5-fluorocitosina e anfotericina-B no tratamento da criptococose do sistema nervoso central

Nobrega, J. P. S.; Livramento, J. A.; Spina-França, A.

doi:10.1590/S0004-282X1975000300003

Resumos

Registro de dois casos de criptococose do sistema nervoso central, em um deles associada a candidíase. Em ambos foram utilizados no tratamento anfotericina-B e 5-fluorocitosina. Em função dos resultados obtidos são feitas considerações quanto à utilidade de cada uma das drogas no tratamento da criptococose, bem como quanto ao uso associado de ambas.

Two cases of cryptococcosis of the central nervous system are reported. The treatment was based on the association of amphotericin-B with 5-fluorocytosine. Details on the therapeutic proprieties of these drugs are discussed considering the results obtained. Amphotericin-B was administered intravenously and intrathecally in the two cases. The total amount of amphotericin administered intravenously in the first case was 5.375 mgm, and the oral doses of 5-fluorocytosine were not superior to 100 mgm/kg/of body weight. This patient died 130 days after the first symptoms of the disease. The second patient had been submitted previously to kidney transplantation after bilateral nephrectomy, and inmunossupressive drugs were administered to him since then. Candidiasis and cryptococcosis of the central nervous system developped two years later. 5-fluorocytosine was administered orally (200 mgm/kg of body weight) and amphotericin-B. The total amount of this drug administered intravenously was 2.00 mgm. There was complete clinical and laboratory remission of the mycoses in this case.

5-fluorocitosina e anfotericina-B no tratamento da criptococose do sistema nervoso central

Amphotericin-B and 5-fluorocytosine in the treatment of cryptococcosis of the central nervous system: report of two cases

J. P. S. Nobrega^I; J. A. Livramento^II; A. Spina-França^III

^IClínica Neurológica da Faculdade de Medicina da Universidade de São Paulo (Prof. H. M. Canelas): Médico assistente

^IIClínica Neurológica da Faculdade de Medicina da Universidade de São Paulo (Prof. H. M. Canelas): Médico adido

^IIIClínica Neurológica da Faculdade de Medicina da Universidade de São Paulo (Prof. H. M. Canelas): Docente Livre

RESUMO

Registro de dois casos de criptococose do sistema nervoso central, em um deles associada a candidíase. Em ambos foram utilizados no tratamento anfotericina-B e 5-fluorocitosina. Em função dos resultados obtidos são feitas considerações quanto à utilidade de cada uma das drogas no tratamento da criptococose, bem como quanto ao uso associado de ambas.

SUMMARY

Two cases of cryptococcosis of the central nervous system are reported. The treatment was based on the association of amphotericin-B with 5-fluorocytosine. Details on the therapeutic proprieties of these drugs are discussed considering the results obtained. Amphotericin-B was administered intravenously and intrathecally in the two cases.

The total amount of amphotericin administered intravenously in the first case was 5.375 mgm, and the oral doses of 5-fluorocytosine were not superior to 100 mgm/kg/of body weight. This patient died 130 days after the first symptoms of the disease.

The second patient had been submitted previously to kidney transplantation after bilateral nephrectomy, and inmunossupressive drugs were administered to him since then. Candidiasis and cryptococcosis of the central nervous system developped two years later. 5-fluorocytosine was administered orally (200 mgm/kg of body weight) and amphotericin-B. The total amount of this drug administered intravenously was 2.00 mgm. There was complete clinical and laboratory remission of the mycoses in this case.

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Clínica Neurológica Faculdade de Medicina, Universidade de São Paulo Caixa Postal 3.461 01000 São Paulo, SP Brasil.

Apresentado ao VI Congresso Brasileiro de Neurologia, Rio de Janeiro, julho 1974.

