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Inicio Enfermedades Infecciosas y Microbiología Clínica Aspectos microbiológicos de la criptococosis en la era post-TARGA
Información de la revista
Vol. 28. Núm. S1.
Programa Externo de Control de Calidad SEIMC. Año 2008
Páginas 40-45 (Enero 2010)
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Vol. 28. Núm. S1.
Programa Externo de Control de Calidad SEIMC. Año 2008
Páginas 40-45 (Enero 2010)
Acceso a texto completo
Aspectos microbiológicos de la criptococosis en la era post-TARGA
Microbiological aspects of the cryptococcosis in the post-HAART era
Visitas
...
Estrella Martín Mazuelos??
Autor para correspondencia
, Ana Isabel Aller García
Unidad de Gestión Clínica de Microbiología, Hospital Universitario de Valme, Sevilla, España
Información del artículo
Resumen

La criptococosis es una micosis que incrementó su incidencia considerablemente con la aparición del sida. Sin embargo, tras la instauración, a finales de los años noventa, del tratamiento antirretroviral de gran actividad (TARGA), esta incidencia ha experimentado una disminución significativa, especialmente en los países desarrollados, aunque no ocurre lo mismo en los países en vías de desarrollo. Con la introducción del TARGA, no sólo se ha visto afectada la tasa de incidencia, sino también las manifestaciones clínicas, que se han presentado en algunos casos de forma anómala, como consecuencia de una recuperación de la inmunidad, describiéndose un nuevo síndrome, el síndrome inflamatorio de reconstitución inmune, así como manifestaciones raras como la linfadenitis y la afectación cutánea. Por otra parte, las pruebas de diagnóstico también han experimentado cambios, y existe un alto porcentaje de casos con cultivos negativos, microscopia negativa y detección tardía del antígeno criptocócico. En cuanto a los patrones de sensibilidad, también se ha observado una recuperación de la sensibilidad en la mayoría de los casos, hecho relacionado, a su vez, con la disminución de casos de criptococosis y con el menor uso de antifúngicos.

Palabras clave:
Criptococosis
TARGA
Sida
Abstract

Cryptococcosis is a mycoses that increased considerably with the AIDS epidemic. However, with the introduction in the late 90's of the highly active antiretroviral therapy (HAART), this incidence has significantly decreased, especially in developed countries, in contrast with that of developing countries. The introduction of HAART not only has affected the incidence rate, but also the clinical presentation as a consequence of the immune recovery of the host, leading to the description of the so called immune reconstitution inflammatory syndrome. In addition, some rare clinical manifestations of cyptococcosis are currently shown, such as lymphadenitis and cutaneous involvement. Besides clinical presentation, diagnostic tests have also changed, with a high percentage of cases with negative cerebrospinal fluid (CSF) and blood cultures, negative direct CSF microscopy, and delayed antigen positive results. Antifungal susceptibility patterns have also changed towards a recuperation of susceptibility, which is related to the decrease in both the incidence of cryptococcosis and less use of antifungal agents.

Keywords:
Cryptococcosis
HAART
AIDS
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Bibliografía
[1.]
E. Martín-Mazuelos, J.M. Torres Rodríguez.
Criptococosis.
Tratado SEIMC de Enfermedades Infecciosas y Microbiología Clínica, pp. 625-629
[2.]
M.A. Viviani, A.M. Tortorano.
Cryptocorcus.
Clinical mycology, pp. 231-249
[3.]
J.R. Graybill, J. Sobel, M. Saag, C. van Der Horst, W. Powderly, G. Cloud, et al.
Diagnosis and management of increased intracranial pressure in patients with AIDS and cryptococcal meningitis.
Clin Infect Dis, 30 (2000), pp. 47-54
[4.]
S.M. Crowe, J.B. Carlin, K.I. Stewart, C.R. Lucas, J.F. Hoy.
Predictive value of CD4 lymphocyte numbers for the development of opportunistic infections and malignancies in HIV-infected persons.
J Acquir Immune Defic Syndr, (1991), pp. 770-776
[5.]
S.A. Mirza, M. Phelan, D. Rimland, E. Graviss, R. Hamill, M.E. Brandt, et al.
