Resumen
La criptococosis es una enfermedad producida por levaduras encapsuladas que se adquiere por la inhalación de propágulos infectantes de Cryptoccoccus, principalmente por la C. neoformnas y en menor frecuencia por la C. gatti. La distribución de este hongo es global, pero se encuentra de manera habitual en excretas de aves como las palomas. El principal compromiso en las personas es a nivel de los pulmones, del cerebro o de forma diseminada. La criptococosis en el sistema nervioso central (SNQ se presenta con meningoencefalitis, rara vez en forma de lesiones localizadas granulomatosas conocidas como criptococoma. Esta micosis es una causa frecuente de meningitis que se encuentra, especialmente, en los pacientes con VIH/SIDA. Las manifestaciones clínicas de esta enfermedad en el SNC son: cefalea, alteración del estado mental, fiebre, náuseas, vómito, deterioro visual, parálisis del sexto nervio craneal y signos de irritación meníngea, entre otras. El diagnóstico se realiza por medio de cultivo, microscopía del líquido cefalorraquídeo (LCR) o detección del antígeno de criptococo. El tratamiento de la meningitis por criptococo se divide en tres fases: inducción, consolidación y mantenimiento. Los pilares del tratamiento son la anfotericina B, la flucitosina y el fluconazol.
Citas
Lizarazo J, Escandón P, Agudelo CI, Firacative C, Meyer W, Castañeda E. Retrospective study of the epidemiology and clinical manifestations of cryptococcus gattii infections in Colombia from 1997-2011. PLoS Negl Trop Dis. 2014;8(11):e3272. doi: 10.1371/journal.pntd.0003272.
Lizarazo J, Linares M, De Bedout C, Restrepo A, Agudelo CI, Castañeda E, et al. Estudio clínico y epidemiológico de la criptococosis en Colombia: resultados de nueve años de la encuesta nacional, 1997-2005. Biomédica. 2007;27(1):94-109: 2. doi:10.7705/biomedica.v27i1.236.
Schwartz S, Kontoyiannis DP, Harrison T, Ruhnke M. Advances in the diagnosis and treatment of fungal infections of the CNS. The Lancet Neurol. 2018;17;362-72 doi: 10.1016/S1474-4422(18)30030-9.
Baddley JW, Schain DC, Gupte AA, Lodhi SA, Kayler LK, Frade JP, et al. Transmission of Cryptococcus neoformans by organ transplantation. Clin Infect Dis. 2011;52(4):94-8. doi: 10.1016/S1474-4422(18)30030-9.
Lagrou K, Van Eldere J, Keuleers S, Hagen F, Merckx R, Verhaegen J, et al. Zoonotic transmission of Cryptococcus neoformans from a magpie to an immunocompetent patient. J Intern Med. 2005;257(4):385-8. doi: 10.1111/j.1365-2796.2005.01466.x.
Christianson JC, Engber W, Andes D. Primary cutaneous cryptococcosis in immunocompetent and immuno-compromised hosts. Med Mycol. 2003;41(3):177-88. doi: 10.1080/1369378031000137224.
Kwon-Chung KJ, Bennett JE, Wickes BL, Meyer W, Cuomo CA, Wollenburg KR, et al. the case for adopting the "species complex" nomenclature for the etiologic agents of cryptococcosis. mSphere. 2017;2(1):1-7. doi: 10.1128/mSphere.00357-16.
Kwon-chung KJ, Polacheck I, Bennett JE. Improved diagnostic medium for separation of Cryptococcus neoformans var. neoformans (serotypes A and D) and Cryptococcus neoformans var. gattii (serotypes B and C). J Clin Microbiol. 1982;15(3):535-7. doi: 10.1128/JCM.15.3.535-537.1982.
Franco-Paredes C, Womack T, Bohlmeyer T, Sellers B, Hays A, Patel K, Lizarazo J, Lockhart SR, Siddiqui W Marr KA. Management of Cryptococcus gattii meningoencephalitis. Lancet Infect Dis. 2015 Mar;15(3):348-55. doi: 10.1016/S1473-3099(14)70945-4.10.
May RC, Stone NRH, Wiesner DL, Bicanic T, Nielsen K. Cryptococcus: from environmental saprophyte to global pathogen. Nat Rev Microbiol. 2016;14(2):106-17. doi: 10.1038/nrmicro.2015.6.
