XI International Meeting on Paracoccidioidomycosis

XI International Meeting on Paracoccidioidomycosis

Resume:127-1

Oral / Poster

127-1

Early and late evaluation of cryptococcosis in non-AIDS patients.

Authors:

Ricardo de Souza Cavalcante (FMB - UNESP - Faculdade de Medicina de Botucatu - UNESP) ; Júlio Defaveri (FMB - UNESP - Faculdade de Medicina de Botucatu - UNESP) ; Kunie Yabuki Rabello Coelho (FMB - UNESP - Faculdade de Medicina de Botucatu - UNESP) ; Lídia Raquel Carvalho (IB - UNESP - Instituto de Biocências - UNESP) ; Rinaldo Pôncio Mendes (FMB - UNESP - Faculdade de Medicina de Botucatu - UNESP)

Abstract

Introduction. Cryptococcosis-CRC is a severe systemic mycosis which affects mainly AIDS-patients, but also organ transplant recipients and nontransplant hosts. This study aims to characterize CRC in non-AIDS patients at a university hospital. Patients and Methods. A retrospective study of 27 CRC patients seen at a university hospital from 1989 to 2010 was carried out. CRC was confirmed by the identification of Cryptococcus spp by India ink test in cerebrospinal fluid-CSF and/or Mayer’s mucicarmine stain in histopathological examination and/or the detection of cryptococcal polysaccharide capsular antigen by latex agglutination in CSF and/or serum. The data were presented as medians and frequencies. Statistical analysis was carried out using Kruskal-Wallis test to compare medians, and chi-square and McNemar tests to compare frequencies; significance was set up at p<0.05. Results. CRC-patients aged from 15 to 72 years (Md=51). Females constituted 59,3% of the patients and males 40,7% (p>0,05). Frequency of predisposing diseases was 37% and the main underlying condition was corticosteroid therapy (five of 10 patients; 50%). The length of disease before the CRC diagnosis was 12 weeks in patients without predisposing factors and 2,5 weeks in immunocompromised patients [p=0,03]. The isolated pulmonary form was observed in 10 (37%) patients; cough (44,4%), dyspnea (27,8%) and chest pain (38,9%) were the most frequent complaints. The disseminated form was present in 17 (63%) patients, seven of whom showing exclusive central nervous system (CNS) involvement; headache (87,5%) and meningeal sign (56,3%) were the main complaints. The other six patients revealed the systemic disseminated form. Four patients were treated with amphotericin B deoxycholate-AmBd in combination with flucytosina, three of whom followed by fluconazole-FLC. Twelve patients received AmBd followed by FLC and one only AmBd. Six patients received only FLC and three only Itraconazole. One patient died before treatment. Satisfactory clinical response were observed in 23 of 26 patients (88,4%) and failure in only two (7,7%). Sequelae was more frequently in patients with CNS involvement (46,2%) than others (0,0%) [p=0,01]. Conclusions. These results show the clinical CRC polymorphism and the need to investigate this disease in non-AIDS patients, including when a risk factor is not identified.

Keyword: Cryptococcosis, Non-AIDS patients, Clinical and treatment aspects

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