Mazuelos Estrella Martín, García Ana Isabel Aller
Hospital Universitario de Valme, Sevilla, España.
Enferm Infecc Microbiol Clin. 2010 Jan;28 Suppl 1:40-5. doi: 10.1016/S0213-005X(10)70007-0.
Cryptococcosis is a mycoses that increased considerably with the AIDS epidemic. However, with the introduction in the late 90's of the highly active antiretroviral therapy (HAART), this incidence has significantly decreased, especially in developed countries, in contrast with that of developing countries. The introduction of HAART not only has affected the incidence rate, but also the clinical presentation as a consequence of the immune recovery of the host, leading to the description of the so called immune reconstitution inflammatory syndrome. In addition, some rare clinical manifestations of cyptococcosis are currently shown, such as lymphadenitis and cutaneous involvement. Besides clinical presentation, diagnostic tests have also changed, with a high percentage of cases with negative cerebrospinal fluid (CSF) and blood cultures, negative direct CSF microscopy, and delayed antigen positive results. Antifungal susceptibility patterns have also changed towards a recuperation of susceptibility, which is related to the decrease in both the incidence of cryptococcosis and less use of antifungal agents.
隐球菌病是一种随着艾滋病流行而显著增加的真菌病。然而，随着90年代末高效抗逆转录病毒疗法（HAART）的引入，这种发病率已显著下降，尤其是在发达国家，与发展中国家形成对比。HAART的引入不仅影响了发病率，还因宿主免疫恢复而影响了临床表现，从而导致了所谓的免疫重建炎症综合征的描述。此外，目前还出现了隐球菌病的一些罕见临床表现，如淋巴结炎和皮肤受累。除了临床表现，诊断测试也发生了变化，脑脊液（CSF）和血培养阴性、CSF直接显微镜检查阴性以及抗原阳性结果延迟的病例比例很高。抗真菌药敏模式也朝着药敏恢复的方向变化，这与隐球菌病发病率的下降和抗真菌药物使用减少有关。
