BRAIN ABSCESS DUE TO Staphylococcus aureus OF CRYPTOGENIC SOURCE IN AN HIV-1 INFECTED PATIENT IN USE OF ANTIRETROVIRAL THERAPY.

The spectrum of neurological complications associated with human immunodeficiency virus type 1 (HIV-1) infection is broad. The most frequent etiologies include primary diseases (caused by HIV itself) or secondary diseases (opportunistic infections or neoplasms). Despite these conditions, HIV-infected patients are susceptible to other infections observed in patients without HIV infection. Here we report a rare case of a brain abscess caused by Staphylococcus aureus in an HIV-infected patient. After drainage of the abscess and treatment with oxacilin, the patient had a favorable outcome. This case reinforces the importance of a timely neurosurgical procedure that supported adequate management of an unusual cause of expansive brain lesions in HIV-1 infected patients.

Brain abscess due to staphylococcus aureus of cryptogenic source in an HIV-1 infected patient in use of antiretroviral therapy

The spectrum of neurological complications associated with human immunodeficiency virus type 1 (HIV-1) infection is broad. The most frequent etiologies include primary diseases (caused by HIV itself) or secondary diseases (opportunistic infections or neoplasms). Despite these conditions, HIV-infected patients are susceptible to other infections observed in patients without HIV infection. Here we report a rare case of a brain abscess caused by Staphylococcus aureus in an HIV-infected patient. After drainage of the abscess and treatment with oxacilin, the patient had a favorable outcome. This case reinforces the importance of a timely neurosurgical procedure that supported adequate management of an unusual cause of expansive brain lesions in HIV-1 infected patients

Report of filamentous forms in a mating type VNI clinical sequential isolates of Cryptococcus neoformans from an HIV virus-infected patient

We reported a cryptococcal meningitis Aids-patient infected with a mating type VNI isolate showing filamentous cells in direct examination of cerebrospinal fluid. Clinical data, outcome, treatment features and microbiological findings were discussed

Report of filamentous forms in a mating type VNI clinical sequential isolates of Cryptococcus neoformans from an HIV virus-infected patient.

We reported a cryptococcal meningitis Aids-patient infected with a mating type VNI isolate showing filamentous cells in direct examination of cerebrospinal fluid. Clinical data, outcome, treatment features and microbiological findings were discussed.

Susceptibility of clinical isolates of Cryptococcus neoformans to amphotericin B using time-kill methodology.

The in vitro activities of amphotericin B (AmB) were evaluated against 40 isolates of Cryptococcus neoformans using time-kill curves. The isolates were obtained from 20 AIDS patients with cryptococcal meningitis submitted to AmB therapy. Isolates were exposed in vitro to 1 microg/mL of AmB that represents a serum concentration of AmB, and the viable colony counts were determined over time. AmB exhibited fungicidal activity at 6 and 12 h for 70.6% of isolates, at 24 h for 7.3%, and at 48 h for 22% of isolates, respectively. This effect was not maximized when the test drug concentration was up to 4 times the AmB MIC for the isolates. Regrowth was observed in 17.5% of the isolates after fungicidal endpoint. With standard in vitro susceptibility testing, this tolerance phenomenon could not be assessed, and thus, these tests may underestimate the resistance of C. neoformans to AmB in vivo. AmB is the first-choice drug for the treatment of cryptococcosis in Brazil, and future studies using time-kill methodology are needed to estimate the predictive value of this test in the clinical failure.

Parâmetros farmacocinéticos e farmacodinâmicos da anfotericina B e fluconazol e sua contribuição no estudo da correlação clínico-laboratorial da criptococose de sistema nervoso central associada à Aids / Pharmacokinetic and pharmacodynamic patterns of amphotericin B and fluconazole and their contribution to the study of clinical and laboratorial correlation of cryptococosis of the central nervous system associated to Aids

