Csf in 85 patients with aids and cns cryptococcosis

Livramento, J. A.; Machado, L. R.; Nóbrega, J. P. S.; Gomes, H. R.; Vianna, L. S.; Spina-frança, A.

doi:10.1590/S0004-282X1992000400012

Abstracts

In an eight years time period (July 1984-June 1992) CSF samples of 40718 patients were studied, and 610 were from patients with AIDS clinically diagnosed and immunologically confirmed through HIV antibodies detection. Among opportunistic infections detected in them 85 were CNS cryptococcosis. For the purpose of this study the CSF of these 85 patients are the AIDS group of CNS cryptococcosis. For comparison, CSF data from 50 patients with CNS cryptococcosis but without AIDS were taken (non-AIDS group); in this group, 22 patients were immunosuppressed after renal transplant. In AIDS group, the more frequent CSF findings were: yeast presence at direct exam (Fuchs-Rosenthal cell counting chamber), growing of the yeast in cultures, and gamma globulins increase. In non-AIDS group were more frequent: hypereytosis, neutrophil cells presence, and total protein increase. Differences between the two groups are discussed taking into account CNS/CSF immune changes induced by HIV infection. It is concluded that in CNS cryptococcosis of patients with AIDS the CSF evidenced more extensive signs of the fungal opportunistic infection than signs of inflammatory response to the infection. The latter were more prominent among patients of the non-AIDS group of CNS cryptococcosis.

cryptococcosis; central nervous system; cerebrospinal fluid; AIDS

Foi estudado o LCR de 85 pacientes com AIDS e criptococose do SNC. O diagnóstico clínico e imunológico de AIDS foi previamente estabelecido em todos os casos. Os resultados foram comparados aos de grupo de 50 paciestes com neurocriptococose porém sem AIDS (grupo não-AIDS). Neste grupo 22 pacientes eram imunossuprimidos após transplante renal. Nos pacientes do grupo AIDS predominavam no LCR: detecção da levedura no exame direto (câmara de Fuchs-Rosenthal de contagem de células), culturas da levedura positivas e aumento do teor de globulinas gama. No grupo não-AIDS predominavam: pleocitose, presença de polinucleares neutrófilos e aumento da concentração protéica total. As diferenças encontradas entre os dois grupos são discutidas, salientando-se as modificações imunes induzidas no SNC/LCR pelo HIV. Conclui-se que na neurocriptococose em pacientes com AIDS o LCR evidenciou mais a infecção pelo fungo que a resposta inflamatória à infecção. Esta última predominou no LCR de pacientes do grupo neurocriptococose não-AIDS.

criptococose; sistema nervoso central; líquido cefalorraqueano; AIDS (SIDA)

J. A. Livramento^I; L. R. Machado^I; J. P. S. Nóbrega^I; H. R. Gomes^II; L. S. Vianna^II; A. Spina-frança^III

^IAssistant Professor. CIN (Neurology Investigation Center, Department of Neurology, Faculty of Medicine, São Paulo University) / LSF (Neurodiagnostics Laboratory)

^IIResearcher Neurologist. CIN (Neurology Investigation Center, Department of Neurology, Faculty of Medicine, São Paulo University) / LSF (Neurodiagnostics Laboratory)

^IIIEmeritus Professor. Ptart of this investigation was presented at the International Quincke Symposium (Göttingen, September 18-21, 1991) and at the Quincke Symposium (Lisboa, November 29-30, 1991). CIN (Neurology Investigation Center, Department of Neurology, Faculty of Medicine, São Paulo University) / LSF (Neurodiagnostics Laboratory)

