Nóbrega J P
Clínica Neurológica, Hospital das Clínicas Faculdade de Medicina, São Paulo, Brasil.
Arq Neuropsiquiatr. 1988 Jun;46(2):117-26. doi: 10.1590/s0004-282x1988000200002.
Thirty-five cases of cryptococcosis of the central nervous system (CNS) were studied, 17 of them submitted to renal transplantation. The objective was to evaluate the therapeutic responses observed in the group of kidney transplant patients with CNS cryptococcosis. They were submitted to amphotericin B therapy, with emphasis to the renal function. The results in this group were compared with the outcome in the group of patients with the same infection, submitted to the same therapeutic scheme, but without previous impairment of renal function. Among the 35 patients, 20 were male; the age varied between 4 and 76 years. Associated clinical conditions were noticed in 25 patients, 17 of them with renal transplantation. Among 35 patients, 10 died in the first days of the treatment; 25 patients were effectively treated for CNS cryptococcosis, 18 of them with associated clinical conditions; 15 were kidney transplant patients. The drugs used in the treatment of CNS cryptococcosis were, as possible, the amphotericin B by intravenous and intrathecal route (lumbar puncture) associated with 5-fluorocytosine. Seven patients died during the treatment; then, of the 35 patients who were initially evaluated, 17 died and 18 were successfully treated, with a death rate of 48.57%. Various intercurrencies were observed with the use of amphotericin B and 5-fluorocytosine. The clinical and therapeutic results recorded in this study were compared with the information met in literature. The analysis of the results emphasizes the need of the discovery of better and less toxic drugs than those currently used. Amphotericin B still is the most important drug in the treatment of CNS cryptococcosis and the therapeutic scheme currently recommended consists in the association of amphotericin B and 5-fluorocytosine, and there has been also advantage in the simultaneous use of intravenous and intrathecal amphotericin B. Statistical analysis of the results showed that there is no harm with the use of intravenous amphotericin B in renal transplanted patients with cryptococcosis of the central nervous system.
对35例中枢神经系统隐球菌病患者进行了研究，其中17例接受了肾移植。目的是评估肾移植患者合并中枢神经系统隐球菌病的治疗反应。他们接受了两性霉素B治疗，重点关注肾功能。将该组结果与相同感染、接受相同治疗方案但既往无肾功能损害患者组的结果进行比较。35例患者中，男性20例；年龄在4岁至76岁之间。25例患者有相关临床情况，其中17例接受了肾移植。35例患者中，10例在治疗初期死亡；25例患者中枢神经系统隐球菌病得到有效治疗，其中18例有相关临床情况；15例为肾移植患者。治疗中枢神经系统隐球菌病使用的药物尽可能为静脉和鞘内途径（腰椎穿刺）给予的两性霉素B联合5-氟胞嘧啶。7例患者在治疗期间死亡；那么，最初评估的35例患者中，17例死亡，18例成功治疗，死亡率为48.57%。使用两性霉素B和5-氟胞嘧啶时观察到各种相互作用。将本研究记录的临床和治疗结果与文献中的信息进行了比较。结果分析强调需要发现比目前使用的药物更好且毒性更小的药物。两性霉素B仍然是治疗中枢神经系统隐球菌病最重要的药物，目前推荐的治疗方案是两性霉素B与5-氟胞嘧啶联合使用，同时静脉和鞘内使用两性霉素B也有优势。结果的统计分析表明，在中枢神经系统隐球菌病的肾移植患者中使用静脉两性霉素B没有危害。