A predição de falha clínica no tratamento da criptococose deveria se apoiar, entre outros parâmetros, na determinação da resistência antifúngica in vitro ao fluconazol (FCZ) e à anfotericina B (AMB). No entanto, o exame laboratorial mais usado em microbiologia, a concentração inibitória mínima(CIM), para cepas de Cryptococcus neoformans (Cn) não permite, ainda, fazer essa correlação. Outras ferramentas, in vitro, foram propostas para essa finalidade, entre elas : ação fungicida de AMB e análise da combinação de AMB e FCZ, além do estudo de aspectos farmacodinâmicos das drogas. Nesta pesquisa foi analisada a evolução clínico-laboratorial e a eficácia antifúngica de AMB e FCZ em 21 pacientes com aids e criptococose de sistema nervoso central(CSNC); 41 amostras de líquor(LCR) foram analisadas, e o agente isolado foi de uma única espécie: C.neoformans. O estudo das concentrações de FCZ e AMB em plasma e LCR, avaliada por cromatografia líquida de alta eficiência (HPLC) confirmou a presença de níveis esperados da droga; o contrário foi observado com AMB. Os testes de microdiluição (EUCAST e CLSI) identificaram amostras menos sensíveis a FCZ (CIM >16 μg/mL) isoladas de 4 (19,1%) pacientes. Em outros 4 casos, foi observado alternância do perfil de sensibilidade ao azol em amostras seriadas, caracterizando heterorresistência. O agente etiológico apresentou alta sensibilidade, tanto a FCZ (CIM<16μg/mL em 87,8% das amostras), quanto à AMB(CIM<2μg/mL em 100% das amostras). A análise da combinação de AMB e FCZ, in vitro, pelo teste do tabuleiro de xadrez mostrou indiferença para a maioria (32/41; 78%) e adição em 22% (9/41) dos isolados. Efeito fungicida de AMB, verificado por curvas de morte, ocorreu entre 6 e 48h para todas as 41 amostras, sendo a maioria deles (70%) inibida entre 6 e 12 h de exposição; este efeito foi independente da CIM para cada isolado. Os maiores valores, tanto...

Parâmetros farmacocinéticos e farmacodinâmicos da anfotericina B e fluconazol e sua contribuição no estudo da correlação clínico-laboratorial da criptococose de sistema nervoso central associada à Aids

A predição de falha clínica no tratamento da criptococose deveria se apoiar, entre outros parâmetros, na determinação da resistência antifúngica in vitro ao fluconazol (FCZ) e à anfotericina B (AMB). No entanto, o exame laboratorial mais usado em microbiologia, a concentração inibitória mínima(CIM), para cepas de Cryptococcus neoformans (Cn) não permite, ainda, fazer essa correlação. Outras ferramentas, in vitro, foram propostas para essa finalidade, entre elas : ação fungicida de AMB e análise da combinação de AMB e FCZ, além do estudo de aspectos farmacodinâmicos das drogas. Nesta pesquisa foi analisada a evolução clínico-laboratorial e a eficácia antifúngica de AMB e FCZ em 21 pacientes com aids e criptococose de sistema nervoso central(CSNC); 41 amostras de líquor(LCR) foram analisadas, e o agente isolado foi de uma única espécie: C.neoformans. O estudo das concentrações de FCZ e AMB em plasma e LCR, avaliada por cromatografia líquida de alta eficiência (HPLC) confirmou a presença de níveis esperados da droga; o contrário foi observado com AMB. Os testes de microdiluição (EUCAST e CLSI) identificaram amostras menos sensíveis a FCZ (CIM >16 μg/mL) isoladas de 4 (19,1%) pacientes. Em outros 4 casos, foi observado alternância do perfil de sensibilidade ao azol em amostras seriadas, caracterizando heterorresistência. O agente etiológico apresentou alta sensibilidade, tanto a FCZ (CIM<16μg/mL em 87,8% das amostras), quanto à AMB(CIM<2μg/mL em 100% das amostras). A análise da combinação de AMB e FCZ, in vitro, pelo teste do tabuleiro de xadrez mostrou indiferença para a maioria (32/41; 78%) e adição em 22% (9/41) dos isolados. Efeito fungicida de AMB, verificado por curvas de morte, ocorreu entre 6 e 48h para todas as 41 amostras, sendo a maioria deles (70%) inibida entre 6 e 12 h de exposição; este efeito foi independente da CIM para cada isolado. Os maiores valores, tanto...

Molecular diversity of serial Cryptococcus neoformans isolates from AIDS patients in the city of São Paulo, Brazil.

Despite highly active anti-retroviral therapy, cryptococcal meningoencephalitis is the second most prevalent neurological disease in Brazilian AIDS patients, being frequently a defining condition with several episodes. As knowledge of Cryptococcus neoformans isolates in the same episode is critical for understanding why some patients develop several episodes, we investigated the genotype characteristics of C. neoformans isolates in two different situations. By pulsed field gel electrophoresis and random amplified polymorphic DNA analysis, 54 isolates from 12 patients with AIDS and cryptococcosis were analyzed. Group 1 comprised 39 isolates from nine patients with a single episode and hospitalization. Group 2 comprised 15 isolates from three patients with two episodes and hospitalizations. Except for three patients from group 1 probably infected with a single C. neoformans isolate, the other nine patients probably were infected with multiple isolates selected in different collection periods, or the infecting isolate might have underwent mutation to adapt and survive the host immune system and/or the antifungal therapy. However, the three patients from group 2 presented genetic diversity among isolates collected in both hospitalizations, possibly having hosted the initial isolate in both periods. These data, emphasize that Cryptococcus diversity in infection can contribute to strategies of treatment and prevention of cryptococcosis.