1. BEINE. J. P.; LONTIE, M. & VANDEPITTE, J. Cryptococcal meningoencephalites and 5-fluorocytosine. Brit. med. J. 5753:107, 1971.
2. FASS, R. J. & PERKINS, R. L. 5-fluorocytosine in the treatment of cryptococcal and candida mycoses. Ann. int. Med. 74:535, 1971.
3. GIORGI, D.; REIS, J. B.; PUPO, P. P. & LIMA, J. G. C. Tratamento da criptococose do sistema nervoso pela anfotericina-B. Arq. Neuro-Psiquiat. (São Paulo) 17:377, 1959.
4. GIORGI, D. R.: REIS, J. B.; BEI, A. & REIS FILHO, J. B. Criptococose do sistema nervoso central. Arq. Neuro-Psiquiat. (São Paulo) 32:77, 1974.
5. GONZALEZ OCHOA, A. Curación de la criptococosis y de la cromomicosis con 5-fluorocitosina. Rev. Invest. Salud Publica (México) 30:63, 1970.
6. MEDOFF, G.; KOBAYASHI, G. S.; KWAN, C. N.; SCHLESSINGER, D. & VENKOV, P. Potentiation of rifampicin and 5-fluorocytosine as antifungal antibiotics by amphotericin-B. Proc. nat. Acad. Sci. 69:196, 1972.
7. OLIVEIRA, C. & ALENCAR, A. Criptococose do sistema nervoso: apresentação de 2 casos. J. brasil. Neurol. (Rio de Janeiro) 17:93, 1965.
8. SCHOLE, H. J. Antimykoticum 5-fluorocytosine. Mykosen 13:179, 1970.
9. SGINA-FRANÇA, A. & SILVA, J. B. Diagnóstico e tratamento da criptococose do sistema nervoso central. Considerações sobre 16 casos. Arq. Neuro-Psiquiat. (São Paulo) 26:115, 1968.
10. TAY, C. H.; CHEW, W. L. S. & LIN, L. C. Y. Cryptococcal meningitis: its apparent increased incidence in the Far East. Brain 95:825, 1972.
11. TOLOSA, A.; LACAZ, C. S. & SPINA-FRANÇA, A. Criptococose do sistema nervoso central. Registro de um caso. Arq. Neuro-Psiquiat. (São Paulo) 14: 171, 1956.
12. UTZ, J. P.; DUNA, R. J.; MEGEHEE, R. F. & WARNER, J. F. Chemotherapy of the systemic mycoses: recent clinical observations. Vth. Congress Internat. Soc. of Human and Animal Mycology, Paris, 1971, pág. 295.
13. VANDEVELDE, A. G.; MAUVERI, A. A. & JOHNSON, J. E. 5-fluorocytosine in the treatment of mycotic infections. Ann. int. Med. 77:43, 1972.
¹⁴
Editorial Flucytosine (Ancobon): a new antifungal drug. The Medical Letter on Drugs and Therapeutics 14:29, 1972.
¹⁵
Prospecto The clinical evaluation of Ancobon (flucytosine). Data on file. Roche Scientific Summary, Nutley, 1971.
¹⁶
Prospecto Data sheet on 5-fluorocytosine. Roche, Nutley, 1972.

Datas de Publicação

Publicação nesta coleção
05 Abr 2013
Data do Fascículo
Set 1975

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

[1] 1. BEINE. J. P.; LONTIE, M. & VANDEPITTE, J. Cryptococcal meningoencephalites and 5-fluorocytosine. Brit. med. J. 5753:107, 1971.

[2] 2. FASS, R. J. & PERKINS, R. L. 5-fluorocytosine in the treatment of cryptococcal and candida mycoses. Ann. int. Med. 74:535, 1971.

[3] 3. GIORGI, D.; REIS, J. B.; PUPO, P. P. & LIMA, J. G. C. Tratamento da criptococose do sistema nervoso pela anfotericina-B. Arq. Neuro-Psiquiat. (São Paulo) 17:377, 1959.

[4] 4. GIORGI, D. R.: REIS, J. B.; BEI, A. & REIS FILHO, J. B. Criptococose do sistema nervoso central. Arq. Neuro-Psiquiat. (São Paulo) 32:77, 1974.

[5] 5. GONZALEZ OCHOA, A. Curación de la criptococosis y de la cromomicosis con 5-fluorocitosina. Rev. Invest. Salud Publica (México) 30:63, 1970.

[6] 6. MEDOFF, G.; KOBAYASHI, G. S.; KWAN, C. N.; SCHLESSINGER, D. & VENKOV, P. Potentiation of rifampicin and 5-fluorocytosine as antifungal antibiotics by amphotericin-B. Proc. nat. Acad. Sci. 69:196, 1972.

[7] 7. OLIVEIRA, C. & ALENCAR, A. Criptococose do sistema nervoso: apresentação de 2 casos. J. brasil. Neurol. (Rio de Janeiro) 17:93, 1965.

[8] 8. SCHOLE, H. J. Antimykoticum 5-fluorocytosine. Mykosen 13:179, 1970.

[9] 9. SGINA-FRANÇA, A. & SILVA, J. B. Diagnóstico e tratamento da criptococose do sistema nervoso central. Considerações sobre 16 casos. Arq. Neuro-Psiquiat. (São Paulo) 26:115, 1968.

[10] 10. TAY, C. H.; CHEW, W. L. S. & LIN, L. C. Y. Cryptococcal meningitis: its apparent increased incidence in the Far East. Brain 95:825, 1972.

[11] 11. TOLOSA, A.; LACAZ, C. S. & SPINA-FRANÇA, A. Criptococose do sistema nervoso central. Registro de um caso. Arq. Neuro-Psiquiat. (São Paulo) 14: 171, 1956.

[12] 12. UTZ, J. P.; DUNA, R. J.; MEGEHEE, R. F. & WARNER, J. F. Chemotherapy of the systemic mycoses: recent clinical observations. Vth. Congress Internat. Soc. of Human and Animal Mycology, Paris, 1971, pág. 295.

[13] 13. VANDEVELDE, A. G.; MAUVERI, A. A. & JOHNSON, J. E. 5-fluorocytosine in the treatment of mycotic infections. Ann. int. Med. 77:43, 1972.

[14] ¹⁴
Editorial Flucytosine (Ancobon): a new antifungal drug. The Medical Letter on Drugs and Therapeutics 14:29, 1972.

[15] ¹⁵
Prospecto The clinical evaluation of Ancobon (flucytosine). Data on file. Roche Scientific Summary, Nutley, 1971.

[16] ¹⁶
Prospecto Data sheet on 5-fluorocytosine. Roche, Nutley, 1972.