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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.17 no.4 São Paulo Dec. 1959

http://dx.doi.org/10.1590/S0004-282X1959000400005 

Tratamento da criptococose do sistema nervoso pelo Amphotericin B

 

The treatment of neuro-criptococcosis with the Amphotericin B

 

 

Dante GiorgiI; Paulo Pinto PupoII; João Baptista dos ReisI; José Geraldo de Camargo LimaIII 

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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