The changing epidemiology of cryptococcosis: an update from population-based active surveillance in 2 large metropolitan areas, 1992-2000.
Clin Infect Dis, 36 (2003), pp. 789-794
[6.]
R. Manfredi, L. Calza, F. Chiodo.
AIDS-associated Cryptococcus infection before and after the highly active antiretroviral therapy era: emerging management problems.
Int J Antimicrob Agents, 22 (2003), pp. 449-452
[7.]
G.K. Abruzzo, A.M. Flattery, C.J. Gill, L. Kong, J.G. Smith, D. Krupa, et al.
Evaluation of water-soluble pneumocandin analogs L-733560, L-705589, and L-731373 with mouse models of disseminated aspergillosis, candidiasis, and cryptococcosis.
Antimicrob Agents Chemother, 39 (1995), pp. 1077-1081
[8.]
L. Ostrosky-Zeichner, B.D. Alexander, D.H. Kett, J. Vazquez, P.G. Pappas, F. Saeki, et al.
Multicenter clinical evaluation of the (1-3) beta-D-glucan assay as an aid to diagnosis of fungal infections in humans.
Clin Infect Dis, 41 (2005), pp. 654-659
[9.]
Dixit A, Carroll SF, Qureshi ST. Cryptococcus gattii: an emerging cause of fungal disease in North America. Interdiscip Perspect Infect Dis. 2009 (En prensa).
[10.]
N. Singh, O. Lortholary, B.D. Alexander, K.L. Gupta, G.T. John, K. Pursell, et al.
An immune reconstitution syndrome-like illness associated with Cryptococcus neoformans infection in organ transplant recipients.
Clin Infect Dis, 40 (2005), pp. 1756-1761
[11.]
J.R. Perfect, A. Casadevall.
Cryptococcosis.
Infect Dis Clin North Am, 16 (2002), pp. 837-874
[12.]
D.C. Saha, I. Xess, A. Biswas, D.M. Bhowmik, M.V. Padma.
Detection of Cryptococcus by conventional, serological and molecular methods.
Med Microbiol, 58 (2009), pp. 1098-1105
[13.]
W.G. Powderly, E.J. Keath, M. Sokol-Anderson, K. Robinson, D. Kirk, J.R. Little, et al.
Amphotericin B-resistant Cryptococcus neoformans in a patient with AIDS.
Infect Dis Clin Pract, 1 (1992), pp. 314-316
[14.]
A. Armengou, C. Pocar, J. Mascaro, F. García-Bragado.
Possible development of resistance to fluconazole during suppressive therapy for AIDS-associated cryptococcal meningitis.
Clin Infect Dis, 23 (1996), pp. 1337-1338
[15.]
A.I. Aller, E. Martin-Mazuelos, F. Lozano, J. Gomez-Mateos, L. Steele-Moore, W.J. Holloway, et al.
Correlation of fluconazole XMIs with clinical outcome in cryptococcal infection.
Antimicrob Agents Chemother, 44 (2000), pp. 1544-1548
[16.]
A.S. Kantarcioglu, A. Yucel.
A flucytosine-resistant Cryptococcus neoformans (seroype D) strain isolated in Turkey from cutaneous lesions.
Med Mycol, 40 (2002), pp. 519-523
[17.]
Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of yeasts. Approved standard. Document M27-A3. Wayne: Clinical and Laboratory Standards Institute; 2008.
[18.]
M.A. Ghannoum, A.S. Ibrahim, Y. Fu, M.C. Shafiq, J.E. Edwards, R.S. Criddle.
Susceptibility testing of Cryptococcus neoformans: a microdilution technique.
J Clin Microbiol, 30 (1992), pp. 2881-2886
[19.]
M.D. Witt, R.J. Lewis, A. Larsen, E. Milefchik, M.A. Leal, R.H. Haubrich, et al.
Identification of patients with acute AIDS-associated cryptococcal meningitis who can be effectively treated with fluconazole: the role of antifungal susceptibility testing.
Clin Infect Dis, 22 (1996), pp. 322-328
[20.]
C.J. Jessup, M.A. Pfaller, A. Messer, J. Zhang, M. Tumberland, E.K. Mbidde, et al.
