Laura Walker

Criptococosis meníngea en pacientes con diabetes y sida

INTRODUCTION Cryptococcal meningitis is a severe AIDS-related infectious disease, with a high mortality rate. Diabetes mellitus (DM) is a metabolic disorder very common worldwide. Infectious diseases in diabetic patients are always more severe than in non-diabetic ones. The aim of this study was to compare the outcome of a group of HIV-positive patients with DM and cryptococcal meningitis with a similar group HIV-positive patients with cryptococcal meningitis, but without DM. MATERIAL AND METHODS A total of 182 clinical records of HIV-positive patients suffering cryptococcal meningitis were reviewed, and 28 of them with similar clinical and epidemiological characteristics, were chosen. They included 14 patients with DM (group A) and the remaining 14 who did not suffer this metabolic disorder (group B). RESULTS Only 21.4% (3/14 cases) of group A patients had negative CSF cultures after 10 weeks of treatment. In group B patients, 78.5% (11/14 cases) achieved negative CSF cultures before 10 weeks. A higher overall mortality rate was observed in the diabetic patients (85.7%, 12/14 cases) than in the non-diabetic group (21.4%, 3/14 cases). All CSF isolates were identified as Cryptococcus neoformans, and all strains were susceptible in vitro to amphotericin B and fluconazole. CONCLUSIONS Cryptococcal meningitis in diabetic patients was associated with a poor clinical outcome and a high mortality rate. A longer treatment induction period is suggested in order to improve the outcome of cryptococcal meningitis in diabetic patients.

Cryptococcosis in an Infectious Diseases Hospital of Buenos Aires, Argentina. Revision of 2041 cases: Diagnosis, clinical features and therapeutics

BACKGROUND Cryptococcosis is still a life-threatening mycosis that continues to be of serious concern in Latin American countries, especially among HIV+positive population. However, there is not any reliable information about the prevalence of this disease in this region. AIMS The aim of this study is to report data of 2041 patients with cryptococcosis that were attended at the Infectious Diseases Hospital F. J. Muñiz over a 30 year-period. METHODS Information about demographic and clinical data, survival time and the applied treatment, was taken from the Mycology Unit database. Mycological exams from different clinical samples were performed. Cryptococcal capsular antigen in serum and cerebrospinal fluid was detected through the latex agglutination technique. Cryptococcus isolates were phenotypically identified and the genotype was determined in some of them. Susceptibility tests were carried out following M27-A3 document. RESULTS Seventy five percent of HIV+positive patients and 50% of the HIV-negative population were males. Mean ages were 34.1 in HIV+positive patients and 44.8 in the HIV-negative. Cryptococcosis was associated with AIDS in 98% of the cases. Meningeal compromise was seen in 90% of the patients. Although cerebrospinal fluid rendered more positive results, blood culture was the first diagnostic finding in some cases. Cryptococcal antigen showed positive results in 96.2% of the sera samples and in the 93.1% of the cerebrospinal fluid samples. Most of the isolates were Cryptococcus neoformans and belonged to genotype VNI. Minimal inhibitory concentration values were mostly below the epidemiological cutoff values. CONCLUSIONS We observed that thanks to a high level of clinical suspicion, early diagnosis, combined therapy and intracranial pressure control by daily lumbar punctures, the global mortality rate has markedly decreased through the years in the analyzed period.

Problema clínicoProblemas clínicos en micología médica: problema número 43Clinical problems in medical mycology: Problem number 43

We present the case of a 42-year-old man, HIV-positive, with low CD4+ T cell count (31 cells/μl), who was admitted to Hospital de Infecciosas F. J. Muniz in Buenos Aires (Argentina) due to a severe lower back pain. He had a history of several highly active antiretroviral therapy treatments and he also had diabetes and chronic B and C viral hepatitis. A spinal cord CT scan showed two lytic bone lesions in L2 and L3. A bone biopsy was carried out and its microbiological study allowed the isolation of a methicillin-resistant Staphylococcus aureus. Intravenous vancomycin was prescribed, together with a corset and physical rest. A few days later the patient presented with acute dermatitis with papules, vesicles, scales and erythema, which spread over the whole lumbar region. The mycological study of the scales led to the isolation in culture of Candida albicans and Candida parapsilosis. With the diagnosis of decubitus candidiasis he was initially treated with a topical ointment containing 3% salicylic acid and 6% benzoic acid, but only slow, partial improvement was observed. The treatment was changed to oral fluconazole at a daily dose of 200 mg. With the latter the patient showed a rapid, complete clinical response.

