ABSTRACT
A total of 148 patients with a diagnosis of HIV infection were studied in order to evaluate the incidence of meningeal cryptococcosis, including epidemic, immunologic and diagnostic characteristics. The diagnosis of cryptococcosis was carried out by direct examination with India ink and culture in Sabouraud agar of CSF in 28 patients (93.3%) and by blood cultures (lysis-centrifugation) in 2 patients (6.6%). All the isolated strains were identified as Cryptococcus neoformans. The incidence was 20.3% (30 patients). The preponderant risk behavior was endovenous drug addiction, and it was observed in 18 patients (60%). The symptomatology that prevailed was headache (87%). The median age was 28 years. At diagnosis, the immunologic impairment was severe (CD4+ lymphocyte count < 200) in 90% of patients. We found that 86.7% of patients had not completed their primary studies and only 13.3% had completed secondary studies. Although the acute mortality was high (36.7%), it was observed that all the patients who survived (24%) had been treated with anti-retroviral drugs.
Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , Meningitis, Cryptococcal/epidemiology , AIDS-Related Opportunistic Infections/cerebrospinal fluid , AIDS-Related Opportunistic Infections/microbiology , Adult , Anti-HIV Agents/therapeutic use , Argentina/epidemiology , CD4 Lymphocyte Count , Female , HIV Infections/drug therapy , Humans , Incidence , Male , Meningitis, Cryptococcal/cerebrospinal fluid , Retrospective Studies , Risk Factors , Sex Distribution , Tuberculosis/epidemiologyABSTRACT
A total of 148 patients with a diagnosis of HIV infection were studied in order to evaluate the incidence of meningeal cryptococcosis, including epidemic, immunologic and diagnostic characteristics. The diagnosis of cryptococcosis was carried out by direct examination with India ink and culture in Sabouraud agar of CSF in 28 patients (93.3
) and by blood cultures (lysis-centrifugation) in 2 patients (6.6
). All the isolated strains were identified as Cryptococcus neoformans. The incidence was 20.3
(30 patients). The preponderant risk behavior was endovenous drug addiction, and it was observed in 18 patients (60
). The symptomatology that prevailed was headache (87
). The median age was 28 years. At diagnosis, the immunologic impairment was severe (CD4+ lymphocyte count < 200) in 90
of patients. We found that 86.7
of patients had not completed their primary studies and only 13.3
had completed secondary studies. Although the acute mortality was high (36.7
), it was observed that all the patients who survived (24
) had been treated with anti-retroviral drugs.
ABSTRACT
Se estudiaron 57 episodios febriles en 42 pacientes internados con el diagnóstico de leucemia aguda, y cifras iguales o menores de 1000 neutrófilos por milímetro cúbico. Las combinaciones antimicrobianas empíricas utilizadas más frecuentemente fueron Cefalotina + Amikacina y Cefuroxine + Mezlocilina; no pudimos establecer la superioridad terapéutica de ningún régimen sobre el otro. De los 57 episodios febriles, 37 cursaron desde el inicio con neutrófilos inferiores a 500/mm3. Los focos probables de infección fueron fundamentalmente el mucocutáneo y el pulmonar (49 y 31,5%, respectivamente). El foco abdominal se asoció a pronóstico severo. Hubo aislamientos microbiológicamente documentados en un 60%, con predominio de agentes Gram positivos con respecto a enterobacterias y Pseudomonas aeruginosa. La evolución de los procesos infecciosos mantuvo estrecha relación con la posibilidad de recuperación de la enfermedad de base
Subject(s)
Adult , Humans , Male , Female , Fever/etiology , Infections/complications , Leukemia/complications , Neutropenia/complications , Acute Disease , Argentina , Follow-Up Studies , Infections/drug therapyABSTRACT
Se estudiaron 57 episodios febriles en 42 pacientes internados con el diagnóstico de leucemia aguda, y cifras iguales o menores de 1000 neutrófilos por milímetro cúbico. Las combinaciones antimicrobianas empíricas utilizadas más frecuentemente fueron Cefalotina + Amikacina y Cefuroxine + Mezlocilina; no pudimos establecer la superioridad terapéutica de ningún régimen sobre el otro. De los 57 episodios febriles, 37 cursaron desde el inicio con neutrófilos inferiores a 500/mm3. Los focos probables de infección fueron fundamentalmente el mucocutáneo y el pulmonar (49 y 31,5%, respectivamente). El foco abdominal se asoció a pronóstico severo. Hubo aislamientos microbiológicamente documentados en un 60%, con predominio de agentes Gram positivos con respecto a enterobacterias y Pseudomonas aeruginosa. La evolución de los procesos infecciosos mantuvo estrecha relación con la posibilidad de recuperación de la enfermedad de base (AU)
