Messina Fernando, Santiso Gabriela, Arechavala Alicia, Romero Mercedes, Depardo Roxana, Marin Emmanuel
Mycology Unit, Infectious Diseases Hospital F.J. Muñiz, Buenos Aires C1282AEN, Argentina.
J Fungi (Basel). 2023 May 30;9(6):631. doi: 10.3390/jof9060631.
Cryptococcosis is one of the most serious opportunistic diseases in patients living with HIV. For this reason, early diagnosis and appropriate treatment are important.
The aim of the study was to understand the development of patients diagnosed with cryptococcosis by detection of antigen in serum by lateral flow assay (CrAg LFA) without nervous system involvement and with treatment in accordance with the results.
A retrospective, longitudinal, analytical study was performed. Seventy patients with cryptococcosis initially diagnosed by serum CrAg LFA without meningeal involvement between January 2019 and April 2022 were analyzed for medical records. The treatment regimen was adapted to the results of blood culture, respiratory material, and pulmonary tomography imaging.
Seventy patients were included, 13 had probable pulmonary cryptococcosis, 4 had proven pulmonary cryptococcosis, 3 had fungemia, and 50 had preemptive therapy without microbiological or imaging findings compatible with cryptococcosis. Among the 50 patients with preemptive therapy, none had meningeal involvement or cryptococcosis recurrences to date.
Preemptive therapy avoided progression to meningitis in CrAg LFA-positive patients. Preemptive therapy with dose adjustment of fluconazole in patients with the mentioned characteristics was useful despite the use of lower doses than recommended.
隐球菌病是艾滋病患者最严重的机会性疾病之一。因此，早期诊断和适当治疗很重要。
本研究的目的是通过侧流分析法（CrAg LFA）检测血清中的抗原，了解未累及神经系统且根据检测结果进行治疗的隐球菌病确诊患者的病情发展情况。
进行了一项回顾性、纵向、分析性研究。对2019年1月至2022年4月期间最初通过血清CrAg LFA确诊且无脑膜受累的70例隐球菌病患者的病历进行了分析。治疗方案根据血培养、呼吸道标本和肺部断层扫描成像结果进行调整。
纳入70例患者，13例可能患有肺隐球菌病，4例已证实患有肺隐球菌病，3例患有真菌血症，50例接受了先发治疗，但其微生物学或影像学检查结果均不符合隐球菌病表现。在50例接受先发治疗的患者中，迄今为止，无一例出现脑膜受累或隐球菌病复发。
先发治疗避免了CrAg LFA阳性患者发展为脑膜炎。对于具有上述特征的患者，尽管使用的氟康唑剂量低于推荐剂量，但调整剂量进行先发治疗仍有效。
