with a large cryptococcoma in the immediate postpartum period. The lesion was not resected, and due to amphotericin B intolerance, she received an extended course of fluconazole monotherapy. There was no disease recurrence during the 4 years of follow-up. The abrupt onset of her symptoms following delivery suggests that she developed a postpartum immune reconstitution syndrome. This case also demonstrates that in specific situations fluconazole monotherapy can be attempted in immunocompetent patients with cryptococcoma.


Subject(s)
Adult , Female , Humans , Antifungal Agents/therapeutic use , Fluconazole/therapeutic use , Meningitis, Cryptococcal/drug therapy , Puerperal Infection/drug therapy , Magnetic Resonance Imaging , Meningitis, Cryptococcal/diagnosis , Puerperal Infection/diagnosis
10.
Rev. cuba. med ; 52(4): 242-253, oct-dic. 2013.
Article in Spanish | LILACS | ID: lil-695024

ABSTRACT

Introducción: las enfermedades oportunistas, y dentro de ellas la meningitis criptocóccica en pacientes inmunodeprimidos, constituyen causa mayor de letalidad en países en vías de desarrollo. Objetivo: identificar factores de mal pronóstico como la acelularidad del líquido cefalorraquídeo (LCR) para individualizar medidas terapéuticas encaminadas al logro de una mayor supervivencia y calidad de vida de estos pacientes. Métodos: se estudió la celularidad de todos los LCR de los 170 casos de Bojanala, North West, ingresados en el Hospital Provincial de Rustenburg, South África por meningitis criptocóccica desde mayo de 2001 hasta abril de 2004. Se interrelacionó el número de células blancas del LCR con la letalidad intrahospitalaria, seropositividad al virus de inmunodeficiencia humana (VIH) y nivel de linfocitos T4. Resultados: se detectó una asociación altamente significativa entre acelularidad basal del LCR y riesgo a morir, y significativa con progresión lineal de mayor mortalidad en los casos con descenso evolutivo del número de células blancas en sucesivos LCR. Se constató un alto índice de letalidad (36,5 por ciento)por meningitis criptocóccica. No hubo diferencias significativas entre acelularidad y letalidad en pruebas de comparación de grupos acorde al nivel de linfocitos T4 y a la confirmación o no de la seropositividad al VIH. Conclusiones: tanto la acelularidad basal como la progresión descendente evolutiva del número de células blancas del LCR constituyen herramientas útiles para la predicción del riesgo a morir por meningitis criptocóccica


Introduction: opportunistic diseases, and among them, cryptococcal meningitis in immune-compromised patients, are a major cause of lethality in developing countries Objective: to identify mal prognostic factors such as acellularity of cerebrospinal fluid (CSF) to identify therapeutic measures aimed to achieve improved survival and quality of life of these patients. Methods: cellularity was studied in all CSF of the 170 cases in Bojanala, North West, who were admitted to the Rustenburg Provincial Hospital, South Africa for cryptococcal meningitis from May 2001 to April 2004. The number of CSF white cell with hospital mortality, seropositive human immunodeficiency virus (HIV) and level of T4 lymphocytes were interrelated. Results: a highly significant association was found between baseline CSF acellularity and risk of death, and significant linear progression of increased mortality in patients with developmental decline in the number of white cells in successive CSF. A high fatality rate (36.5 percent) for cryptococcal meningitis was also found. No significant differences was found between acellularity and lethality tests comparing groups according to the level of T4 lymphocytes and the confirmation or otherwise of HIV seropositivity. Conclusions: both basal acellularity and evolutionary downward progression of the number of CSF white cells are useful tools for predicting the risk of death for cryptococcal meningitis


Subject(s)
Humans , Male , Female , Cerebrospinal Fluid , Meningitis, Cryptococcal/complications , Meningitis, Cryptococcal/diagnosis , Prognosis
11.
Article in English | IMSEAR | ID: sea-156367

ABSTRACT

Cryptococcosis is a common opportunistic systemic disease in immunocompromised patients. Pulmonary or brain cryptococcosis is the most common clinical presentation. Immunocompetent patients can also be affected, especially in tropical and subtropical zones where the life cycle of the causal agent, Cryptococcus gattii, is completed. We present a previously healthy man with progressive intracranial hypertension and a right paraventricular mass on CT scan and MRI. Cryptococcus gattii yeasts were isolated from the cerebrospinal fluid. A ventriculoperitoneal shunt was placed and the patient was treated with amphotericin B, fluconazole and dexamethasone. The patient died due to severe intracranial hypertension.