Vergara I, Saavedra M, Saravia J, González G, Lorenzana P, Acosta C, et al. Criptococosis del sistema nervioso central Estudio de 32 casos 1975-1991. Acta Neurol Colomb. 1993:18(4):199-210.
Maziarz EK, Perfect JR. Cryptococcosis. Infect Dis Clin North Am. 2016;30(1):179-206. doi: 10.1016/j.idc.2015.10.006.
Perfect JR. Cryptococcus neoformans: A sugar-coated killer with designer genes. FEMS Immunol Med Microbiol. 2005;45(3):395-404. doi: 10.1016/j.femsim.2005.06.005.
Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG, Chiller TM. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 2009;23(4):525-30. doi: 10.1097/QAD.0b013e328322ffac.
Características del estudio citoquímico y microbiológico del líquido cefalorraquídeo en adultos atendidos con la sospecha de meningitis en la E.S.E. Hospital El Tunal en Bogotá D.C. 2015-2016 [Internet]. Universidad Nacional de Colombia; 2017. Disponible en: http://bdigital.unal.edu.co/55800/
Lizarazo J, Chaves O, Peña Y, Escandón P, Agudelo CI, Castañeda E. Comparación de los hallazgos clínicos y de supervivencia entre pacientes VIH positivos y VIH negativos con criptococosis meníngea en un hospital de tercer nivel. Acta Med Colomb. 2012;37:49-61.
Kaplan JE, Benson C, Holmes KK, Brooks JT, Pau A, Masur H; Centers for Disease Control and Prevention (CDC); National Institutes of Health; HIV Medicine Association of the Infectious Diseases Society of America. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1-207.
Rajasingham R, Smith RM, Park BJ, Jarvis JN, Govender NP, Chiller TM, et al. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis. 2017;17(8):873-81. doi: 10.1016/S1473-3099(17)30243-8.
Vidal JE, Penalva de Oliveira AC, Dauar RF, Boulware DR. Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America. Braz J Infect Dis. 2013;17(3):353-62. doi: 10.1016/j.bjid.2012.10.020.
Escandón P, de Bedout C, Lizarazo J, Agudelo CI, To-bón A, Bello S, et al. Cryptococcosis in Colombia: Results of the national surveillance program for the years 2006-2010. Biomedica. 2012;32(3):386-98. doi: 10.1590/S0120-41572012000300009.
Loyse A, Moodley A, Rich P, Molloy SF, Bicanic T, Bishop L, et al. Neurological, visual, and MRI brain scan findings in 87 South African patients with HIV-associated cryptococcal meningoencephalitis. J Infect. 2015;70(6):668-75. doi: 10.1016/j.jinf.2014.10.007.
Abassi M, Boulware DR, Rhein J. Cryptococcal Meningitis: Diagnosis and management update. Curr Trop Med Rep. 2015;2(2):90-9. doi: 10.1007/s40475-015-0046-y.
World Health Organization. Guidelines for the diagnosis, prevention and management of cryptococcal Disease in HIV-infected adults, adolescents and children. WHO; 2018.
Kozel TR, Bauman SK. CrAg lateral flow assay for cryptococcosis. Expert Opin Med Diagn. 2012;6(3):245-51. doi: 10.1517/17530059.2012.681300.
Charlier C, Dromer F, Lévêque C, Chartier L, Cordoliani YS, Fontanet A, et al. Cryptococcal neuroradiological lesions correlate with severity during cryptococcal meningoencephalitis in HIV-positive patients in the HAART era. PLoS One. 2008;3(4):e1950. doi: 10.1371/journal.pone.0001950.
Bruno S, Duarte L, Oshima MM, Vitor J, Mesquita A, Pereira Do Nascimento FB, et al. Magnetic resonance imaging findings in central nervous system cryptococcosis: comparison between immunocompetent and immunocompromised patients. Radiol Bras. 2017;50(6):359-65. doi: 10.1590/01003984.2016.0017.
Zhong Y, Zhou Z, Fang X, Peng F, Zhang W Magnetic resonance imaging study of cryptococcal neuroradiological lesions in HIV-negative cryptococcal meningitis. Eur J Clin Microbiol Infect Dis. 2017;36(8):1367-72. doi: 10.1007/s10096-017-2941-8.
