cryptococcal infections in patients with aids

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1、CRYPTOCOCCALINFECTIONSINPATIENTSWITHAIDSStephenJ.Gluckman,M.D.Botswana-UPENNPartnershipMicrobiologyEncapsulatedyeast4serotypesA(C.neoformansvgrubii)BandC(C.gatti)D(C.neoformansvneoformans)AlltypescancausehumandiseaseLifecycleAsexual:yeastthatreproducebybuddingHumaninfectionsSex

2、ual:onlyseeninthelaboratoryEcologyandEpidemiologyWorldwideC.neoformansassociatedwithbirddroppingsC.gattinotassociatedwithbirds,associatedwitheucalyptustreesGenerallyaninfectionofimmunocompromisedbutcancauseclinicaldiseaseinhealthypersonsDecreasedCell-mediatedimmunityAIDS–CD4usu

3、ally<100ProlongedcorticosteroidsOrgantransplantEcologyandEpidemiology15-30%ofAIDSpatientsinSub-SaharanAfrica*MuchlesscommoninchildrenNopersontopersontransmission*Powderly,WGClinInfectDis1993ClinicalPresentationsPulmonaryAsymptomaticnoduleSymptomatic:notdistinguishablefromotherc

4、ausesHistory,PE,routinelaboratorytestingdoesnotproducefeaturespeculiarlysuggestiveofcryptococcalinfectionDiagnosisStainingofbiopsyspecimenCultureofsputumand/orbloodSerumcryptococcalantigen(CRAG)AllpatientswithpulmonarydiseaseneedaCSFexaminationtor/osubclinicalmeningitisSilverSt

5、ainClinicalPresentationsCutaneousDisseminateddiseaseLookssimilartomolluscumcontageosumDiagnosis:UnroofingalesionandmakingasmearandcultureSerumCRAGAllpatientswithcutaneousdiseaseneedaCSFexaminationtor/osubclinicalmeningitisClinicalPresentationsCryptococcalMeningitisTypicalSubacu

6、teonsetoffeverandheadachePhotophobiaand/ormeningealsignsinonly25%LesstypicalSeizuresConfusionProgressivedementiaVisualorhearingimpairmentFUODiagnosisCSFSerumCRAG:>99%sensitiveinAIDSpatientsCryptococcalMeningitisIn2003therewere193(+)CSFculturesforcryptococcusfromPMH*LeucocytesNo

7、leucocytesin31%Only1-10leucocytesin23%7%had>250leucocytes30%ofthesehadpredominatelyPMN’s95%(+)IndiaInk1%(-)cryptococcalantigenLiteratureSensitivity:93-100%Specificity:93-98%*BissonetalIndiaInkPrognosisforCryptococcalMeningitisPriorto1950itwasuniformlyfatalAmphotericinBintroduce

8、dandmortalityfelltothe30-40%rangeIn1970’s5-FCwasreleas