Estudo retrospectivo terapêutico da neurocriptococose em 112 aidéticos ou não

Campos, Evanil Pires de; Carvalho, Valquíria Oliveira; Marinho, Sonia Fontes; Kushnaroff, Tuba Milstein; Galvão, Paulo Augusto Ayrosa; Padovani, Carlos Roberto

doi:10.1590/S0037-86821992000400005

Resumos

Cento e doze aidéticos ou não com neurocriptococose, admitidos no Hospital Emílio Ribas - São Paulo, Brasil, receberam anfotericina B (AMB) - grupo III ou a associação AMB/ 5 fluorcitosina (5FC): grupos I e II. Testes de Goodman aplicados revelaram: 1. leuco e glicorraquia semelhantes nos três grupos eproteinorraquia inferior a 85mg/dlapós 1, 5g/AMB; 1. a coloração pelo método da tinta da China e a cultura para Cryptococcus neoformans, positivas até l,Og/AMB; 3. hipocalemia na monoterapia, hipo e hipercalemia durante a associação; 4. as reações adversas mais evidentes a > 0,7gAMB/250g 5FC; 5. óbitos (precoce e tardio) frequentes no grupo 1 e nos grupos I e III entre 2,5 a 4,0g de AMB; 6. remissão e morte semelhantes nos grupos. A associação terapêutica iniciale amanutençãopelo AMB conduziram à recaída tardia

Neurocriptococose; Aidéticos e não; Terapia

A total of 112 AIDS and no AIDS cryptococcosis patients admitted at Emílio Ribas Hospital - São Paulo, Brazil, were treated with amphotericin B (AMB) or amphotericin B and 5 fluorcytosine (5FC). Age, race, predisposing and epidemiological factors, respiratory symptons were evaluated. Goodman tests applied in three patients groups (I, II and III) with associate or unique therapy revealed: 1. prognostic factors: leukocytes ang glucose showed similar response in groups I, II and 111 and protein spinal fluid after l.Sg/AMB; 2. India ink tests and Cryptococcus culture were often positive until l.Og/AMB; 3. significant hypokalemia during monotherapy. Hypo and hyperkalemia had similar data in associate therapy; 4. significant difference in adverse reactions often appeared above 0.7g AMB/250g 5FC; 5. early and late death were common in group 111 (unique) and group I (no AIDS) and III (2.5 to 4. Og) respectively; 6. similar remission and deaths were verified in AIDS/ cryptococosis. Conclusions: adverse reactions were observed above 0.75g/AMBplus 250g 5FC. Association was important in initial therapy and AMB maintenance permitted late relapses.

Neurocryptococcosis; AIDS and no AIDS; Therapy

ARTIGOS

Estudo retrospectivo terapêutico da neurocriptococose em 112 aidéticos ou não

Evanil Pires de Campos; Valquíria Oliveira Carvalho; Sonia Fontes Marinho; Tuba Milstein Kushnaroff; Paulo Augusto Ayrosa Galvão; Carlos Roberto Padovani

^{Endereço para correspondência} Endereço para correspondência: Prof. Evanil Pires de Campos. Rua João Miguel Rafael 350 18602-220 Botucatu, SP, Brasil

RESUMO

Cento e doze aidéticos ou não com neurocriptococose, admitidos no Hospital Emílio Ribas - São Paulo, Brasil, receberam anfotericina B (AMB) - grupo III ou a associação AMB/ 5 fluorcitosina (5FC): grupos I e II. Testes de Goodman aplicados revelaram: 1. leuco e glicorraquia semelhantes nos três grupos eproteinorraquia inferior a 85mg/dlapós 1, 5g/AMB; 1. a coloração pelo método da tinta da China e a cultura para Cryptococcus neoformans, positivas até l,Og/AMB; 3. hipocalemia na monoterapia, hipo e hipercalemia durante a associação; 4. as reações adversas mais evidentes a > 0,7gAMB/250g 5FC; 5. óbitos (precoce e tardio) frequentes no grupo 1 e nos grupos I e III entre 2,5 a 4,0g de AMB; 6. remissão e morte semelhantes nos grupos. A associação terapêutica iniciale amanutençãopelo AMB conduziram à recaída tardia

Palavras-chave: Neurocriptococose. Aidéticos e não. Terapia.

