[Cryptococcosis in hematology practice].

AIM: To study the clinical manifestations of cryptococcosis, its diagnostic features, and treatment results in patients with hemoblastoses. SUBJECTS AND METHODS: The study included adult patients with cryptococcosis treated at the Hematology Research Center (HRC) in 2005 to 2011. The diagnosis of cryptococcosis was established on the basis of isolation of Cryptococcus neoformans from a blood culture or determination of positive cryptococcal antigen in the cerebrospinal fluid (CSF) of patients with infection symptoms. RESULTS: During 7 years, 19 patients aged 19 to 68 years (median 47 years) were diagnosed as having cryptococcosis. In the pattern of cryptococcosis, there was a preponderance of patients with lymphoma (31%) and those with acute lymphoblastic leukemia (26%) at the stages of hemoblastosis remission induction (32%) and consolidation (26%). The diagnosis was made in 9 (47%) patients at the Intensive Care Department, HRC. The major risk factors of cryptococcosis were previous cytostatic drug exposure (68%), use of immunosuppressive and glucocorticoid drugs (63%), and granulocytopenia (42%). Seventeen (78%) patients were diagnosed with cryptococcal meningitis or meningoencephalitis; 1 patient had cryptococcal sepsis and 1 patient had possible cryptococcal pneumonia. All the patients were given antifungal agents. Amphotericin B, fluconazole, and a combination of antimycotics were used as first-line drugs in 16 (84%), 1 (5.5%), and 2 (10.5%), respectively. When their health became better, the patients were treated with voriconazole or fluconazole. Within 30 days after the diagnosis of cryptococcosis, 5 (26%) patients died; of them 2 had tumor progression concurrent with infection. CONCLUSION: In cryptococcosis, the central nervous system is predominantly involved in the infectious process. The determination of cryptococcal antigen in CSF is a necessary diagnostic component in meningitis and meningoencephalitis in patients with blood system tumors, lymphatic ones in particular. When cryptococcosis is timely diagnosed and treated, its mortality, when the tumor is controlled, is lower than that in other invasive mycoses.

[Hemostasis in influenza and acute respiratory viral infections in the middle-aged and elderly]. / Sostoianie gemostaza pri grippe i ostrykh respiratornykh virusnykh infektsiiakh v pozhilom i starcheskom vozraste.

Hemostasis was examined over time in 168 patients with influenza and ARVI. There were 53 elderly patients, 54 senile patients and 4 long-livers. 57 patients under 60 years made up a reference group. The patients with influenza did not differ significantly from those with ARVI as regards hemostasis. The elderly persons manifested pronounced acceleration of phases I-II blood coagulation. In the acute disease period, the old men demonstrated high platelet aggregation, whereas during convalescence, activation of the plasmic component of hemostasis in the presence of relatively low antithrombin III. Analysis was also made of the age-associated changes in hemostasis depending on influenza and ARVI complications (pneumonia, exacerbation of coronary disease, bronchitis). The changes revealed dictate the necessity of hemostasis control in elderly and senile persons afflicted with influenza and ARVI.