Cerebral infection caused by Cryptococcus gattii: a case report and antifungal susceptibility testing.
We report a clinical case of cerebral infection caused by Cryptococcus gattii in a 10 year-old boy. Clinical and laboratory exams did not demonstrate any apparent immunosuppressed state (HIV antibody and the tuberculin skin tests, both negative, were performed; blood cells count and immunoglobulin l...
| Publicado en: | Revista Iberoamericana de Micologia Vol. 25; no. 4; pp. 242 - 246 |
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| Autores principales: | , , , , , , |
| Formato: | Case Study |
| Publicado: |
Elsevier B.V.
dic2008
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=lth&AN=36491096&site=ehost-live header: @attributes: shortDbName: lth uiTerm: 36491096 longDbName: MedicLatina uiTag: AN controlInfo: bkinfo: jinfo: jid: 11301406 PVP jtl: Revista Iberoamericana de Micologia issn: 11301406 maglogo: N pubinfo: dt: dic2008 vid: 25 iid: 4 pid: 467 pub: Elsevier B.V. artinfo: ui: 36491096 10.1016/S1130-1406(08)70057-3 ppf: 242 ppct: 4 formats: fmt: @attributes: type: P size: 1.7MB tig: atl: Cerebral infection caused by Cryptococcus gattii: a case report and antifungal susceptibility testing. aug: au: Soares, Betânia Maria Santos, Daniel Assis Kohler, Lidiane Meire César, Giovana da Costa de Carvalho, Inácio Roberto Martins, Marilena dos Anjos Cisalpino, Patrícia Silva affil: Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Centro Geral de Pediatria, Belo Horizonte, Minas Gerais Seção de Micologia, Instituto Adolfo Lutz, São Paulo, São Paulo, Brazil su: Infection treatment Cryptococcus Antifungal agents Drug synergism sug: subj: Infection treatment Cryptococcus Antifungal agents Drug synergism keyword: Amphotericin B Antifungal susceptibility testing Antifungal therapy Cryptococcus gattii Anfotericina B Cryptococcus gattii Sensibilidad antifúngica Terapia antifúngica ab: We report a clinical case of cerebral infection caused by Cryptococcus gattii in a 10 year-old boy. Clinical and laboratory exams did not demonstrate any apparent immunosuppressed state (HIV antibody and the tuberculin skin tests, both negative, were performed; blood cells count and immunoglobulin levels were within normality). Treatment was begun with amphotericin B-deoxycholate but renal toxicity signs led to its substitution by fluconazole. The infection proceeded even after treatment with fluconazole. In vitro determination of minimum inhibitory concentration values were high for itraconazole (≥ 2 µg/ml), fluconazole and 5-flucytosine (≥ 64 µg/ml) and low for amphotericin B (1.0 µg/ml). Renal toxicity signs, induced by amphotericin B, progression of infection after fluconazole, and likely in vivo resistance to this triazole made this case difficult to treat. In vitro drug interaction tests confirmed probable synergism between amphotericin B and 5-flucytosine (frational inhibitory concentration - FIC = 0.375). In contrast, a probable additive effect was observed for amphotericin B and fluconazole (FIC = 0.75). Initial treatment of persistent high intracranial pressure was insufficient and neurological surgery was necessary. Antifungal susceptibility tests and Cryptococcus species identification were important in selecting appropriate antifungal therapy. Relatamos un caso clínico de infección cerebral provocada por Cryptococcus gattii en un niño de 10 años. Los exámenes clínicos y de laboratorio no demostraban ningún estado aparente de inmunosupresión (anticuerpos VIH y prueba de tuberculina negativos, recuento sanguíneo y niveles de inmunoglobulinas dentro de la normalidad). El tratamiento comenzó con anfotericina B desoxicolato, pero la toxicidad renal condujo a su sustitución por fluconazol. La infección persistió después del tratamiento con fluconazol. La determinación in vitro de los valores de la concentración inhibitoria mínima mostraron valores altos para el itraconazol (≥ 2 µg/ml), el fluconazol y la 5-fluorocitosina (≥ 64 µg/ml), y bajos para la anfotericina B (1 µg/ml). Los signos de intoxicación renal inducidos por la anfotericina B, el avance de la infección después del tratamiento con fluconazol y probablemente la resistencia in vivo a este triazol hacen que éste sea un caso difícil de tratar. Las pruebas de interacción in vitro entre las drogas confirman un probable sinergismo entre la anfotericina B y la 5-fluorocitosina (concentración inhibitoria fraccionaria - CIF = 0,375). Sin embargo, se ha observado un probable efecto aditivo para la anfotericina B y fluconazol (CIF = 0,75). El tratamiento inicial de la alta presión intracraneal persistente fue insuficiente y fue necesaria cirugía neurológica. Las pruebas de sensibilidad antifúngica y de identificación de las especies de Cryptococcus fueron importantes en la selección de la terapia antifúngica apropiada. pubtype: Academic Journal doctype: Case Study src: R language: English refInfo: copyright: @attributes: flag: Y custom: Copyright of Revista Iberoamericana de Micologia is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. item: Revista Iberoamericana de Micologia holder: Elsevier B.V. dt: @attributes: year: 2008 holdings: @attributes: islocal: N |
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