Fluconazole susceptibility testing of C. neoformans: comparison of two microdilution methods and clinical correlates among isolates from Ugandan AIDS patients.
J Clin Microbiol, 36 (1998), pp. 2874-2876
[21.]
A.L. Colombo, F. Barchiesi, D.A. McGough, M.G. Rinaldi.
Comparisson of Etest with National Committee for Clinical Laboratory Standards broth macrodilution method for azole antifungal susceptibility testing.
J Clin Microbiol, 33 (1995), pp. 535-540
[22.]
M.A. Pfaller, S.A. Messer, A. Karlsson, A. Bolmstrom.
Evaluation of Etest method for determining fluconazole susceptibilities of 402 clinical yeast isolates by using three different agar media.
J Clin Microbiol, 36 (1998), pp. 2586-2589
[23.]
A.I. Aller, E. Martin-Mazuelos, M.J. Gutierrez, S. Bernal, M. Chavez, F.J. Recio.
Comparison of Etest and microdilution method for antifungal susceptibility testing of Cryptococcus neoformans to four antifungal agents.
J Antimicrob Chemother, 46 (2000), pp. 997-1000
[24.]
M.J. Maxwell, S.A. Messer, R.J. Hollis, D.J. Diekema, M.A. Pfaller.
Evaluation of Etest method for determining voriconazole and amphotericin B MICs for 162 clinical isolates of Cryptococcus neoformans.
J Clin Microbiol, 41 (2003), pp. 97-99
[25.]
M. Lozano-Chiu, V.L. Paetznick, M.A. Ghannoum, J.H. Rex.
Detection of resistance to amphotericin B. among Cryptococcus neoformans clinical isolates: performances of three different media assessed by using Etest and National Committee for Clinical Laboratory Standards M27-A Methodologies.
J Antimicrob Chemother, 36 (1998), pp. 2817-2822
[26.]
E. Dannaoui, M. Abdul, M. Arpin, A. Michel-Neguyen, M.A. Piens, A. Favel, et al.
Results obtained with various antifungal susceptibility testing methods do not predict early clinical outcome in patients with cryptococcosis.
Antimicrob Agents Chemother, 50 (2006), pp. 2464-2470
[27.]
Clinical and Laboratory Standards Institute. 2004. Method for antifungal disk diffusion susceptibility testing of yeasts. Document M44-A. Wayne: Clinical and Laboratory Standards Institute; 2004.
[28.]
M.A. Pfaller, S.A. Messer, L. Boyken, S. Tendolkar, R.J. Hollis, D.J. Diekema.
Evaluation of the NCCLS M44 P Disk Diffusion Method for determining suscepytibilities of 276 clinical isolates of Cryptococcus neoformans to fluconazole.
J Clin Microbiol, 42 (2004), pp. 380-383
[29.]
M.A. Pfaller, D.J. Diekema, M.G. Rinaldi, R. Barnes, B. Hu, A.V. Velesov, et al.
Results of ASTEMIS DISK global antifungal surveillance study: a 6.5 year analysis of susceptibilities of Candida and other yeast species to fluconazole and voriconazole standardized dik diffusion testing.
J Clin Microbiol, 43 (2005), pp. 5848-5859
[30.]
A. Espinel-Ingroff, E. Cantón, D. Gibbs, A. Wang.
Correlation of NeoSensitabs tablet diffusion assay results on three different agar Media with CLSI broth microdilution M27-A2 and disk diffusion M44-A results for testing susceptibilities of Candida spp. and Cryptococcus neoformans to amphotericin B, caspofungin, fluconazole, itraconazole and voriconazole.
J Clin Microbiol, 45 (2007), pp. 858-864
[31.]
O. López-Jodra, J.M. Torres-Rodriguez, R. Mendez-Vazquez, E. Ribas-Forcadell, Y. Modera-Lopez, T. Baro-Tomas, et al.
In vitro susceptibility of C. neoformans isolates to five antifungal drugs using a colorimetric system and the reference microbroth method.
J Antimicrob Chemother, 45 (2000), pp. 645-649
[32.]
J.M. Torres-Rodriguez, E. Alvarado-Ramirez.
