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[Microbiological aspects of the cryptococcosis in the post-HAART era]

Estrella Martín Mazuelos1, Ana Isabel Aller García

  • 1Hospital Universitario de Valme, Sevilla, España. e.martinmazuelos.sspa@juntadeandalucia.es <e.martinmazuelos.sspa@juntadeandalucia.es>

Enfermedades Infecciosas Y Microbiologia Clinica
|February 23, 2010
PubMed

Insights

Highly active antiretroviral therapy (HAART) has decreased cryptococcosis incidence and altered its clinical presentation. Diagnostic methods and antifungal susceptibility have also shifted due to HAART

Area of Science:

  • Mycology and Infectious Diseases
  • Immunology and Virology

Context:

  • Cryptococcosis incidence surged with the Acquired Immunodeficiency Syndrome (AIDS) epidemic.
  • The advent of highly active antiretroviral therapy (HAART) in the late 1990s significantly impacted cryptococcosis rates, particularly in developed nations.

Purpose:

  • To analyze the evolving epidemiology, clinical manifestations, diagnostic approaches, and antifungal susceptibility patterns of cryptococcosis in the era of HAART.
  • To highlight the influence of immune reconstitution inflammatory syndrome (IRIS) on cryptococcal disease presentation.

Summary:

  • HAART has led to reduced cryptococcosis incidence but also altered clinical presentations, including rare manifestations like lymphadenitis and cutaneous involvement.
  • Diagnostic challenges have emerged, with increased rates of negative cerebrospinal fluid (CSF) and blood cultures, and delayed antigen detection.
  • Antifungal susceptibility patterns show a trend towards restored susceptibility, correlating with decreased disease incidence and reduced antifungal agent usage.

Impact:

  • Understanding these shifts is crucial for adapting diagnostic and treatment strategies for cryptococcosis globally.
  • The findings underscore the profound effect of antiretroviral therapy on opportunistic infections in immunocompromised patients.

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