| Popis: |
Evaluation of the clinical features and diagnostic methods in the cryptococcosis of central nervous system (CNS), so as to facilitate a rapid recognition which may result in earlier diagnosis in view of the rapid increase in frequency shown in that condition.A retrospective study of 13 patients with CNS cryptococcosis seen during the last 4 years. The isolation of C. neoformans in CSF, cerebral biopsy or other appropriate tissue was required for inclusion. The following were evaluated: 1) Age, sex, and underlying disease; 2) Clinical features; 3) Yield of biochemical, microbiological, pathological and imaging diagnostic procedures; 4) Treatment and evolution.Age (X +/- SD): 37 +/- 20 years (range: 15-81). Sex: 77% males. Underlying disease was identified in 10 cases (77%): HIV infection in 7 (54%), diabetes mellitus in 2, alcohol abuse in 2, systemic erythematous lupus on corticoid and immunosuppressant therapy in 1 and chronic liver disease in 1. Clinical features on admission: abnormal behaviour in 10 (77%), headache in 10, low/high grade fever in 9 (69%), abnormal consciousness in 7, respiratory features in 5 (38%); motor deficit, cranial nerve involvement and visual abnormalities in 4 (31%) each; and meningeal signs in 3. Investigation of CSF was carried out in 12 cases. The biochemical studies were normal in 5 (42%). China ink stain was positive in 55% of cases, and latex agglutination in 80%. CSF culture was diagnostic in 92% of cases and the culture for C. neoformans was positive in 2 cerebral and one pulmonary biopsies and in two urine cultures. All patients were treated with amphotericin B and flucytosine was associated in 9. Two patients were subsequently treated with fluconazole. The outcome was good in 8 patients, and 4 had sequelae. One case relapsed.1) HIV infection is the most common underlying disease. 2) There is a high rate of CNS cryptococcosis with normal CSF or with mild biochemical abnormalities. 3) The yield of the microbiological studies of CSF is high, with diagnostic confirmation in 92% of cases. 4) Differences in CNS cryptococcosis were not found between cases with HIV infection and those with other underlying diseases. |