Subject(s)
Adult , Cryptococcus gattii , Fatal Outcome , Humans , Immunocompetence , Intracranial Hypertension/microbiology , Intracranial Hypertension/surgery , Magnetic Resonance Imaging , Male , Meningitis, Cryptococcal/complications , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/drug therapy , Tomography, X-Ray Computed , Ventriculoperitoneal Shunt
12.
Rev. chil. infectol ; 29(5): 554-557, oct. 2012. ilus
Article in Spanish | LILACS | ID: lil-660031

ABSTRACT

Three cases of meningitis due to criptococcus in children infected with HIV are reported. All patients had severe immunodeficiency. The first case occurred before antiretroviral therapy. The second case had poor adherence to treatment. The third case is a teenager with prolonged fever, who did not have a clear source of transmission of HIV and was immunodeficient at the time of diagnosis. Examination of cerebrospinal fluid with India ink dye was essential for making the diagnosis in all three cases. The disease course was adequate in all three patients despite flucytosine not being available.


Se presentan tres casos de meningitis por Cryptococcus sp. en niños infectados con VIH e inmunodeficiencia grave. El primero fue en la época en que no se disponía de TAR. El segundo fue un paciente no adherente al tratamiento. La tercera fue una adolescente en la que se hizo diagnóstico por una enfermedad febril prolongada, donde no fue posible encontrar la fuente de transmisión de VIH y que en el momento del diagnóstico estaba con inmunosupresión grave. En los tres fue fundamental para el diagnóstico rápido la tinción de LCR con tinta china. La evolución de la enfermedad fue adecuada en los tres pacientes aunque no se contó en ninguno de los casos con flucitosina.


Subject(s)
Adolescent , Child , Female , Humans , Male , AIDS-Related Opportunistic Infections/diagnosis , Cryptococcus neoformans , Meningitis, Cryptococcal/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Meningitis, Cryptococcal/drug therapy
16.
Yonsei Medical Journal ; : 482-487, 2011.
Article in English | WPRIM | ID: wpr-95670

ABSTRACT

PURPOSE: Cryptococcal meningitis is a relatively common opportunistic infection in human immunodeficiency virus (HIV) patients and it can frequently occur in immunocompetent hosts without any apparent underlying disease. Nevertheless, little is known about cyptococcal meningitis in the Korean population. The purpose of this study was to evaluate the clinical features and initial laboratory findings of cryptococcal meningitis in patients with and without HIV at a tertiary care teaching hospital. MATERIALS AND METHODS: We performed a retrospective study at a tertiary care teaching hospital from January 2001 to December 2009. Eleven HIV positive patients and nine HIV negative patients were included. RESULTS: The most common symptoms were headache and fever in cryptococcal meningitis, and diabetic mellitus, end stage renal disease and liver cirrhosis were the main associated conditions in patients without HIV. Patients with HIV showed lower peripheral CD4+ cell counts (median: 9, range: 1-107) and a higher burden of cryptococcus than patients without HIV. There were no statistically significant differences in serum CRP level and other cerebrospinal fluid parameters between patients with HIV and without HIV. The in-hospital mortality was 10%, and recurrence of cyptococcal meningitis was observed in 3 patients with HIV and this occurred within 5 months of the first episode. CONCLUSION: Cryptococcal meningitis is fatal without treatment, therefore, rapid recognition of symptoms such as fever and headache and diagnosis is required to decrease the mortality. Recurrence of meningitis after treatment should carefully be followed up, especially in advanced HIV patients.


Subject(s)
Adult , Aged , Comorbidity , Female , HIV Infections/complications , Hospitals , Humans , Male , Meningitis, Cryptococcal/diagnosis , Middle Aged , Republic of Korea/epidemiology , Retrospective Studies
17.
Rev. Soc. Bras. Med. Trop ; 43(6): 746-748, Nov.-Dec. 2010. ilus
Article in English | LILACS | ID: lil-569450

ABSTRACT

Cryptococcus gattii causes meningoencephalitis in immunocompetent hosts, occurring endemically in some tropical and subtropical regions. Recently, this fungus was involved in an outbreak in Vancouver Island and British Columbia (Canada). In this temperate region, the VGII type is predominant. The paper describes an autochthonous case of meningoencephalitis by C. gattii VGII in a previously health child in Rio de Janeiro, considered nonendemic region of Brazil. The fungus was identified by biochemical tests and the molecular type was determined by URA5-RFLP. The present report highlights the need for clinical vigilance for primary cryptococcal meningitis in nonendemic areas.


