Central nervous system and Cryptococcus neoformans.

摘要: Cryptococcus neoformans continues to be an important cause of morbidity and mortality, is the most common central nervous system (CNS) mycosis in immunocompromised patients, particular those with AIDS. C. has also increased transplant patients,[1,2,3,4] a systemic mycosis. The incidence infection due varies among continents. C. form yeast biochemical, antigenic, epidemiological differences. There are two known varieties. Most infections var. grubii lesser number gattii (Africa, Australia, Canada, Latin America). Clinical presentations depend on characteristics immunological competency patients. In general, it fungal its origin as inhalation neoformans, initially affecting lungs. Therefore, CNS manifestations result dissemination this fungus from lung.[5] The polysaccharide capsule potent virulence factor, which allows evade immune system. Laboratory diagnosis accomplished either by ELISA or latex agglutination test, visualization upon direct examination fresh cerebrospinal fluid (CSF), China ink (India staining nigrosine for identification 4-20 mm diameter). With negative stain, image center will possible. When burden high, pseudomycelium may observed time. On other occasions practical centrifuge CSF at 3,000 rpm Χ 10 min. sediment useful microscopic study cultures. Another accessible agglutination, identifies A, B, C, D serotypes that constitute neoformans/C. complex. Clinical correlation suspicion important. As all laboratory tests, there false negatives positives, thereby importance obtaining culture, yeasts neoformans. Genotypic proposed genotyping working group selected multilocus sequence typing (MLST), structural genes.[6] Treatment been established,[7] however, we must pay close attention not only treatment, but cryptococcal reconstitution inflammatory syndrome (IRIS) present itself clinical deterioration new recurrent presentation disease after initiation antiretroviral therapy (ART), despite microbiological evidence effective antifungal treatment.[8,9]