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[Cryptococcosis in AIDS patients: a study of 19 cases]
E Gazapo Carretero1, C García Aguado, M Adrados de Llano
1Servicio de Enfermedades Infecciosas, Hospital de la Princesa, Madrid.
Revista Clinica Espanola
|May 1, 1992
Summary
Cryptococcus neoformans infections, including meningitis, are diagnosed in 4% of AIDS patients. Early diagnosis via culture and antigen tests, along with suppressive therapy, improves survival and reduces relapse rates.
Area of Science:
- Infectious Diseases
- Immunology
- Neurology
Background:
- Cryptococcus neoformans is an opportunistic pathogen causing severe infections in individuals with Acquired Immunodeficiency Syndrome (AIDS).
- Cryptococcal meningitis is a significant cause of morbidity and mortality in AIDS patients, often presenting with nonspecific clinical and cerebrospinal fluid (CSF) findings.
Purpose of the Study:
- To analyze the clinical characteristics, diagnostic methods, treatment outcomes, and survival rates of Cryptococcus neoformans infections in a cohort of AIDS patients.
- To evaluate the efficacy of different therapeutic strategies, including antifungal agents and suppressive therapy, for cryptococcosis in AIDS.
Main Methods:
- Retrospective analysis of 19 cases of Cryptococcus neoformans infection diagnosed in 438 admitted AIDS patients.
- Evaluation of diagnostic techniques including CSF culture, serum cryptococcal antigen testing, and CSF parameter analysis.
- Assessment of treatment responses and one-year survival rates, comparing amphotericin B alone versus with fluconazole or fluconazole maintenance therapy.
Main Results:
- Cryptococcus neoformans infection was diagnosed in 4% of AIDS patients, with 14 cases presenting as meningitis.
- Culture of C. neoformans in CSF and serum antigen determination showed the best diagnostic yield.
- One-year survival probability was 75%, with good treatment response. Fluconazole demonstrated effectiveness in maintenance therapy, and suppressive treatment significantly reduced relapse rates (10% vs. 50%).
Conclusions:
- Cryptococcal infections in AIDS patients often present insidiously, highlighting the importance of sensitive diagnostic tools like CSF culture and antigen assays.
- Amphotericin B-based therapy appears effective, with no added benefit from fluconazole in acute treatment. Fluconazole is effective for maintenance therapy.
- Long-term suppressive therapy is crucial for preventing relapses in AIDS patients treated for cryptococcosis.