Cryptococcus gattii é causa de meningoencefalite em hospedeiros imunocompetentes, ocorrendo endemicamente em regiões tropicais e subtropicais. Recentemente foi causador de surtos na Ilha de Vancouver e na Columbia Britânica (Canadá). Nesta região de clima temperado, o tipo VGII é predominante. Relatamos um caso de meningoencefalite pelo C.gattii tipo VGII acometendo criança previamente saudável autóctone do Rio de Janeiro, região não endêmica do Brasil. O agente foi identificado por testes bioquímicos e o tipo molecular determinado através de URA5-RFLP. O presente relato enfatiza a necessidade de vigilância clínica para a meningite criptocóccica primária em áreas não endêmicas.


Subject(s)
Child, Preschool , Humans , Male , Cryptococcus gattii/genetics , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/microbiology , Polymorphism, Restriction Fragment Length
18.
Rev. chil. infectol ; 27(2): 155-159, abr. 2010. tab
Article in Spanish | LILACS | ID: lil-548132

ABSTRACT

Cryptococcal meningitis is an uncommon but well-known and frequently fatal complication of systemic lupus erythematosus (SLE). The clinical manifestations are unspecific and frequently are confused with lupus activity. A patient with cryptococcal meningitis and SLE, who responded well to amphotericin deoxycolate therapy, is reported. In a review through MEDLINE of the Spanish and English literature, 57 cases of SLE and cryptococcal meningitis were found. Simultaneous presentation of both diseases has been reported in only three cases. This temporal coexistence suggests that specific underlying immune defects associated with SLE directly predisposes to mycotic infections.


La meningitis por Cryptococcu neoformans es una inusual pero reconocida fatal complicación en los pacientes con lupus eritematoso sistémico (LES). Se presenta con un cuadro clínico inespecífico y frecuentemente se confunde con la actividad lúpica. Se reporta un caso de un paciente diagnosticado con meningitis por C. neoformans, al comienzo de LES, que fue tratada satisfactoriamente con anfotericina B deoxicolato. En la revisión de la literatura en español e inglés a través de MEDLINE, se encontró que han sido reportados 57 casos de pacientes con LES y criptococosis meníngea, de los cuales hay solamente 3 casos cuya infección se presentó simultáneamente con el LES. La presentación simultánea de criptococosis meníngea y LES enfatiza la posibilidad de que defectos inmunológicos intrínsecos en pacientes con LES sean los directamente responsables de la predisposición a adquirir infecciones micóticas.


Subject(s)
Adolescent , Female , Humans , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Cryptococcus neoformans/isolation & purification , Lupus Erythematosus, Systemic/complications , Meningitis, Cryptococcal/complications , Immunocompromised Host , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/drug therapy
19.
Bol. micol ; 24: 89-94, dic. 2009. tab, graf
Article in Spanish | LILACS | ID: lil-585749

ABSTRACT

La anfotericina B es un antifúngico ampliamente usado en infecciones sistémicas por hongos levaduriformes y filamentosos, entre ellas las meningitis por Cryptococcus neoformans. Sus reacciones adversas pueden ser inmediatas o dosis y tiempo dependiente. En nuestro trabajo en el hospital C. van Buren de Valparaíso, se revisaron 27 fichas de pacientes que cumplieron con los criterios de inclusión (24 hombres y 3 mujeres). El principal síntoma de la meningitis por Crytococcus fue la cefalea (96,3 por ciento). En 25 casos hubo confirmación con tinta china y/o cultivo. Durante el tratamiento con anfotericina B la hipokalemia fue la reacción adversa que se presento con mayor frecuencia (83 por ciento) y la nefrotoxicidad en un 59,1 por ciento. La dosis acumulada administrada fue en promedio 525 mg, suspendiendo generalmente su administración cuando se lograba una mejoría clínica junto a esterilidad del LCR (tinta china y/o cultivo negativo). Un 33,3 por ciento de los pacientes con diagnostico de meningitis por C. neoformans falleció por distintas complicaciones.