ABSTRACT

A total of 112 AIDS and no AIDS cryptococcosis patients admitted at Emílio Ribas Hospital - São Paulo, Brazil, were treated with amphotericin B (AMB) or amphotericin B and 5 fluorcytosine (5FC). Age, race, predisposing and epidemiological factors, respiratory symptons were evaluated. Goodman tests applied in three patients groups (I, II and III) with associate or unique therapy revealed: 1. prognostic factors: leukocytes ang glucose showed similar response in groups I, II and 111 and protein spinal fluid after l.Sg/AMB; 2. India ink tests and Cryptococcus culture were often positive until l.Og/AMB; 3. significant hypokalemia during monotherapy. Hypo and hyperkalemia had similar data in associate therapy; 4. significant difference in adverse reactions often appeared above 0.7g AMB/250g 5FC; 5. early and late death were common in group 111 (unique) and group I (no AIDS) and III (2.5 to 4. Og) respectively; 6. similar remission and deaths were verified in AIDS/ cryptococosis. Conclusions: adverse reactions were observed above 0.75g/AMBplus 250g 5FC. Association was important in initial therapy and AMB maintenance permitted late relapses.

Keywords: Neurocryptococcosis. AIDS and no AIDS. Therapy.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido para publicação em 16/03/92.

Trabalho do Hospital Emílio Ribas, São Paulo e Instituto de Biociências, Universidade Estadual Paulista, Botucatu, SP.

1. Ajello L. Occurence of Cryptococcus neoformans in soils. American Journal of Hygiene 67:72-77, 1958.
2. Atkinson W, Troxler S, McFarland L. Extrapulmonary crytococcal disease as manifestations of AIDS in Lousiana. In: Abstracts of International conference of AIDS, Montreal p.484, 1989.
3. Bennett JE, Kwon-Chung KJ, Howard DH. Epidemiological differences between the two varieties of Cryptococcus neoformans American Journal of Epidemiology 120:123-130, 1977.
4. Campos CEOP, Santos NNQ, Takahashi MM, Astone E, Ayrosa Galvão PA, Campos EP. Cryptococcus neoformans meningitis (CNM) in Hospital Emilio Ribas - São Paulo, Brazil. In: Abstracts ofXI Congress of the International Society for Human and Animal Mycology, Montreal p.82, 1991.
5. Campos EP, Marinho SF, Carvalho VO, Kushnaroff TM, Ay rosa Galvão PA. Clinicaltherapy sutdy: 110 AIDS and no AIDS cryptococcosis. In: Abstracts of International Conference on Cryptococcus and Cryptococcosis. Jeruzalem p.5, 1989.
6. ChuckSL, SandeMA. Infections with Cryptococcus neoformans in acquired immunodeficiency syndrome. New England JournalMedicine 321:794- 799, 1989.
7. Diamond RD. Cryptococcus neoformans In: Mandell GL, Douglas Jr RG, Bennett JE (eds). Clinical and practice of infectious diseases, 2^nd edition, John Wiley, New York p.1981, 1990.
8. Diamond RD, Bennett JJE. Prognostic factors in cryptococcal meningitis. A study in 111 cases. Annals of Internal Medicine 80:176-181, 1974.
9. Dismukes WE, Cloud G, Galtes HA, Kerkering TM, Medoff G, Blackweder WC. Treatment of cryptococcal meningitis with combination Amphotericin B and Flucytosine for fo ur as compared with six weeks. New England Journal of Medicine 317:334-398, 1987.
10. Gonçalves AJR, Rosembaun R, Wanke B, Vieira W. A criptococose no Estado do Rio de Janeiro. Apresentação de 10 casos e revisão da literatura fluminense. Arquivo Brasileiro deMedicina 65:395- 398, 1988.
11. Goodman LA. Simultaneous confidence intervals for contrast among multinomial populations. Annals of Matematical-Statistic 35:716-775, 1964.
12. Howard DH, Chung KJ. The ecology and epidemiology of neoformans and gattii of Cryptococcus neoformans In: Abstracts of International Conference on Cryptococcus and Cryptococcosis. Jeruzalem p.S-2, 1989.
13. KovacsJA, Kovaks AA, Polis M,WrightC, GillVJ, Bennett JE. Cryptococcosis in the immunodeficiency syndrome. Annals of Internal Medicine 103:533- 583, 1985.
14. Lopez DLR, Marinho SF, Cirino EMI, Ayrosa Galvão PA, Campos EP. Itraconazol em Aidético com Criptococose. In: Resumos do XXVI Congresso da Sociedade Brasileira de Medicina Tropical, Natal p.79, 1990.
15. Mckenzie R, Travis WD, Dolan SA, Pittaluga S, Yarchoan R, Masur H. The causes of death in patients with human immunodeficiency virus infection. A clinical and pathologic study with emphasis on role of pulmonary diseases. Medicine 70:326-343, 1991.
16. Morales Calvo BM. Antigeno capsular, variedades y serotipos de Cryptococcus neoformans en pacientes con imuno deficiencia adquirida y neuro criptococcosis en São Paulo - Brasil. Tese de mestrado, Escola Paulista de Medicina, São Paulo, SP, 1989.
17. Negroni P. Cryptococcosis. In: Micosis profundas (cutaneas y visceralis). Buenos Aires. Comission de Investigacíon Cientifica III: 13.-47, 1966.
18. Perez LPR, Bertrand A, Melhem MSC, Giudice MC, Pires MFC, Grosco SFR, Campos EP, Ayrosa Galvão PA, Lahamann M. Cryptococcosis in HIV-1 infections: clinical, laboratory and epidemiological study. In: Abstracts ofXI Congress of International Society for Human and Animal Mycology, Montreal p. 99, 1991.
19. Pitrak DL, Burton R, Andersen BR. Cerebral blastomycosis after ketoconazole therapy for respiratory tract blastomycosis. Annals Journal of Medicine 86:713-714, 1989.
20. Rippon JW. Cryptococcosis. In: Medical Mycology: The pathogenic Actinomicetes. 3^rd edition Sanders. Philadelphia p.582-609, 1988.
21. Sugar AM, Stem JJ, Dupont B. Treatment of cryptococcal meningitis. Review of Infectious Diseases 12 (supl.3):338-348, 1990.
22. Staib F. Cultural diagnosis of Cryptococcus neoformans and cryptococcosis. In: Abstracts of International Conference on Cryptococcus and Cryptococcosis. Jeruzalem p.S-16, 1989.
23. SwineD, NkurikiyinfiiraJR,MuyembeTL. Clinical isolate of Cryptococcus neoformans from Zaire. Journal of Clinical Microbiology 5:50-51, 1986.
24. Takahashi M, Corez RN, Pereira AD, Huggins DW, Lacaz CS. Isolamento de Cryptococcus neoformans das fezes do pombo, do solo e ninho de pombos. Revista Brasileira de Medicina 44:6-9, 1987.

