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      Disseminated cutaneous cryptococcosis in a patient with AIDS Translated title: Criptococose cutânea disseminada em paciente com SIDA. Relato de caso

      case-report

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          Abstract

          The authors study a patient carrying Aids, with exuberant dermatological manifestations of cryptococcosis. They stress the therapeutic effectiveness of short-term amphotericin B. The authors reviewed cases of cutaneous infection with Cryptococcus reported in the national and international literature, verifying that the frequency has increased with the AIDS epidemic. Also, they discuss about the differential diagnosis with some cases of dermatosis, particularly with the disseminated giant molluscum contagiosum. In relation to the therapy, they affirm that the choice of drug depends on the organ involved, as well as the immune state of the patient.

          Translated abstract

          Os autores estudam um paciente portador de SIDA, com manifestações dermatológicas exuberantes de criptococose. Destacam a eficácia terapêutica da anfotericina B, a curto prazo. Revisam os casos de criptococose cutânea relatados na literatura nacional e internacional, ressaltando o aumento de sua freqüência com a epidemia da SIDA. Também discutem o diagnóstico diferencial com várias dermatoses, particularmente com o molusco contagioso gigante disseminado. Em relação à terapêutica, afirmam que a escolha da droga depende do órgão comprometido, assim como do estado imunológico do paciente.

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          Most cited references54

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          Cryptococcus neoformans var. grubii: separate varietal status for Cryptococcus neoformans serotype A isolates.

          Cryptococcus neoformans var. neoformans presently includes isolates which have been determined by the immunologic reactivity of their capsular polysaccharides to be serotype A and those which have been determined to be serotype D. However, recent analyses of the URA5 sequences and DNA fingerprinting patterns suggest significant genetic differences between the two serotypes. Therefore, we propose to recognize these genotypic distinctions, as well as previously reported phenotypic differences, by restricting C. neoformans var. neoformans to isolates which are serotype D and describing a new variety, C. neoformans var. grubii, for serotype A isolates.
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            Clinical epidemiological study of 171 cases of cryptococcosis.

            We retrospectively studied 171 patients with cryptococcosis who were divided into three groups according to their associated predisposing conditions (if any): group 1 comprised nonimmunosuppressed patients, group 2 comprised patients with AIDS, and group 3 comprised those patients with other conditions and/or who were users of immunosuppressive drugs. Analysis and correlation of the behavior of the mycosis among the three groups showed differences in the demographic data, clinical forms and manifestations of cryptococcosis, laboratory results, morbidity and mortality rates, and histopathologic aspects. Study of the clinical isolates of Cryptococcus neoformans from 83 patients with cryptococcosis showed that 75 were characterized as C. neoformans variety neoformans and eight as C. neoformans var. gatti. Comparison of the distribution of the gattii and neoformans varieties between the nonimmunosuppressed (group 1) and immunosuppressed (groups 2 and 3) patients showed a significant statistical difference (P < .01).
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              Combination antifungal therapies for HIV-associated cryptococcal meningitis: a randomised trial.

              It frequently takes more than 2 weeks for drug treatments for cryptococcal meningitis to sterilise cerebrospinal fluid (CSF). In-vitro and animal studies lend support to the use of combinations of amphotericin B, flucytosine, and fluconazole for treatment of cryptococcosis. We compared the fungicidal activity of combinations of these drugs for initial treatment of patients with cryptococcal meningitis. 64 patients with a first episode of HIV-associated cryptococcal meningitis were randomised to initial treatment with: amphotericin B (0.7 mg/kg daily); amphotericin B plus flucytosine (100 mg/kg daily); amphotericin B plus fluconazole (400 mg daily); or triple therapy with amphotericin B, flucytosine, and fluconazole. Our primary endpoint was fungicidal activity, measured by the rate of reduction in CSF cryptococcal colony-forming units (CFU) from serial quantitative CSF cultures on days 3, 7, and 14 of treatment. Baseline CSF CFU counts were an important prognostic factor. Clearance of cryptococci from the CSF was exponential and was significantly faster with amphotericin B plus flucytosine than with amphotericin B alone (p=0.0006), amphotericin B plus fluconazole ( p=0.02), or triple therapy (p=0.02). At these doses, amphotericin B plus flucytosine is the most rapidly fungicidal regimen. Quantification of CSF cultures provides a powerful new means to accurately assess the fungicidal activity of new treatment regimens for cryptococcal meningitis.
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                Author and article information

                Journal
                rimtsp
                Revista do Instituto de Medicina Tropical de São Paulo
                Rev. Inst. Med. trop. S. Paulo
                Instituto de Medicina Tropical (São Paulo, SP, Brazil )
                1678-9946
                December 2006
                : 48
                : 6
                : 353-358
                Affiliations
                [01] orgnameUSP orgdiv1FM
                [02] orgnameUNIFESP
                [03] orgnameUNILUS
                Article
                S0036-46652006000600011 S0036-4665(06)04800611
                10.1590/S0036-46652006000600011
                17221135
                4cd7f411-33bc-4e67-9ec5-29c25de122cf

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

                History
                : 26 June 2006
                : 08 September 2005
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 33, Pages: 6
                Product

                SciELO Brazil

                Categories
                Case Report

                Cryptococcosis,Aids,Disseminated cryptococcosis,Cutaneous cryptococcosis

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