SUMMARY

In an eight years time period (July 1984-June 1992) CSF samples of 40718 patients were studied, and 610 were from patients with AIDS clinically diagnosed and immunologically confirmed through HIV antibodies detection. Among opportunistic infections detected in them 85 were CNS cryptococcosis. For the purpose of this study the CSF of these 85 patients are the AIDS group of CNS cryptococcosis. For comparison, CSF data from 50 patients with CNS cryptococcosis but without AIDS were taken (non-AIDS group); in this group, 22 patients were immunosuppressed after renal transplant. In AIDS group, the more frequent CSF findings were: yeast presence at direct exam (Fuchs-Rosenthal cell counting chamber), growing of the yeast in cultures, and gamma globulins increase. In non-AIDS group were more frequent: hypereytosis, neutrophil cells presence, and total protein increase. Differences between the two groups are discussed taking into account CNS/CSF immune changes induced by HIV infection. It is concluded that in CNS cryptococcosis of patients with AIDS the CSF evidenced more extensive signs of the fungal opportunistic infection than signs of inflammatory response to the infection. The latter were more prominent among patients of the non-AIDS group of CNS cryptococcosis.

Key words: cryptococcosis, central nervous system, cerebrospinal fluid, AIDS.

RESUMO

Foi estudado o LCR de 85 pacientes com AIDS e criptococose do SNC. O diagnóstico clínico e imunológico de AIDS foi previamente estabelecido em todos os casos. Os resultados foram comparados aos de grupo de 50 paciestes com neurocriptococose porém sem AIDS (grupo não-AIDS). Neste grupo 22 pacientes eram imunossuprimidos após transplante renal. Nos pacientes do grupo AIDS predominavam no LCR: detecção da levedura no exame direto (câmara de Fuchs-Rosenthal de contagem de células), culturas da levedura positivas e aumento do teor de globulinas gama. No grupo não-AIDS predominavam: pleocitose, presença de polinucleares neutrófilos e aumento da concentração protéica total. As diferenças encontradas entre os dois grupos são discutidas, salientando-se as modificações imunes induzidas no SNC/LCR pelo HIV. Conclui-se que na neurocriptococose em pacientes com AIDS o LCR evidenciou mais a infecção pelo fungo que a resposta inflamatória à infecção. Esta última predominou no LCR de pacientes do grupo neurocriptococose não-AIDS.

Palavras-chave: criptococose, sistema nervoso central, líquido cefalorraqueano, AIDS (SIDA).

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Acknowledgement The authors thank Professor Carlos da Silva Lacaz (Laboratory of Mycology, Faculty of Medicine, São Paulo University) for the kindness of his assistance throughout the years this study run, and for Figure 3-1.

Dr. José Antonio Livramento Caixa Postal 5199 - 01061-970 São Paulo SP - Brasil.

1. Biancalana MLN, Stefani HNV, Pasternak J, Rosenthal C, Levi GC, Mendonça JS. AIDS in São Paulo, Brasil: clinical experience with 116 hospitalized cases. In: International Congress for Infectious Diseases/Congresso da Sociedade Brasileira de Infectolo-gia 5. Rio de Janeiro 1988, p 255 (Abstr 672).
2. Calvo B, Fishman O, Castelo A Filho, Reis J Filho, Del Bianco R, Barbosa RM, Zaror L. Detección de antígeno del polisacarido capsular de Cryptococcus neoformans en pacientes con SIDA y neurocriptococosis en São Paulo, Brasil. Rev Inst Med Trop São Paulo 1991, 33:485-490.
3. Eng RHK, Bishburg E, Smith SM. Cryptococcal infections in patients with acquired immune deficiency syndrome. Am J Med 1986, 81:19-23.
4. Kovacs JA, Kovacs AA, Polis M, Wright C, Gill VJ, Tuazon CV, Gelmann EP, Lane NC, Longfield R, Overturf G, Macher AM, Fauci AS, Parrillo JG, Bennet JE, Masur H. Cryptococcosis in the acquired immunodeficiency syndrome. Ann Intern Med 1985, 103:533-5389
5. Levy RM, Bredesen DE, Rosemblum ML. Opportunistic central nervous system pathology in patients with AIDS. Ann Neurol 1988, 23 (Suppl): S7-S12.
6. Livramento JA, Machado LR, Spina-França A. Anormalidades do líquido cefalorraquea-no em 170 casos de AIDS. Arq Neuro-Psiquiat (São Paulo) 1989, 47:326-331.
7. Livramento JA, Machado LR, Gomes HR, Vianna LS, Spina-França A. AIDS: a CSF laboratory experience on 470 cases in a seven year time period. Arq Neuro-Psiquiat (São Paulo) 1992, 50:56-59.
8. Machado LR., Fecchio D, Limongi JCP, Berger A, Livramento JA, Spina-França A. Neurocriptococose e imunossupressão: modelo experimental em camundongos. Arq Neuro-Psiquiat (São Paulo) 1985, 43:29-38.
9. Nóbrega JPS. Anfotericina B no tratamento da neurocriptococose em pacientes submetidos a transpalnte renal. Arq Neuro-Psiquiat (Sao Paulo) 1988, 46:117-126.
10. Zuger A, Louie E, Holzman RS, Simberkoff MS, Rahal JJ. Cryptococcal disease in patients with the acquired immunodeficiency syndrome. Ann Intern Med 1986, 104:234-240.