Endereço para correspondência:

Prof. Evanil Pires de Campos.

Rua João Miguel Rafael 350

18602-220

Botucatu, SP, Brasil

Datas de Publicação

Publicação nesta coleção
19 Abr 2013
Data do Fascículo
Dez 1992

Histórico

Aceito
16 Mar 1992
Recebido
16 Mar 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Ajello L. Occurence of Cryptococcus neoformans in soils. American Journal of Hygiene 67:72-77, 1958.

[2] 2. Atkinson W, Troxler S, McFarland L. Extrapulmonary crytococcal disease as manifestations of AIDS in Lousiana. In: Abstracts of International conference of AIDS, Montreal p.484, 1989.

[3] 3. Bennett JE, Kwon-Chung KJ, Howard DH. Epidemiological differences between the two varieties of Cryptococcus neoformans American Journal of Epidemiology 120:123-130, 1977.

[4] 4. Campos CEOP, Santos NNQ, Takahashi MM, Astone E, Ayrosa Galvão PA, Campos EP. Cryptococcus neoformans meningitis (CNM) in Hospital Emilio Ribas - São Paulo, Brazil. In: Abstracts ofXI Congress of the International Society for Human and Animal Mycology, Montreal p.82, 1991.

[5] 5. Campos EP, Marinho SF, Carvalho VO, Kushnaroff TM, Ay rosa Galvão PA. Clinicaltherapy sutdy: 110 AIDS and no AIDS cryptococcosis. In: Abstracts of International Conference on Cryptococcus and Cryptococcosis. Jeruzalem p.5, 1989.

[6] 6. ChuckSL, SandeMA. Infections with Cryptococcus neoformans in acquired immunodeficiency syndrome. New England JournalMedicine 321:794- 799, 1989.

