RESUMEN
Immune reconstitution inflammatory syndrome in meningitis caused by Cryptococcus gattii in immunocompetent patients after initiation of antifungal therapy appears to be the result of paradoxical antifungal treatment-induced clinical deterioration due to improved local immune responses to cryptococcal organisms. Recent anecdotal reports have suggested a favorable clinical response to corticosteroids in select patients with C. gattii central nervous system (CNS) infections. In this report, we describe a 65-year-old patient with meningoencephalitis caused by C. gattii who developed persistent intracranial hypertension and was successfully managed with antifungal therapy, repeated lumbar puncture and corticosteroids. Our observations suggest a possible benefit of dexamethasone in the management of select cases of C. gattii CNS infection with intracranial hypertension. Further studies are necessary to evaluate the long-term use of steroids in select patients with C. gattii with intracranial hypertension.
Asunto(s)
Corticoesteroides/uso terapéutico , Cryptococcus gattii/fisiología , Hipertensión Intracraneal/tratamiento farmacológico , Meningitis Criptocócica/tratamiento farmacológico , Meningoencefalitis/tratamiento farmacológico , Anciano , Cryptococcus gattii/aislamiento & purificación , Humanos , Hipertensión Intracraneal/microbiología , Masculino , Meningitis Criptocócica/complicaciones , Meningoencefalitis/complicaciones , Meningoencefalitis/microbiologíaRESUMEN
Autologous spleen grafts were implanted in various abdominal sites in 32 guinea pigs (Cavea porcellus) divided in 2 groups according to the use of slided or maccerated spleens. Each guinea pig was grafted in 5 different sites: subcutaneous tissue, rectus abdominalis muscle, properitoneum, greater omentum and mesenterial root. Grafts weighted initially 50 mg and were examined after 16 weeks according to the following variables: phagocytic ability (as measured by recovery of Tc99m-labelled, heat-modified erithrocytes), weight and histological appearance. Statistical analysis showed better graft results of sliced as compared to maccerated specimens in respect to weight and histological appearance (p less than or equal to 0.01). No significant difference was found regarding phagocytic ability. Intra-abdominal sites, especially the greater omentum, were found to yield significantly better graft results than sites at the abdominal wall (p less than or equal to 0.01). No graft-associated pathological changes were observed during the study period.