Csf in 85 patients with aids and cns cryptococcosis

Líquido cefalarraqueano em 85 pacientes com AIDS e neurocriptococose

Publication Dates

Publication in this collection
22 Feb 2011
Date of issue
Dec 1992

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

[1] 1. Biancalana MLN, Stefani HNV, Pasternak J, Rosenthal C, Levi GC, Mendonça JS. AIDS in São Paulo, Brasil: clinical experience with 116 hospitalized cases. In: International Congress for Infectious Diseases/Congresso da Sociedade Brasileira de Infectolo-gia 5. Rio de Janeiro 1988, p 255 (Abstr 672).

[2] 2. Calvo B, Fishman O, Castelo A Filho, Reis J Filho, Del Bianco R, Barbosa RM, Zaror L. Detección de antígeno del polisacarido capsular de Cryptococcus neoformans en pacientes con SIDA y neurocriptococosis en São Paulo, Brasil. Rev Inst Med Trop São Paulo 1991, 33:485-490.

[3] 3. Eng RHK, Bishburg E, Smith SM. Cryptococcal infections in patients with acquired immune deficiency syndrome. Am J Med 1986, 81:19-23.

[4] 4. Kovacs JA, Kovacs AA, Polis M, Wright C, Gill VJ, Tuazon CV, Gelmann EP, Lane NC, Longfield R, Overturf G, Macher AM, Fauci AS, Parrillo JG, Bennet JE, Masur H. Cryptococcosis in the acquired immunodeficiency syndrome. Ann Intern Med 1985, 103:533-5389

[5] 5. Levy RM, Bredesen DE, Rosemblum ML. Opportunistic central nervous system pathology in patients with AIDS. Ann Neurol 1988, 23 (Suppl): S7-S12.

[6] 6. Livramento JA, Machado LR, Spina-França A. Anormalidades do líquido cefalorraquea-no em 170 casos de AIDS. Arq Neuro-Psiquiat (São Paulo) 1989, 47:326-331.

[7] 7. Livramento JA, Machado LR, Gomes HR, Vianna LS, Spina-França A. AIDS: a CSF laboratory experience on 470 cases in a seven year time period. Arq Neuro-Psiquiat (São Paulo) 1992, 50:56-59.

[8] 8. Machado LR., Fecchio D, Limongi JCP, Berger A, Livramento JA, Spina-França A. Neurocriptococose e imunossupressão: modelo experimental em camundongos. Arq Neuro-Psiquiat (São Paulo) 1985, 43:29-38.

[9] 9. Nóbrega JPS. Anfotericina B no tratamento da neurocriptococose em pacientes submetidos a transpalnte renal. Arq Neuro-Psiquiat (Sao Paulo) 1988, 46:117-126.

[10] 10. Zuger A, Louie E, Holzman RS, Simberkoff MS, Rahal JJ. Cryptococcal disease in patients with the acquired immunodeficiency syndrome. Ann Intern Med 1986, 104:234-240.