Dromer F, Mathoulin-Pélissier S, Launay O, Lortholary O, Achard J, Chabasse D, et al. Determinants of disease presentation and outcome during cryptococcosis: The CryptoA/D study. PLoS Med. 2007;4(2): 297-308. doi: 10.1371/journal.pmed.0040021.
Perfect JR, Dismukes WE, Dromer F, Goldman DL, Gray-bill JR, Hamill RJ, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of America. Clin Infect Dis. 2010;50(3):291-322. doi: 10.1086/649858.
Kaplan JE, Benson C, Holmes KH, Brooks JT, Pau A, Masur H. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4).
Day JN, Chau TTH, Wolbers M, Mai PP, Dung NT, Mai NH, et al. Combination antifungal therapy for cryptococcal meningitis. N Engl J Med. 2013;368(14):1291-302. doi: 10.1056/NEJMc1305981.
Lawrence DS, Boyer-Chammard T, Jarvis JN. Emerging concepts in HIV-associated cryptococcal meningitis. Curr Opin Infect Dis. 2019;32(1):16-23. doi: 10.1097/QCO.0000000000000514.
Agnihotri SP. Central Nervous System opportunistic infections. Semin Neurol. 2019;39(3):383-90. doi: 10.1055/s-0039-1687842.
Jarvis JN, Leeme TB, Molefi M, Chofle AA, Bidwell G, Tsholo K, et al. Short-course high-dose liposomal amphotericin B for human immunodeficiency virus-associated cryptococcal meningitis: a phase 2 randomized controlled trial. Clin Infect Dis. 2019;68(3):393-401. doi: 10.1093/cid/ciy515.
Molloy SF, Kanyama C, Heyderman RS, Loyse A, Kouanfack C, Chanda D, et al. Antifungal combinations for treatment of cryptococcal meningitis in Africa. N Engl J Med. 2018;378(11):1004-17.
Li Y, Huang X, Qin Y, Wu H, Yan X, Chen Y What Is the most appropriate induction regimen for the treatment of HIV-associated cryptococcal meningitis when the recommended regimen is not available? Evidence from a network meta-analysis. Front Pharmacol. 2020;30;11:963. doi: 10.3389/fphar.2020.00963.
Bicanic T, Brouwer AE, Meintjes G, Rebe K, Limmathurot-sakur D, Chierakul W, et al. Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with crypto-coccal meningitis undergoing serial lumbar punctures. AIDS. 2009;23(6):701-6. doi: 10.1097/QAD.0b013e32832605fe
Jarvis JN, Bicanic T, Loyse A, Namarika D, Jackson A, Nussbaum JC, et al. Determinants of mortality in a combined cohort of 501 patients with HIV-associated cryptococcal meningitis: Implications for improving outcomes. Clin Infect Dis. 2014;58(5):736-45. doi: 10.1093/cid/cit794.
Antinori S, Ridolfo AL, Fasan M, Magni C, Galimberti L, Milazzo L, et al. AIDS-associated cryptococcosis: A comparison of epidemiology, clinical features and outcome in the pre- and post-HAART eras. Experience of a single centre in Italy. HIV Med. 2009;10(1):6-11. doi: 10.1111/j.1468-1293.2008.00645.x
Hasimoto E Souza LK, Costa CR, De Fátima Lisboa Fernandes O, Abrao FY, Silva TC, Treméa CM, et al. Clinical and microbiological features of cryptococcal meningitis. Rev Soc Bras Med Trop. 2013;46(3):343-7. doi: 10.1590/0037-86820061-2012.
Chang CC, Perfect JR. Repeated therapeutic lumbar punctures in cryptococcal meningitis - necessity and/or opportunity? Curr Opin Infect Dis. 2016;29(6):539-45. doi: 10.1097/QCO.0000000000000315.
Meda J, Kalluvya S, Downs JA, Chofle AA, Seni J, Kidenya B, Fitzgerald DW, Peck RN. Cryptococcal meningitis management in Tanzania with strict schedule of serial lumber punctures using intravenous tubing sets: an operational research study. J Acquir Immune Defic Syndr. 2014;66(2):e31-6. doi: 10.1097/QAI.0000000000000147.
