Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
CRYPTOCOCCOSIS IN PATIENTS WITH ACQUIRED IMMUNODEFICIENCY SYNDROME
Infect Dis Ther; 3:267-84 1989. Unique Identifier : AIDSLINE ICDB/90665450 Simberkoff MS; Zuger A; Infectious Disease Section, New York Veterans Admin. Medical; Center, New York, NY
Abstract:
Cryptococcosis is one of the life-threatening infectious diseases seen in patients (pts) with AIDS. It is caused by Cryptococcus neoformans, an encapsulated yeast-like fungus found throughout the world and related to several nonpathogenic species. Cryptococci are not part of the normal flora of humans; their isolation almost always indicates clinical or subclinical infection. Host defense mechanisms against Cryptococcus; prevalence, organ involvement, and clinical manifestations of cryptococcosis in AIDS; diagnosis of cryptococcosis (CNS disease and extraneural infection); treatment of cryptococcosis; prognosis; maintenance treatment; and future directions in therapy are reviewed. C neoformans var neoformans has been associated with most instances of cryptococcosis in the United States; however, C neoformans var gattii has accounted for approx 40% of the clinical isolates in southern California. Although both humoral and cellular immunity operate against cryptococcosis, the latter appears to be more important. The absence of an effective cell-mediated immune response in pts with AIDS, as well as in those with less advanced HIV infection, predisposes them to cryptococcosis when they encounter this pathogen. Cryptococcosis has been observed in 5-10% of pts with AIDS evaluated at medical centers across the United States. No geographic variations in prevalence have been observed; the disease appears to occur equally in all risk groups. Multiple organ systems may be involved simultaneously. From 65-90% of cryptococcal infections in pts with AIDS involve the CNS, either alone or as part of the disseminated infection. In pts with CNS cryptococcosis, determination of cryptococcal antigen titers in cerebrospinal fluid or serum is most likely to lead to a rapid diagnosis. In most cryptococcal infections in AIDS without CNS involvement, histopathologic examination and culture have been the mainstays of diagnosis. Amphotericin B (iv) is the only established therapy for cryptococcal infection in pts with AIDS. Fluconazole and itraconazole, two new triazole compounds, have recently undergone evaluation in experimental cryptococcosis. Clinical experience with these new drugs has been limited. Fluconazole has been used as a maintenance treatment for five pts after an initial course of amphotericin B; none of these pts had clinical relapses. These results suggest that the new triazole compounds may be useful adjuncts to conventional therapy for cryptococcosis in AIDS. (69 Refs)
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS/DIAGNOSIS Antifungal Agents/THERAPEUTIC USE Cryptococcosis/*COMPLICATIONS/DIAGNOSIS Cryptococcus neoformans/IMMUNOLOGY Human Immunity, Cellular/IMMUNOLOGY Opportunistic Infections/*COMPLICATIONS/DIAGNOSIS JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL 901030
M90A0686
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Important note: Information in this article was accurate in 1990. The state of the art may have changed since the publication date.