Molecular diversity of serial Cryptococcus neoformans isolates from AIDS patients in the city of São Paulo, Brazil

Despite highly active anti-retroviral therapy, cryptococcal meningoencephalitis is the second most prevalent neurological disease in Brazilian AIDS patients, being frequently a defining condition with several episodes. As knowledge of Cryptococcus neoformans isolates in the same episode is critical for understanding why some patients develop several episodes, we investigated the genotype characteristics of C. neoformans isolates in two different situations. By pulsed field gel electrophoresis and random amplifield polymorphic DNA analysis, 54 isolates from 12 patients with AIDS and cryptococcosis were analyzed. Group 1 comprised 39 isolates from nine patients with a single episode and hospitalization. Group 2 comprised 15 isolates from three patients with two episodes and hospitalizations. Except for three patients from group 1 probably infected with a single C. neoformans isolate, the other nine patients probably were infected with multiple isolates selected in different collection periods, or the infecting isolate might have underwent mutation to adapt and survive the host immune system and/or the antifungal therapy. However, the three patients from group 2 presented genetic diversity among isolates collected in both hospitalizations, possibly having hosted the initial isolate in both periods. These data, emphasize that Cryptococcus diversity in infection can contribute to strategies of treatment and prevention of cryptococcosis.

AIDS-associated central nervous system cryptococcosis: a Brazilian case study.

In recent years the effect of HAART in patients with AIDS has been great at decreasing the incidence of opportunistic infections. Nonetheless, patients with AIDS living in developing countries still present with severe central nervous system cryptococcosis, with high mortality rates. The study of the clinical-epidemiological-laboratory aspects of the patients treated before the HAART era might be useful in an assessment of the impact of these drugs in the prognosis of cases.

Cryptococcus neoformans varieties isolated from patients with aids referred to a hospital of São Paulo city during 1996-1999

Cryptococcus neoformans é uma levedura capsulada que apresenta tropismo pelo sistema nervoso central causando meningoencefalite. É a micose mais freqüente em pacientes com AIDS, e é responsável pela alta morbidade e mortalidade. Há duas variedades: var. neoformans e var. gattii. C. neoformans var.neoformans está distribuído mundialmente e é comumente encontrado em fezes de aves, principalmente de pombo. C. neoformans var. gattii está geograficamente limitado a regiões tropicais e subtropicais e está associado a algumas espécies de árvores, principalmente, Eucalyptus sp. A proposta desse estudo foi de avaliar a prevalência das variedades de Cryptococcus neoformans isoladas de 452 amostras de líquido cefalorraquiano (LCR) provenientes de 183 pacientes com AIDS, internados no Instituto de Infectologia Emílio Ribas – São Paulo-SP, de 1996 a...

Cryptococcus neoformans is an encapsulated yeast that presents tropism for central nervous system, and causes meningoencephalitis. Cryptococcosis is the most frequent mycosis in patients with AIDS, and itis the cause of high morbidity and mortality. C. neoformans presents two varieties var. neoformans andvar. gattii. Cryptococcus neoformans var. neoformans has been world-wide isolated from avian feces, especially pigeon excreta. C. neoformans var. gattii is geographically restricted to tropical and subtropical regions, and it is associated with some trees species, mainly Eucalyptus sp. The proposal of this study was to evaluate the prevalence of Cryptococcus neoformans varieties isolated from 452 cerebrospinalfluid (CSF) samples from 183 patients with AIDS referred to the Instituto de Infectologia Emilio Ribas- São Paulo-SP, from 1996 to 1999. CSF samples were cultured on canavanine-glycine-bromothymolblue...

Cryptococcosis: a review of the brazilian experience for the disease

Cryptococcosis is a systemic mycosis caused by Cryptococcus neoformans. The disease occurs in patients with cellular immunodeficiency. The incidence of cryptococcosis arises with aids, and mycosis is one of the opportunistic infections that defines AIDS. After the HAART era the occurrence of cryptococcosis decreased all over the world, but it still continues to be a prevalent disease in Brazil. Thus, we consider this paper to be very important as a result of our reviewing of Brazilian literature regarding some relevant aspects of that disease.