Abstract
Introduction. The incidence of infections caused by Cryptococcus neoformans has increased over the past 20 years as a result of the Human Immunodeficiency Virus epidemic and the raise of immunosuppressive therapies. A clinical and epidemiological study in Colombia found a mean annual incidence rate of cryptococcosis in the general population of 2.4/1’000000 inhabitants, central nervous system cryptococcosis in 891 (95.7%) of the subjects, and HIV infection in 78.1% of the patients.
Objetive. To describe the demographics, clinic presentation and laboratory results of patients with a first episode of cryptococcal meningitis. The frequency of positive cerebrospinal fluid cultures after administration of 500 mg and 1 g of amphotericin B, respectively, was also assessed.
Materials y Methods. Case series study. The subjects were eighteen patients with first episode of cryptococcal meningitis confirmed by positive cerebrospinal fluid culture. Demographic, clinical, laboratory and post treatment changes were described.
Results. 77.7% of the subjects were male. All the patients presented headache as the main symptom. HIV infection was found in 83.3%. Initial cerebrospinal fluid analysis revealed an average of 24.8 white blood cells/ul, and average values for protein and glucose were 117mg/dL and 32.1 mg/dL, respectively. After treatment with 1 gram of amphotericin B, the average values cerebrospinal fluid values for white blood cells, protein and glucose were 20.2 ul, 85.7 mg/dL, and 42.3 mg/dL, respectively. The frequency of positive Cryptococcus culture after administration of 500 mg of amphotericin B was 23%, and 0% after 1 gr. India ink stain remained positive after the treatment in 53.8% of subjects and the latex agglutination test was reactive in 84.6%.
Conclusions. Almost all the subjects were found to have HIV infection and other bad prognostic features. The analysis of initial vs. post treatment cerebrospinal fluid analysis did not reveal statistically significant differences; The most sensitive tool to asses treatment response was the cerebrospinal fluid culture. The minimal effective dose to adequately treat criptococcal meningitis, has not been determined.
References
Tihana B, Thomas SH. Cryptococcal meningitis. British Medical Bulletin 2004;72:99-118.
Bekondi C, Bernede C, Passone N, et al. Primary and opportunistic phatogens associated con meningitis in adults in Bangui, Central African Republic, in relation to human immunodeficiency virus serostatus. Int J Infect Dis 2006; 10:387-395.
Schutte CM, Van der Meyden CH, Magazy DS. The impact of HIV on meningitis at seen at a south African Academic Hospital (1994 to 1998). Infection 2000;28:3-7.
Jonh R.P, William ED, Francoise D, et al. Clinical Practice Guidelines for the Management of Cryptoccocal Disease: 2010 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2010;50:291-322.
SHIH CC, CHEN YC, CHANG SC, LUH KT, HSIEH WC. Cryptoccocal meningitis in non-HIV infected patients. Q J Med 2000;93:245-251.
Jairo L, Melva L, Catalina de B, et al. Estudio clínico y epidemiológico de la criptococosis en Colombia: resultado de nueve años de la encuesta nacional, 1997-2005. Biomedica 2007;27:94-109.
Sidrim JJ, Costa AK, Cordeiro RA, Brilhante RS, Moura FE, Castelo-Branco DS, Neto MP, Rocha MF. Molecular methods for the diagnosis and characterization of Cryptococcus:a review. Can J Microbiol. 2010;56:445-58.
Granados DP, Castaneda E. Isolation and characterization of Cryptococcus neoformans varieties recovered from natural sources in Bogotá, Colombia, and study of ecological conditions in the area. Microb Ecol. 2005;49:282-90.
Rodrigues ML, Alviano CS, Travassos LR. Pathogenicity of Cryptococcus Neoformance virulence factors and inmunological mechanisms. Microbes Infect. 1999;1:293-301.
Satishchandra P, Mathew T, Gadre G, et al. Cryptococcal meningitis: clinical, diagnostic and therapeutic overviews. Neurology India. 2007;55:3.
Graybill JR, Sobel J, Saag M, et al. Diagnosis and management of increased intracranial pressure in patients with AIDS and cryptococcal meningitis. The NIAID Mycosis Study Group and AIDS Cooperative treatment Groups. Clin Infect Dis. 2000;30:47-54.
Derek S, Sipho D, Navin P, Martin D. Treatment of acute cryptococcal meningitis in HIV infected adults with an emphasis on resource-limited settings. Cochrane Database of Systematic Reviews 2008;4.
Hongzhou L, Yingjie Z, Youkuan Y, Xiaozhang P, Xinhua W. Cryptococcal antigen test revisited: significance for cryptococcal meningitis therapy monitoring in a tertiary Chinese hospital. Journal of Clinical microbiology 2005;0:2989-2990.
Silvia DP, Nora CC. Criptococosis en pacientes con SIDA: manifestaciones cutáneas y sistémicas, diagnóstico y terapéutica. Rev CES Med 2008;22:79-88.
Saha DC, Immaculata X, Neena J. Evaluation of conventional and serological methods for rapid diagnosis of cryptococcosis. Indian J Med Res 2008;127:483-488.
Kaufman L, Blumer S. The latex agglutination test for cryptococcosis, from laboratory diagnosis by serological methods. U:S Dept. of HEW. Public Health Service, Centers for disease control. Bureau of laboratories, laboratory Training section, Palmer DF and Staff.
Prevost E, Newell R. Commercial cryptococcal latex kit: clinical evaluation in a medical center hospital. J clin Microbiol. 1978;8:529-533.
Dolan CS, Immaculata X, Ashutosh B, Dipankar M.B, M.V. Padma. Detection of cryptococcus by conventional, serological and molecular methods. Journal of Medical Microbiology 2009;58:1098-1105.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.