RESUMEN
We have studied 10 patients with cryptococcal meningitis and AIDS. Nine of them were intravenous drug users and four have been previously diagnosed of AIDS. In 60% of them cryptococcal meningitis was the first opportunistic infection, and as group represented only 6.3% of our 158 patients with AIDS on the same period. The most common symptoms were: malaise (100%), headache (80%), fever (60%), meningeal signs (50%). Two of them had focal neurological disease. CSF culture and serum cryptococcal antigen test were positive in 90%, the Indian ink in 77% and blood cultures in 30% of the cases, while indian ink preparation did it in 77%. MRI showed bilateral small lesions, deeply located, in 3 cases; it was also useful to prove optical tract lesions in a patient with blindness as a result of cryptococcal meningitis. We had treatment successes in 80% of the cases, all patients being treated with amphotericin B, alone in 4 and amphotericin B plus fluorocytosine in 6. Two patients died within the first 2 weeks. Maintenance therapy with fluconazole was effective and well tolerated, with 3 patients dying from causes other than cryptococcal meningitis. We recorded a survival rate over 12 months in 33% of patients.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Meningitis Criptocócica/complicaciones , Infecciones Oportunistas/complicaciones , Adulto , Antifúngicos/uso terapéutico , Antígenos Fúngicos/análisis , Cryptococcus neoformans/inmunología , Cryptococcus neoformans/aislamiento & purificación , Femenino , Humanos , Incidencia , Masculino , Meningitis Criptocócica/líquido cefalorraquídeo , Meningitis Criptocócica/tratamiento farmacológico , Meningitis Criptocócica/epidemiología , Infecciones Oportunistas/líquido cefalorraquídeo , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/epidemiología , RecurrenciaRESUMEN
We present 54 cases of tuberculosis (TBC) and Acquired Immunodeficiency Syndrome (AIDS) that were observed during five years and represent 37% of our AIDS patients. TBC was diagnosed before AIDS in 7, after AIDS in 5 and simultaneously in 42. Eighty-seven per cent were intravenous drug users (IVDU) and no hemophilia cases were recorded. The tuberculin skin test (PPD) showed a reaction greater than 5 mm in 43%. Prophylaxis has not been used in any patient. TBC was localized in 39% and disseminated in 61%; the lung was the main organ involved. Diagnosis was established by culture in 42 cases and by pathology exam in 12 cases. Eighteen patients had multiple isolations, while 36 had a single one. Co-occurrence with other opportunistic infections was observed in 27 cases. Death related to TBC was seen in 3 patients, and there were no differences in survival between disseminated and localized presentations. Compliance of treatment was very low and follow-up was not achieved in large number of patients.