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)
Antifungal Agents/therapeutic use , Fluconazole/therapeutic use , Meningitis, Cryptococcal/drug therapy , Puerperal Infection/drug therapy , Adult , Female , Humans , Magnetic Resonance Imaging , Meningitis, Cryptococcal/diagnosis , Puerperal Infection/diagnosisABSTRACT
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/diagnosisABSTRACT
Chagas disease (CD) remains a major cause of stroke in developing countries, but cognitive repercussion of CD has not been well studied. OBJECTIVE: To compare the frequency and pattern of cognitive dysfunction in patients with CD cardiomyopathy (CDC) and other cardiomyopathies (OC). METHODS: We studied 37 patients with CDC and 42 patients with OC with similar age, educational level and cardiac systolic function. Cognitive tests were applied to both groups by a single examiner blinded to CD status. Logistic regression multivariable models were constructed to ascertain predictors of cognitive dysfunction for each test. RESULTS: Cognitive dysfunction was detected in 9 (24%) CDC patients and 6 (14%) OC patients by Mini Mental State Exam (MMSE) corrected for educational level. Independent predictors of abnormal MMSE (p<0.05) included stroke history (OR=5.51; 95% CI=1.27-24.01) and digoxin use (OR=0.23, 95% CI=0.06-0.89), while CD showed a trend toward statistical significance (OR=4.63; 95% CI=0.87-24.73, p=0.07). Delayed recall of Rey's Complex Figure Test was significantly worse in CD patients, where this remained a significant predictor in the multivariable analysis (OR=4.67; 95% CI=1.23-17.68). CONCLUSIONS: Cognitive dysfunction is frequent in Chagas disease and should be considered as an outcome measure in Chagas disease studies.
A doença de Chagas (DC) permanence uma causa importante de acidente vascular cerebral em países em desenvolvimento, mas a repercussão cognitiva dessa doença não tem sido bem estudada. OBJETIVO: Comparar a frequência e padrão de disfunção cognitiva em pacientes com cardiomiopatia associada à DC (CDC) em comparação com outras cardiomiopatias (OC). MÉTODOS: Foram estudados 37 pacientes com CDC e 42 portadores de OC com idade, nível de instrução e função sistólica cardíaca semelhantes. Testes cognitivos foram realizados em ambos os grupos por um único investigador cegado quanto ao diagnóstico de DC. Modelos de regressão logística multi-variável foram construídos para detectar preditores de disfunção cognitiva para cada teste. RESULTADOS: Disfunção cognitiva foi detectada em 9 (24%) pacientes com CDC e 6 (14%) com OC pelo Mini Exame do Estado Mental (MEEM) corrigido pelo nível de instrução. Preditores independentes de MEEM anormal (p<0,05) foram: história de AVC (OR=5,51; IC 95%=1,2724,01) e uso de digoxina (OR=0,23, IC 95%=0,060,89); DC mostrou tendência a significância estatística (OR=4,63; IC 95%=0,8724,73, p=0,07). Pacientes com CDC apresentaram pior desempenho na evocação tardia da figura complexa de Rey. Neste teste, a DC se manteve um preditor significante de disfunção cognitiva na análise multivariável (OR=4,67; IC 95%=1,2317,68). CONCLUSÕES: Disfunção cognitiva é frequente na doença de Chagas e deve ser considerada como desfecho quantificado nos estudos da doença de Chagas.
