Tratamento da criptococose do sistema nervoso pelo Amphotericin B

Giorgi, Dante; Pupo, Paulo Pinto; Reis, João Baptista dos; Lima, José Geraldo de Camargo

doi:10.1590/S0004-282X1959000400005

Resumos

Os autores descrevem a evolução dos conhecimentos sôbre a meningoen-cefalite produzida pelo Criptococcus neoformans, analisando as dificuldades anteriormente havidas para o diagnóstico em vida, as quais foram superadas depois que se usou rotineiramente a pesquisa do cogumelo no LCR pelo método de coloração de tinta da China e pela cultura. Assinalam, a seguir, o aparecimento do Amphotericin B, novo antibiótico fungicida que veio modificar o prognóstico desta afecção. Apresentam sua experiência com 14 casos de meningite por criptococos diagnosticados em vida e referem pormenorizadamente 2 casos tratados com o Amphotericin B. O primeiro, de paciente portadora desta afecção, evoluindo de maneira crônica, com períodos de exacerbação que melhoram nitidamente com o Amphotericin B e que está com uma sobrevida de 20 meses. O segundo, de paciente portadora de forma aguda desta afecção que teve cura clínica e está com LCR absolutamente normal, com seguimento de 11 meses. Em ambos os casos foi usada a via endovenosa, sendo feitas séries de 10 injeções, cada uma de 50 mg de Amphotericin B em 500 ml de sôro glicosado a 5%. No primeiro caso foram feitas 4 séries e no segundo apenas duas. Não foram registradas reações colaterais de importância. Os autores terminam considerando o Amphotericin B como um elemento que veio tornar muito mais favorável o prognóstico desta afecção até então mortal.

The authors made a review of the diagnostic difficulties in meningoencephalitis by the Criptococcus neoformans, in vivo, today easier by special methods such as China ink and culture in the CSF. From their diagnosed 14 cases, 2 have been treated by Amphotericin B. The first was a chronic case with acute episodes which were less severe when Amphotericin B was used. This case has been alive for 20 months. The second case was an acute one with clinical and spinal fluid normalization and has a follow-up of 11 months. In both cases Amphotericin was used intravenously (50 mg in 500 ml of a solution of glycose at 5%) in the first case 4 series and in the second case 2 series. There were no complications. The authors consider that the use of Amphotericin B has given those cases a better prognosis.

Dante Giorgi^I; Paulo Pinto Pupo^II; João Baptista dos Reis^I; José Geraldo de Camargo Lima^III

^IAssistente

^IIChefe de Clinica

^IIIMédico interno

RESUMO

Os autores descrevem a evolução dos conhecimentos sôbre a meningoen-cefalite produzida pelo Criptococcus neoformans, analisando as dificuldades anteriormente havidas para o diagnóstico em vida, as quais foram superadas depois que se usou rotineiramente a pesquisa do cogumelo no LCR pelo método de coloração de tinta da China e pela cultura. Assinalam, a seguir, o aparecimento do Amphotericin B, novo antibiótico fungicida que veio modificar o prognóstico desta afecção.

Apresentam sua experiência com 14 casos de meningite por criptococos diagnosticados em vida e referem pormenorizadamente 2 casos tratados com o Amphotericin B. O primeiro, de paciente portadora desta afecção, evoluindo de maneira crônica, com períodos de exacerbação que melhoram nitidamente com o Amphotericin B e que está com uma sobrevida de 20 meses. O segundo, de paciente portadora de forma aguda desta afecção que teve cura clínica e está com LCR absolutamente normal, com seguimento de 11 meses. Em ambos os casos foi usada a via endovenosa, sendo feitas séries de 10 injeções, cada uma de 50 mg de Amphotericin B em 500 ml de sôro glicosado a 5%. No primeiro caso foram feitas 4 séries e no segundo apenas duas. Não foram registradas reações colaterais de importância.

Os autores terminam considerando o Amphotericin B como um elemento que veio tornar muito mais favorável o prognóstico desta afecção até então mortal.

SUMMARY

The authors made a review of the diagnostic difficulties in meningoencephalitis by the Criptococcus neoformans, in vivo, today easier by special methods such as China ink and culture in the CSF.

From their diagnosed 14 cases, 2 have been treated by Amphotericin B. The first was a chronic case with acute episodes which were less severe when Amphotericin B was used. This case has been alive for 20 months. The second case was an acute one with clinical and spinal fluid normalization and has a follow-up of 11 months.

In both cases Amphotericin was used intravenously (50 mg in 500 ml of a solution of glycose at 5%) in the first case 4 series and in the second case 2 series.

There were no complications. The authors consider that the use of Amphotericin B has given those cases a better prognosis.

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Trabalho do Serviço de Neurologia da Escola Paulista de Medicina (Prof. Paulino W. Longo), apresentado no Departamento de Neuro-Psiquiatria da Associação Paulista de Medicina em 5 maio 1959.

Serviço de Neurologia da Escola Paulista de Medicina - Caixa Postal 5496 - São Paulo, Brasil.

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Tratamento da criptococose do sistema nervoso pelo Amphotericin B

The treatment of neuro-criptococcosis with the Amphotericin B

Datas de Publicação

Publicação nesta coleção
09 Dez 2013
Data do Fascículo
Dez 1959

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[1] 1. ABBOT, Κ. H.; CUTLER, O. I. - Chronic coccidioidal meningitis. Arch. Pathol., 21:320-330, 1936.

