Abstract

GOMEZ ARIAS, Bety  and  ZARCO MONTERO, Luis A. Meningeal criptococcosis: clinical and laboratory characteristics. Acta Neurol Colomb. [online]. 2011, vol.27, n.1, pp.19-27. ISSN 0120-8748.

Introduction. The incidence of infections caused by Cryptococcus neoformans has increased over the past 20 years as a result of the Human Immunodeficiency Virus epidemic and the raise of immunosuppressive therapies. A clinical and epidemiological study in Colombia found a mean annual incidence rate of cryptococcosis in the general population of 2.4/1’000000 inhabitants, central nervous system cryptococcosis in 891 (95.7%) of the subjects, and HIV infection in 78.1% of the patients. Objetive. To describe the demographics, clinic presentation and laboratory results of patients with a first episode of cryptococcal meningitis. The frequency of positive cerebrospinal fluid cultures after administration of 500 mg and 1 g of amphotericin B, respectively, was also assessed. Materials y Methods. Case series study. The subjects were eighteen patients with first episode of cryptococcal meningitis confirmed by positive cerebrospinal fluid culture. Demographic, clinical, laboratory and post treatment changes were described. Results. 77.7% of the subjects were male. All the patients presented headache as the main symptom. HIV infection was found in 83.3%. Initial cerebrospinal fluid analysis revealed an average of 24.8 white blood cells/ul, and average values for protein and glucose were 117mg/dL and 32.1 mg/dL, respectively. After treatment with 1 gram of amphotericin B, the average values cerebrospinal fluid values for white blood cells, protein and glucose were 20.2 ul, 85.7 mg/dL, and 42.3 mg/dL, respectively. The frequency of positive Cryptococcus culture after administration of 500 mg of amphotericin B was 23%, and 0% after 1 gr. India ink stain remained positive after the treatment in 53.8% of subjects and the latex agglutination test was reactive in 84.6%. Conclusions. Almost all the subjects were found to have HIV infection and other bad prognostic features. The analysis of initial vs. post treatment cerebrospinal fluid analysis did not reveal statistically significant differences; The most sensitive tool to asses treatment response was the cerebrospinal fluid culture. The minimal effective dose to adequately treat criptococcal meningitis, has not been determined.

Keywords : Criptococcosis; Amphotericin B; Acquired immunodeficiency syndrome.

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