Department of Infectious Diseases. Universidade Federal do Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
Mycoses. 2011 Jul;54(4):e178-82. doi: 10.1111/j.1439-0507.2010.01870.x. Epub 2010 Mar 22.
Cryptococcosis is frequently associated to the immune reconstitution inflammatory syndrome (IRIS) in AIDS patients on highly active antiretroviral therapy (HAART). This study aimed to evaluate clinical and evolutive features of IRIS associated cryptococcosis patients in Uberaba, Brazil.
Eighty-one AIDS individuals admitted at the teaching hospital with cryptococcal meningitis were evaluated and from these, 40 were prospectively followed. Of 40 patients with cryptococcosis, nine (22.5%) presented clinical and laboratory features of IRIS. Six (66.6%) were male, with a mean age of 37.2. Five (55.5%) presented cryptococcosis as first AIDS defining condition. In seven (77.9%) IRIS was characterised as a relapse of meningeal symptoms after 10 weeks, mean time of 72 days, of starting HAART whereas, two asymptomatic patients developed the syndrome as an unmasked cryptococcosis after 10 and 12 weeks on HAART. Lymphadenitis as isolated finding associated with IRIS was evidenced in three cases. All patients presented low CD4(+) and high RNA viral load baseline values. Cultures of cerebrospinal fluid and lymph-node fragments tissues of these cases were negative. Six of nine individuals developed high intracranial pressure requiring a daily relief lumbar puncture. No deaths occurred during the evolution of these patients. The incidence and clinical evolutive profile observed in this case series are in accordance with other reports elsewhere.
在接受高效抗逆转录病毒治疗 (HAART) 的艾滋病患者中，隐球菌病常与免疫重建炎症综合征 (IRIS) 相关。本研究旨在评估巴西 Uberaba 地区与 IRIS 相关的隐球菌病患者的临床和演变特征。
81 名在教学医院因隐球菌性脑膜炎入院的艾滋病患者接受了评估，其中 40 名患者进行了前瞻性随访。在 40 名隐球菌病患者中，有 9 名 (22.5%) 出现了 IRIS 的临床和实验室特征。6 名患者为男性，平均年龄为 37.2 岁。5 名患者的隐球菌病是艾滋病的首发表现。7 例 (77.9%) 的 IRIS 表现为 HAART 开始后 10 周出现脑膜症状复发，中位时间为 72 天，而 2 例无症状患者在 HAART 开始后 10 周和 12 周时出现隐球菌病未被掩盖。在 3 例患者中，淋巴结炎是与 IRIS 相关的孤立发现。所有患者的 CD4(+)细胞计数低和 RNA 病毒载量高。这些病例的脑脊液和淋巴结组织培养均为阴性。9 例中有 6 例患者因颅内压升高而需要每天进行腰椎穿刺以缓解压力。在这些患者的病程中没有死亡发生。本病例系列观察到的发病率和临床演变特征与其他地方的报告一致。
