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

Criptococosis diseminada en pacientes con SIDA. Análisis clÝnico, microbiológico e inmunológico de 51 pacientes / Disseminated cryptococcosis in patients with AIDS. Clinical, microbiological, and immunological analysis of 51 patients

In the context of HIV infection, cryptococcal meningitis is the most common mycosis threatening the patient's life. We conducted a retrospective evaluation to determine the epidemiological, microbiological, immunological and clinical characteristics of disseminated cryptococcosis in 51 hospitalised HIV seropositive patients. All the individuals (n = 51) presented reactive serology for HIV (ELISA and/or Western blot) and none fulfilled strict HAART treatment, previous to the opportunistic infection. CD4+ lymphocyte T counts showed levels between 361 and 0 cells/microliter (mean = 45). All patients but one had counts lower than 100 cells/microliter. Cryptococcosis presented as unique episode in 35 patients (68.6) and in 16 as relapse (31.3). In all of them we detected central nervous system involvement. The induction treatment was carried out with amphotericin B (AMB), continued with maintenance therapy with fluconazole. Lethality rate was 36.7, slightly superior among patients in relapse (40) compared to those who presented a first episode of the mycosis (35.2). In those individuals for whom data were available, 65.2 of blood cultures, 94.1 of CSF cultures and 79.06 of microscopic CSF examination with India ink were positive. Titers of Cryptococcus neoformans capsular antigen in CSF > or = 1/1000 were found in 36.1 and > or = 1/1000 in 73.6 of serum samples. In conclusion, manifestations and severity of disseminated cryptococcosis continue maintaining the characteristics of half a decade behind, in those patients who are not treated with HAART. Neurological involvement existed in all patients of this cohort. Treatment is not able to modify the parameters of mortality seen in previous communications. Diagnostic methods applied in this study are in accordance with those in the bibliography.

Meningite criptocócica em pacientes imunocompetentes: relato de dois casos e revisäo da literatura / Cryptococcal meningitis in immunocompetent patients: report of two cases and literature review

A criptococose é uma doença sistêmica causada pelo fungo Cryptococcus neoformans, que acomete com mais freqüência os pulmões e o sistema nervoso central e, menos freqüentemente, a pele, o sistema esquelético e a próstata. Até a década de 80, antes do surgimento da AIDS, era relativamente rara. Apesar dela ocorrer com freqüência no hospedeiro imunodeprimido, cerca de um terço dos pacientes com a doença näo apresenta uma condiçäo de base, nem fatores predisponentes evidentes. Relatamos dois casos de pacientes imunocompetentes que apresentaram meningite criptocócica, enfatizando epidemiologia, etiopatogenia, clínica, diagnóstico e conduta terapêutica

Estudio comparativo mediante pruebas inmunológicas y micológicas para el diagnóstico de la criptococosis meníngea / Comparative study through immunologic and mycologic test for the diagnosis of meningeal cryptococosis

Se estudió un grupo de 24 pacientes con diagnóstico de criptococosis meníngea. Con el líquido cefalorraquídeo se realizaron métodos tradicionales de diagnóstico, como son cultivos en Sabouraud y tinción de tinta china, y se compararon con un medio de cultivo diferencial de alpiste negro (Guizotia abissinica) de producción casera, y tinción de resaltado capsular. De manera independientes se determinó y tituló antígeno criptococósico en líquido cefalorraquídeo mediante aglutinación con anticuerpos adheridos a látex (reactivo previamente preparado y estandarizado). Los resultados obtenidos se analizaron en base a la prueba de X² y no se encontraron diferencias estadísticamente significtivas entre los métodos tradicionales y los propuestos. El medio de alpiste funcionó como un método diferencial eficaz (95 por ciento). La tinción de resaltado capsular fue ligeramente superior a la tradicional, sin diferencia significativa. La cuantificación de antígeno criptococósico fue una prueba sumamente sensible (83.3 por ciento) sin que se puediera correlacionar clínicamente