Manfredi Roberto, Fulgaro Ciro, Sabbatani Sergio, Legnani Giorgio, Fasulo Gianni
Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna Alma Mater Studiorum, S. Orsola Hospital, Bologna, Italy.
AIDS Patient Care STDS. 2006 Apr;20(4):227-32. doi: 10.1089/apc.2006.20.227.
A unique occurrence of two subsequent episodes of HIV-associated Cryptococcus neoformans followed by C. laurentii meningoencephalitis (successfully cured with fluconazole after demonstrated amphotericin B resistance) is presented and discussed. The available literature reported only two cases of HIV-associated C. laurentii infection to date, while a concurrent infection by C. neoformans and C. laurentii has been reported only once in a patient without HIV disease. The absence of prior descriptions of documented central nervous system infection by C. laurentii in non-HIV-infected patients is emphasized as well as the unpredictable in vitro and in vivo antifungal susceptibility of this non-neoformans Cryptococcus spp., and its apparent prevalence in hospitalized patients who received prior antifungal treatments. All epidemiologic, diagnostic, clinical, and therapeutic implications are discussed on the basis of the evolving characteristics of opportunism in the era of highly active antiretroviral therapy (HAART).
本文报告并讨论了一例独特病例，患者先后出现两起与HIV相关的新型隐球菌感染，随后发生罗伦隐球菌脑膜脑炎（在证明对两性霉素B耐药后，氟康唑成功治愈）。迄今为止，现有文献仅报道了两例与HIV相关的罗伦隐球菌感染病例，而在一名无HIV疾病的患者中仅报告过一次新型隐球菌和罗伦隐球菌的合并感染。强调了在非HIV感染患者中既往无罗伦隐球菌中枢神经系统感染记录的描述，以及这种非新型隐球菌属真菌在体外和体内不可预测的抗真菌药敏性，及其在接受过先前抗真菌治疗的住院患者中的明显流行情况。基于高效抗逆转录病毒治疗（HAART）时代机会性感染不断演变的特征，讨论了所有流行病学、诊断、临床和治疗方面的影响。