[2] 2. ALMEIDA, F.; LACAZ, C. S. - Micose pelo Crypto-coccus neoformans (1º caso observado em São Paulo). An. Paul. Med., 42:385-394, 1941.

[3] 3. ALMEIDA, F.; LACAZ, C. S.; MONTEIRO SALES, F. J. - Blastomicose do tipo Busse-Buschke (granulomatose criptocócica, torulose). An. Fac. Med. Univ. São Paulo, 20:115-139, 1944.

[4] 4. AMORIM, M. F.; PASQUALLUCCI, M. E. A. - Natureza das lesões do sistema nervoso central na torulose. Rev. Latino-Amer. de Anatomia Patológica, 7:41-50, 1958.

[5] 5. APPELBAUM, E.; SHTOKALKO, S. - Cryptococeus meningitis arrested with Amphotericin B. An. Int. Med., 47:346-351, 1957.

[6] 6. BEE-SON, P. B. - Cryptococcic meningitis of nearly sixteen years duration. Arch. Int. Med., 89:797-801, 1952.

[7] 7. CALDWELL, D. C; RAPHAEL, S. S. - A case of crypto-coccal meningitis. J. Clin. Path., 8:32-37, 1955.

[8] 8. CARTON, C. A. - Neurosurgical aspects of cryptococcosis. J. Neurosurg., 8:143-156, 1951.

[9] 9. CARTON, C. A. - Treatment of central nervous system cryptococcosis: review and report of four cases treated with Actidione. An. Int. Med., 37:123-154, 1952.

[10] 10. CARTON, C. A.; LIEBIG, C. S. - Treatment of central nervous system cryptococcosis. Arch. Int. Med., 91:773-783, 1953.

[11] 11. CHAMPION DE CRESPIGNY, C. T. Torula infection of the central nervous system. Med. J. Australia, 2:605-615, 1944.

[12] 12. CLAUSELL, D. T. - Infecção primitiva do sistema nervoso central por Torulopsis neoformans (Torula histolytica): relato de um caso. An. Fac. Med. de Pôrto Alegre, 9:71-77, 1949.

[13] 13. COHEN, M. - Binocular papilledema in case of Torulosis associated with Hodgkin's disease. Arch. Ophth., 32:477-479, 1944.

[14] 14. COLLINS, V. P. - Bone involvement in cryptococcosis (Torulosis). Am. J. Roentgenol., 63:102-104, 1950.

[15] 15. CONANT, N. F.; MARTIN, D. S.; SMITH, D. T.; BAKER, R. D.; CALLAWAY, J. L. - Manual of Clinical Micology. W. B. Saunders Co., Filadélfia-Londres, 1944.

[16] 16. CORTEZ, J. M. - Criptoccocose pulmonar. An. Paul. Med. Cir., 58:315-329, 1949.

[17] 17. COX, L. B.; TOLHURST, J. C. - Cit. por Mosberg e col.⁷¹

[18] 18. CRUTCHER, J. - Fungizone for infusion. Squibb Technical Leaflet, 1958.

[19] 19. DANIEL, P. M.; SCHILLER, F.; VOLLUM, R. L. - Torulosis of the central nervous system. Lancet, 256:53-56, 1949.

[20] 20. DELABARRE, J. - Fungizone for infusion. Squibb Technical Leaflet, 1958.

[21] 21. DIAMOND. H. - Fungizone for infusion. Squibb Technical Leaflet, 1958.

[22] 22. DICKIE, H. - Fungizone for infusion. Squibb Technical Leaflet, 1958.

[23] 23. DROUET, E.; SEGRETAIN, G. - The action of hyaluronidase on the capsule of Torula histolytica. Compt. Rendu Acad. Sc., 228:424-425, 1949.

[24] 24. DUARTE, E. - Criptococose generalizada: apresentação de um caso com autópsia completa. Hospital, 43:345-361, 1953.

[25] 25. ECHOLS, D.; GARCIA, J. - Circular do Lab. Up John, 1949.

[26] 26. FIALHO, A. - Sôbre um caso de micose pulmonar e meníngea produzida pelo Cryptococcus neoformans. Brasil Méd., 66:201-202, 1952.

[27] 27. FISCHER, A. M. - The clinical picture associated with infections due to Cryptococcus neoformans. Bull. John Hopkins Hosp., 86:383-414, 1950.

[28] 28. FITZPATRICK, M. - Fungizone for infusion. Squibb Technical Leaflet, 1958.

[29] 29. FITZPATRICK, M. J.; RUBIN, H.; POSER, C. M. - The treatment of cryptococcal meningitis with Amphotericin B; a new fungicidal agent. An. Int. Med., 49:249-259, 1958.

[30] 30. FLINN, L. B.; HOOKER, J. W.; SCOTT, E. G. - Torula histolytica (Cryptococeus hominis) infection; case refractory to sulfonamides (Sulfathiazole and Sulfadiazine). Delaware State M. J., 18:141-147, 1946.

[31] 31. GEEVER, E. F.; CARTER, H. R.; NUEBUER-GER, Κ. T.; SCHMIDT, E. A. - Roentgenologic and pathologic aspects of pulmonary tumors probably alveolar in origin, with report one of them complicated by torulosis of the central nervous system. Radiology, 44:319-327, 1945.

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