[7] 7. Diamond RD. Cryptococcus neoformans In: Mandell GL, Douglas Jr RG, Bennett JE (eds). Clinical and practice of infectious diseases, 2^nd edition, John Wiley, New York p.1981, 1990.

[8] 8. Diamond RD, Bennett JJE. Prognostic factors in cryptococcal meningitis. A study in 111 cases. Annals of Internal Medicine 80:176-181, 1974.

[9] 9. Dismukes WE, Cloud G, Galtes HA, Kerkering TM, Medoff G, Blackweder WC. Treatment of cryptococcal meningitis with combination Amphotericin B and Flucytosine for fo ur as compared with six weeks. New England Journal of Medicine 317:334-398, 1987.

[10] 10. Gonçalves AJR, Rosembaun R, Wanke B, Vieira W. A criptococose no Estado do Rio de Janeiro. Apresentação de 10 casos e revisão da literatura fluminense. Arquivo Brasileiro deMedicina 65:395- 398, 1988.

[11] 11. Goodman LA. Simultaneous confidence intervals for contrast among multinomial populations. Annals of Matematical-Statistic 35:716-775, 1964.

[12] 12. Howard DH, Chung KJ. The ecology and epidemiology of neoformans and gattii of Cryptococcus neoformans In: Abstracts of International Conference on Cryptococcus and Cryptococcosis. Jeruzalem p.S-2, 1989.

[13] 13. KovacsJA, Kovaks AA, Polis M,WrightC, GillVJ, Bennett JE. Cryptococcosis in the immunodeficiency syndrome. Annals of Internal Medicine 103:533- 583, 1985.

[14] 14. Lopez DLR, Marinho SF, Cirino EMI, Ayrosa Galvão PA, Campos EP. Itraconazol em Aidético com Criptococose. In: Resumos do XXVI Congresso da Sociedade Brasileira de Medicina Tropical, Natal p.79, 1990.

[15] 15. Mckenzie R, Travis WD, Dolan SA, Pittaluga S, Yarchoan R, Masur H. The causes of death in patients with human immunodeficiency virus infection. A clinical and pathologic study with emphasis on role of pulmonary diseases. Medicine 70:326-343, 1991.

[16] 16. Morales Calvo BM. Antigeno capsular, variedades y serotipos de Cryptococcus neoformans en pacientes con imuno deficiencia adquirida y neuro criptococcosis en São Paulo - Brasil. Tese de mestrado, Escola Paulista de Medicina, São Paulo, SP, 1989.

[17] 17. Negroni P. Cryptococcosis. In: Micosis profundas (cutaneas y visceralis). Buenos Aires. Comission de Investigacíon Cientifica III: 13.-47, 1966.

[18] 18. Perez LPR, Bertrand A, Melhem MSC, Giudice MC, Pires MFC, Grosco SFR, Campos EP, Ayrosa Galvão PA, Lahamann M. Cryptococcosis in HIV-1 infections: clinical, laboratory and epidemiological study. In: Abstracts ofXI Congress of International Society for Human and Animal Mycology, Montreal p. 99, 1991.

[19] 19. Pitrak DL, Burton R, Andersen BR. Cerebral blastomycosis after ketoconazole therapy for respiratory tract blastomycosis. Annals Journal of Medicine 86:713-714, 1989.

[20] 20. Rippon JW. Cryptococcosis. In: Medical Mycology: The pathogenic Actinomicetes. 3^rd edition Sanders. Philadelphia p.582-609, 1988.

[21] 21. Sugar AM, Stem JJ, Dupont B. Treatment of cryptococcal meningitis. Review of Infectious Diseases 12 (supl.3):338-348, 1990.

[22] 22. Staib F. Cultural diagnosis of Cryptococcus neoformans and cryptococcosis. In: Abstracts of International Conference on Cryptococcus and Cryptococcosis. Jeruzalem p.S-16, 1989.

[23] 23. SwineD, NkurikiyinfiiraJR,MuyembeTL. Clinical isolate of Cryptococcus neoformans from Zaire. Journal of Clinical Microbiology 5:50-51, 1986.

[24] 24. Takahashi M, Corez RN, Pereira AD, Huggins DW, Lacaz CS. Isolamento de Cryptococcus neoformans das fezes do pombo, do solo e ninho de pombos. Revista Brasileira de Medicina 44:6-9, 1987.