Problemas clínicos en micología médica, problema número 43

We present the case of a 42-year-old man, HIV-positive, with low CD4+ T cell count (31 cells/μl), who was admitted to Hospital de Infecciosas F. J. Muniz in Buenos Aires (Argentina) due to a severe lower back pain. He had a history of several highly active antiretroviral therapy treatments and he also had diabetes and chronic B and C viral hepatitis. A spinal cord CT scan showed two lytic bone lesions in L2 and L3. A bone biopsy was carried out and its microbiological study allowed the isolation of a methicillin-resistant Staphylococcus aureus. Intravenous vancomycin was prescribed, together with a corset and physical rest. A few days later the patient presented with acute dermatitis with papules, vesicles, scales and erythema, which spread over the whole lumbar region. The mycological study of the scales led to the isolation in culture of Candida albicans and Candida parapsilosis. With the diagnosis of decubitus candidiasis he was initially treated with a topical ointment containing 3% salicylic acid and 6% benzoic acid, but only slow, partial improvement was observed. The treatment was changed to oral fluconazole at a daily dose of 200 mg. With the latter the patient showed a rapid, complete clinical response.

Problemas clínicos en micología médica: problema número 44

7.900/ l, neutrófilos 71%, eosinófilos 2%, basófilos 0%, linfocitos 21%, monocitos 6%, plaquetas 220.000/ l, uremia 20 mg/dl, creatininemia 0,80 mg/dl, glucemia 88 mg/dl, uricemia 4,5 mg/dl, Paciente de 19 años de edad, sexo femenino, que residía en Merlo zona oeste del gran Buenos Aires), en una vivienda urbana con anitarios completos. Acudió a consulta por nódulos supurantes en l cuero cabelludo. Su enfermedad había comenzado 12 años antes como una placa e cabellos ralos con superficie escamosa. En esa época tenía en su asa gatos y perros. Fue vista por un médico pediatra que le recetó ratamientos locales y no pidió estudios de la lesión para establecer n diagnóstico. El proceso del cuero cabelludo evolucionó de forma órpida y fueron apareciendo nódulos, algunos de los cuales supuaban. Cinco años después la paciente fue estudiada en el Hospital arrahan, donde le efectuaron estudios microbiológicos e histopaológicos de las lesiones cutáneas. Se llegó a un diagnóstico y se nstauró un tratamiento por vía oral que la paciente no toleró bien que tomaba de forma irregular. Experimentó una mejoría parcial. En el año 2008 se le extrajeron quirúrgicamente dos nódulos el cuero cabelludo y nuevamente se efectuaron estudios microiológicos que confirmaron los resultados previos. La paciente fue edicada con dos fármacos por vía oral que tomaba en forma de ulsos, y siguió este tratamiento en forma discontinua por probleas económicos. En el año 2010 le diagnosticaron una tuberculosis pulmonar; ecibió tratamiento con tres tuberculostáticos durante 6 meses, con uenos resultados clínicos y microbiológicos. El 23 de mayo de 2011 acudió a consulta a la Unidad Micología el Hospital de Infecciosas Francisco Javier Muñiz.

Problemas clínicos en micología médica: problema número 42

Paciente A.S., de sexo femenino, 43 años de edad, vivía en aferrere, provincia de Buenos Aires. Era indigente, adicta a la ocaína y sexualmente promiscua. Conoció su situación de VIH seropositiva 3 meses antes de su nternación. Tenía dos hijos, de 6 y 11 años de edad, respectivaente, que no vivían con ella. Ingresó en la Unidad 21 del Hospital de Infecciosas Francisco avier Muñiz el 5 de octubre de 2010 por presentar un estado conusional y lesiones cutáneas diseminadas.