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Academia Mexicana de Neurología, A.C.

2012, Number 6

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Rev Mex Neuroci 2012; 13 (6)

Clinical experience on cryptococcal meningoencephalitis in a public hospital from Venezuela

Ferrer Y, Muñoz-Cabas D, Hernández A, Ferrer O, Noguera O, Ayubi A, Villasmil O, Oliva M, Moreau N

Language: Spanish
References: 28
Page: 301-305
PDF size: 193.47 Kb.


ABSTRACT

Introduction: The genus Cryptococcus includes around 37 species. Among these, Cryptococcus neoformans is the only species that is pathogenic, and comprises in turn three main varieties: var. gattii, var. neoformans and var. grubii. Currently most of the cases of neurocryptococcosis occur in HIV-infected patients; however, it can also exist in subjects without HIV infection (especially by Cryptococcus var. gattii and var. grubii). Objective: To describe the clinical experience on patients with the diagnosis of Cryptococcus neoformans meningoencephalitis Servicio Autónomo Hospital Universitario de Maracaibo, Venezuela, during the period 2004-2010.Methods: All patients who arrived to our hospital with combinations of the following symptoms were registered: headache, fever, vomiting and altered consciousness. The clinical diagnosis at arrival was acute meningoencephalitis and afterwards by cerebrospinal fluid cytochemistry, microbiological analyses (India ink stain and cultures), as well as antigenic determination, a confirmed diagnosis of Cryptococcus neoformans as the etiological agent was reached. Results: A total of 22 patients were analyzed, 69% males and 60% seronegatives to HIV infection. At hospital arrival 90% presented with headache, 65% fever, 40% vomiting, 35% altered mental status and 65% intracranial hypertension. A 75% of patients received amphotericin B as a first-line agent and the rest (25%) received fluconazol, observing a substantial clinical improvement in the majority of patients. Conclusion: Although more common in HIV-infected patients, neurocryptococcosis can occur in immunocompetent subjecs and should be considered on the differential diagnosis of meningoencephalitis even in non-HIV patients.


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