Rolfes MA, Hullsiek KH, Rhein J, Nabeta HW, Taseera K, Schutz C, et al. The effect of therapeutic lumbar punctures on acute mortality from cryptococcal meningitis. Clin Infect Dis. 2014;59(11):1607-14. doi: 10.1093/cid/ciu596.
Haddow LJ, Colebunders R, Meintjes G, Lawn SD, Elliott JH, Manabe YC, et al. Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions. Lancet Infect Dis. 2010;10(11):791-802. doi: 10.1016/S1473-3099(10)70170-5.
Khaw YM, Aggarwal N, Barclay WE, Kang E, Inoue M, Shinohara ML. Th1-dependent cryptococcus-associated immune reconstitution inflammatory syndrome model with brain damage. Front Immunol. 2020;11:529219. doi: 10.3389/fimmu.2020.529219.
Balasko A, Keynan Y. Shedding light on IRIS: from patho-physiology to treatment of cryptococcal meningitis and immune reconstitution inflammatory syndrome in HIV-infected individuals. HIV Med. 2019;20(1):1-10. doi: 10.1111/hiv.12676.
Pettersen KD, Pappas PG, Chin-Hong P, Baxi SM. A paradoxical decline: intracranial lesions in two HIV-positive patients recovering from cryptococcal meningitis. BMJ Case Rep. 2015;2015:bcr2015212108. doi: 10.1136/bcr-2015-212108.
Longley N, Harrison TS, Jarvis JN. Cryptococcal immune reconstitution inflammatory syndrome. Curr Opin Infect Dis. 2013;26(1):26-34. doi: 10.1097/QCO.0b013e32835c21d1.
Bicanic T, Meintjes G, Rebe K, Williams A, Loyse A, Wood R, et al. Immune reconstitution inflammatory syndrome in HIV-associated cryptococcal meningitis: a prospective study. J Acquir Immune Defic Syndr. 2009;51(2):130-4. doi: 10.1097/QAI.0b013e3181a56f2e.
Sueki H, Mizukawa Y, Aoyama Y. Immune reconstitution inflammatory syndrome in non-HIV immunosuppressed patients. J Dermatol. 2018;45(1):3-9. doi: 10.1111/13468138.14074.
Boulware DR, Meya DB, Muzoora C, Rolfes MA, Huppler Hullsiek K, Musubire A, et al; COAT Trial Team. Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis. N Engl J Med. 2014;370(26):2487-98. doi: 10.1056/NEJMoa1312884.
Beardsley J, Wolbers M, Kibengo FM, Ggayi AB, Kamali A, Cuc NT, et al; CryptoDex Investigators. Adjunctive dexamethasone in HIV-associated cryptococcal meningitis. N Engl J Med. 2016;374(6):542-54. doi: 10.1056/NEJ-Moa1509024.
Somerville LK, Henderson AP, Chen SC, Kok J. Successful treatment of Cryptococcus neoformans immune reconstitution inflammatory syndrome in an immunocompetent host using thalidomide. Med Mycol Case Rep. 2014;7:12-4. doi: 10.1016/j.mmcr.2014.12.003.
Wu X, Shen Y Management of human immunodeficiency virus-associated cryptococcal meningitis: Current status and future directions. Mycoses. 2019;62(10):874-82. doi: 10.1111/myc.12977.
Spec A, Powderly WG. Cryptococcal meningitis in AIDS. Handb Clin Neurol. 2018;152:139-50. doi: 10.1016/B978-0-444-63849-6.00011-6.
Kwon-Chung KJ, Fraser JA, Doering TL, Wang Z, Janbon G, Idnurm A, Bahn YS. Cryptococcus neoformans and Cryp-tococcus gattii, the etiologic agents of cryptococcosis. Cold Spring Harb Perspect Med. 2014;4(7):a019760. doi: 10.1101/cshperspect.a019760.
Xue X, Deng H, Zhao L, Zang X, Asuquo IP, Meng M, et al. Cryptococcosis caused by cryptococcus gattii: 2 case reports and literature review. Medicine (Baltimore). 2020;99(50):e23213. doi: 10.1097/MD.0000000000023213.
Chen SC, Meyer W, Sorrell TC. Cryptococcus gattii infections. Clin Microbiol Rev 2014;27(4):980-1024. doi: 10.1128/CMR.00126-13.
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.