In vitro susceptibilities to yeasts using ATB FUNGUS 2 method, compared with Sensititre Yeast One and standard CLSI (NCCLS) M27-A2 methods.
J Antimicrob Chemother, 60 (2007), pp. 658-661
[33.]
M.E. Brandt, M.A. Pfaller, R.A. Hajjrd, J. Hamill, P.G. Pappas, A.L. Ringold, et al.
Trend in antifungal susceptibility of C. neoformans isolates in the United States: 1992 to 1994 and 1996 to 1998.
Antimicrob Agents Chemother, 45 (2001), pp. 3065-3069
[34.]
S.T. Yildirian, A.W. Fothergill, D.A. Sutton, M.G. Rinaldi.
In vitro susceptibilities of cerebrospinal fluid isolates of C. neoformans collected during a ten-year period against fluconazole, voriconazole and posaconazole (SCH56592).
Mycoses, 45 (2002), pp. 378-383
[35.]
M.A. Pfaller, S.A. Messer, L. Boyken, R.J. Hollis, C. Rice, S. Tendolkar, et al.
In vitro activities of voriconazole, posaconazole and fluconazole against 4169 clinical isolates of Candida spp. and Cryptococcus neoformans collected during 2001 and 2002 in the ARTEMIS global antifungal surveillance program.
Diagn Microbiol Infect Dis, 48 (2004), pp. 201-205
[36.]
M.A. Pfaller, S.A. Messer, L. Boyken, C. Rice, S. Tendolkar, R.J. Hollis, et al.
Global trends in the antifungal susceptibility of C. neoformans (1990 to 2004).
J Clin Microbiol, 43 (2005), pp. 2163-2167
[37.]
A.I. Aller, R. Claro, C. Castro, C. Serrano, M.F. Colom, E. Martin-Mazuelos.
Antifungal susceptibility of Cryptococcus neoformans isolates in HIV-infected patients to fluconazole, itraconazole and voriconazole in Spain:1994-1996 and 1997-2005.
Chemotherapy, 53 (2007), pp. 300-305
[38.]
A. Perkins, A. Gomez-Lopez, E. Mellado, J.L. Rodriguez-Tudela, M. Cuenca-Estrella.
Rates of antifungal resistance among clinical isolates of C. neoformans var. neoformans.
J Antimicrob Chemother, 56 (2005), pp. 1144-1147
[39.]
K. Datta, N. Jain, S. Sethi, A. Rattan, A. Cassadevall, U. Banerjee.
Fluconazole and itraconazole susceptibility of clinical isolates of Cryptococcus neoformans at a tertiary care centre in India: a need for care.
J Antimicrob Chemother, 52 (2003), pp. 683-686
[40.]
B. Sar, D. Monchy, M. Vann, C. Keo, J.L. Sarthou, Y. Buisson.
Increasing in vitro resistance to fluconazole in Cryptococcus neoformans Cambodian isolates: April 2000 to March 2002.
J Antimicrob Chemother, 54 (2004), pp. 563-565
[41.]
M.R. Cappor, P. Mandal, M. Deb, P. Aggarwal, U. Banerjee.
Current scenario of cryptococcosis and antifungal susceptibility pattern in India: a cause for reappraisal.
[42.]
G.R. Thompson, N.P. Wiederhold, A.W. Fothergill, A.V. Vallo, B.L. Wickes, T.F. Patterson.
Antifungal susceptibilities among different serotypes of Cryptococcus gatii and Cryptococcus neoformans.
Antimicrob Agents Chemother, 53 (2009), pp. 309-311
[43.]
L. Trilles, B. Fernandez-Torres, S. Lazera Mdos, B. Wanke, J. Guarro.
In vitro antifungal susceptibility of Cryptococcus gattii.
J Clin Microbiol, 42 (2004), pp. 4815-4817
[44.]
A. Gomez-Lopez, O. Zaragoza, D.A. Martins, C. Melhem, J.L. Rodriguez-Tudela, M. Cuenca Estrella.
In vitro susceptibility of Cryptococcus gattii clinical isolates.
Clin Microbiol Infect, 14 (2008), pp. 727-739
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