Metta H A, Corti M E, Negroni R, Helou S, Arechavala A, Soto I, Villafañe M F, Muzzio E, Castello T, Esquivel P, Trione N
Unidad 10 y Unidad de Micología, Hospital de Infecciosas F.J. Muñiz, Buenos Aires, Argentina.
Rev Argent Microbiol. 2002 Jul-Sep;34(3):117-23.
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.
在HIV感染的背景下，隐球菌性脑膜炎是最常见的威胁患者生命的真菌病。我们进行了一项回顾性评估，以确定51例住院的HIV血清阳性患者播散性隐球菌病的流行病学、微生物学、免疫学和临床特征。所有个体（n = 51）HIV血清学反应呈阳性（ELISA和/或Western印迹法），且在机会性感染之前均未接受严格的高效抗逆转录病毒治疗（HAART）。CD4 + T淋巴细胞计数显示水平在361至0个细胞/微升之间（平均 = 45）。除1例患者外，所有患者的计数均低于100个细胞/微升。35例患者（68.6%）的隐球菌病表现为单发，16例（31.3%）为复发。在所有患者中，我们均检测到中枢神经系统受累。诱导治疗采用两性霉素B（AMB），随后用氟康唑进行维持治疗。致死率为36.7%，复发患者（40%）略高于首次发生真菌病的患者（35.2%）。在有数据可查的个体中，65.2%的血培养、94.1%的脑脊液培养以及79.06%的脑脊液墨汁显微镜检查呈阳性。脑脊液中新隐球菌荚膜抗原滴度≥1/1000的患者占36.1%，血清样本中≥1/1000的患者占73.6%。总之，在未接受HAART治疗的患者中，播散性隐球菌病的表现和严重程度仍保持着五年前的特征。该队列的所有患者均存在神经受累。治疗无法改变先前报道中的死亡率参数。本研究中应用的诊断方法与文献中的方法一致。