Amphotericin B is a antifungal drug widely used in systemic infections by filamentous and levaduriform fungi, as in meningitis by Cryptococcus neoformans. Its adverse reactions can be immediate or dose and time dependent. In our paper, 27 patient files were reviewed in C. van Buren hospital of Valparaíso and all of them met the criteria for inclusion (24 men and 3 women). In 96.3 percent of cases, headaches were the main symptom of meningitis caused by Cryptococcus. Twenty five cases were confirmed by the use of chinese ink and/or by culture. During the treatment with amphotericin B, the most frequent changes were hypokalemia (83 percent) and nefrotoxicity in 59.1 percent. The average of cumulative dose administered was 525 mg and was suspended when a clinical recovery was achieved next to a sterile cefalorraquid liquid (negative to chinese ink and/or culture). 33.3 percent of the patients diagnosed with meningitis by C. neoformans died due to different complications.


Subject(s)
Humans , Male , Female , Amphotericin B/administration & dosage , Amphotericin B/adverse effects , Amphotericin B/history , Amphotericin B/toxicity , Amphotericin B/therapeutic use , HIV Infections , Meningitis, Cryptococcal/complications , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/history , Meningitis, Cryptococcal/therapy , Chile
20.
Rev. Inst. Med. Trop. Säo Paulo ; 51(5): 289-294, Sept.-Oct. 2009. tab
Article in English | LILACS | ID: lil-530136

ABSTRACT

INTRODUCTION: Cryptococcosis has become an important entity due to the epidemic of AIDS and therefore it is a significant opportunistic infection. However, there are case reports of cryptococcal meningitis in immune competent pregnant women. Since pregnancy is considered a period of relative immunosuppression, which likely prevents fetal rejection, this could explain the occurrence of opportunistic infections. OBJECTIVE: To report a case of cryptococcosis, and review all cases involving pregnancy and neurocryptococcal infection in immune competent pregnant patients. METHODS: Case report and systematic review of the literature using the MEDLINE and SciELO databases. DISCUSSION: A total of 27 patients were analyzed from 19 studies. The mean age at diagnosis was 26.4 years. There were six patients in their first trimester of pregnancy, 10 in the second, eight in the third and three post-partum. The most prevalent symptoms were headache (85.2 percent), altered vision (44.4 percent), altered mental status (44.4 percent), nausea (40.7 percent) and fever (33.3 percent). There were nine deaths (33.3 percent). Most of the patients received intravenous amphotericin B as treatment (77.8 percent). The majority (66.6 percent) of the patients accomplished a term delivery with healthy infants. CONCLUSION: Cryptococcal meningitis should be considered during pregnancy in cases of unexplained headache, altered vision, altered mental status, nausea and fever. Patients with a confirmed diagnosis should be admitted and treated with amphotericin B.


INTRODUÇÃO: Com a epidemia da AIDS, a neurocriptococose foi melhor estudada e considerada infecção fúngica oportunista. No entanto, há casos descritos de gestantes acometidas, apesar de imunocompetentes. A gestação, por si só, pode ser considerada um período de imunossupressão, para adaptação materno-fetal, o que poderia predispor à instalação de certas infecções. OBJETIVOS: Relato de caso de gestante com neurocriptococose e revisão sistemática dos casos descritos na literatura desta patologia durante a gestação, em pacientes imunocompetentes. METODOLOGIA: Revisão sistemática com busca MEDLINE e SciELO. RESULTADOS: Foram analisadas 27 pacientes com diagnóstico de neurocriptococse na gestação. A média de idade foi 26,4 anos. Seis pacientes estavam no primeiro trimestre de gravidez ao diagnóstico, 10 no segundo, oito no terceiro e três eram puérperas. O sintoma mais prevalente foi cefaléia (85,2 por cento), seguido por alteração visual (44,4 por cento), confusão mental (44,4 por cento), náusea (40,7 por cento) e febre (33 por cento). Houve nove óbitos maternos (33,3 por cento). Vinte e uma pacientes foram tratadas com anfotericina B (77,8 por cento). A maioria dos casos evoluiu com gestação a termo, com recém-nascidos saudáveis (66,6 por cento). CONCLUSÕES: Neurocriptococose deve ser um diagnóstico a se considerar na gestação, nos casos de cefaléia, alteração visual, confusão mental, náusea e febre persistentes, sendo indicada terapia intensiva e uso de anfotericina B.


Subject(s)
Adult , Female , Humans , Pregnancy , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Cryptococcus neoformans/isolation & purification , Immunocompetence , Meningitis, Cryptococcal/diagnosis , Pregnancy Complications, Infectious/diagnosis , HIV Seronegativity , Meningitis, Cryptococcal/drug therapy , Pregnancy Complications, Infectious/drug therapy
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