Fatores prognósticos da meningoencefalite criptocócica

Abstract

RESUMO - Prognostic factors in cryptococcal meningoencephalitisABSTRACT -Objective: To identify demographic, clinical and cerebrospinal fluid (CSF) variables associated to intrahospitalar lethality of patients with cryptococcal meningoencephalitis. Study design: Retrospective cohort to study prognosis. Setting: Hospital Couto Maia (HCMaia) reference for patients with infectious diseases in the State of Bahia Northeastern Brazil. Population: Patients admitted at HCMaia, from 1972 to 1996, with the diagnosis of cryptococcal meningoencephalitis. Results: Lethality rate was 42.7%. The most important neurological abnormalities were neck stiffness, decreased consciousness level, behavior changes, cranial nerve palsy and visual alterations. Disease time over 30 days, involvement of consciousness level and cerebrospinal fluid cells under 40/mm³ were associated to a higher lethality rate. Conclusion: Disease time over 30 days, involvement of consciousness level, and CSF decreased cellularity were the only predictors of lethality in the studied population.

A retrospective study of contributing factors for prognosis and survival length of cryptococcal meningoencephalitis in Southern part of China (1998–2013)

“…Darze [23] reported that consciousness level contributes to CM prognosis, while other studies demonstrated a lower CSF opening pressure and a change of white blood cell in CSF was associated to a higher lethality rate [24]. In our study, however, we analyzed both symptoms induced by brain tissue damage, such as change of consciousness level, epilepsy, cerebellum symptoms and psychosis, and CSF changes in CM patients.…”

Clinical Laboratory Characteristics of Cryptococcosis in Patients Admitted to the Emergency Room Hospital das Clínicas, Federal University of Minas Gerais, Tertiary Reference of the Unified Health System: Retrospective Analysis from 2000 to 2013

“…A pesquisa de criptococo deve ser realizada em todo paciente com meningite, meningo-encefalite ou hipertensão intracraniana não identificados, associados a aspecto inflamatório no líquor.A causa principal do fracasso da terapia para a neurocriptococose associada a SIDA é devida à baixa imunidade do hospedeiro. 2 A letalidade é elevada entre 45 a 72%, sendo de pior prognóstico a presença de: [86][87] elevada carga fúngica, comprovada pela pesquisa no líquor e pelos títulos da reação do látex elevados (> 1/1024); alterações sensoriais no início da apresentação clínica; obnubilação, torpor ou coma; ausência de resposta inflamatória no líquor (< 20 cels/mm 3 ); presença de invasão micótica extraneurológica (pulmões, sangue, fígado, pele, dentre outros); imunossupressão avançada (LTCD 4 + < 50 cels/mm 3 ). A importância crescente das micoses profundas estimula seu estudo para que possam ser identificadas com precocidade e adequadamente tratadas, como também são de valor o reconhecimento da histoplasmose, paracoccidiodiomicose, maduromicose, esporotricose, candidíase e pneumocistose, em várias circunstâncias em que a imunossupressão passa a predominar em que a tecnologia disponível não consegue reverter sua evolução para a morte.…”

“…49,53,[72][73][74][75][76][77][78][79] A mortalidade por criptococose é estimada em 10% a 43% com sobrevida em torno de 14 dias. 2,[80][81][82][83][84][85][86][87] O objetivo deste estudo foi o de descrever os dados demográficos, clínicos, comorbidades, sintomas ou sinais, permanência hospitalar, e o prognóstico de pacientes com neurocriptococose, atendidos no HC da UFMG.…”

Gender-specific contributing risk factors and outcome of female cryptococcal meningoencephalitis patients

“…Decreased consciousness level, a lower CSF opening pressure and the decreased ratio of CSF glucose-to-blood glucose were reported contributed to CM prognosis [ 26 ]. In our study, decreased ratio of CSF glucose-to-blood glucose was the only factor related to the survival length of female CM patients.…”