Consenso em criptococose: 2008

Grumach, Anete Sevciovic; Filho, Flávio de Queiroz Telles; Mendes, Rinaldo Pôncio; Colombo, Arnaldo Lopes; Moretti, Maria Luíza; Kono, Adriana; Penalva, Augusto César de Oliveira; Wanke, Bodo; Aranha, Luiz Fernando; Lazéra, Márcia dos Santos; Severo, Luiz Carlos; Ferreira, Marcelo Simão; Vergara, Mario Leon Silva; Martínez, Roberto; Resende, Mariângela Ribeiro; Salmito, Maria do Amparo; Shikanai-Yasuda, Maria Aparecida; Andrade, Najara Maria Procópio; Trabasso, Plı́nio; Ponzio, Vinícius

doi:10.1590/s0037-86822008000500022

Cited by 60 publications

(39 citation statements)

References 107 publications

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“…The less toxic agent fluconazole (FCZ) offered an attractive alternative in the treatment of cryptococcosis and a variety of other invasive fungal infections in nonneutropenic patients (2,3); however, its use is limited due to resistance of Cryptococcus spp. (4). Recently, voriconazole (VRC), which exhibits fungistatic activity against resistant strains of Cryptococcus (5,6), has been recognized as a novel therapeutic option for the treatment of cryptococcal meningitis (7)(8)(9)(10), but there are scarce studies focusing on its pharmacokinetic/pharmacodynamic (PK/PD) behavior during the infectious process in the brain.…”

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confidence: 99%

Influence of Experimental Cryptococcal Meningitis in Wistar Rats on Voriconazole Brain Penetration Assessed by Microdialysis

Alves

Staudt

Silva

et al. 2017

Antimicrob Agents Chemother

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To make advances in the treatment of cryptococcal meningitis, it is crucial to know a given drug's free fraction that reaches the biophase. In the present study, we applied microdialysis (D) as a tool to determine the free levels reached by voriconazole (VRC) in the brains of healthy and Cryptococcus neoformans-infected rats. The infection was induced by the intravenous (i.v.) administration of 1 ϫ 10 5 CFU of yeast. The dose administered was 5 mg/kg (of body weight) of VRC, given i.v. Plasma and microdialysate samples were analyzed by liquid chromatographytandem mass spectrometry (LC-MS/MS) and LC-UV methods. The free brain/free plasma ratio (fT) and population pharmacokinetic (popPK) analyses were performed to evaluate the impact of infection on PK parameters of the drug. The brain penetration ratio showed an increase on brain exposure in infected animals (fT healthy ϭ 0.85 versus fT infected ϭ 1.86). The structural PK model with two compartments and Michaelis-Menten (MM) elimination describes the VRC concentration-time profile in plasma and tissue simultaneously. The covariate infection was included in volume of distribution in the peripheral compartment in healthy animals (V 2 ) and maximum rate of metabolism (V M ). The levels reached in infected tissues were higher than the values described for MIC of VRC for Cryptococccus neoformans (0.03 to 0.5 g ml Ϫ1 ), indicating its great potential to treat meningitis associated with C. neoformans.

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confidence: 99%

Influence of Experimental Cryptococcal Meningitis in Wistar Rats on Voriconazole Brain Penetration Assessed by Microdialysis

Alves

Staudt

Silva

et al. 2017

Antimicrob Agents Chemother

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“…( 10 ) Although host immunocompetence contributes to pulmonary cryptococcosis presenting as nodules, such nodules are typically subpleural and smaller in size, as described in guidelines published in 2008. ( 11 ) A low level of symptoms is not uncommon, being found in cases of tuberculosis ( 10 ) and in approximately 25% of all cases of cryptococcosis ( 11 ) in immunocompetent patients. Nevertheless, in the present case, the finding of cryptococcosis widely present in the mediastinal lymph nodes and sparsely present in the lung parenchyma prompted a reassessment of the immune status of the patient.…”

Section: Discussionmentioning

confidence: 99%

“…( 10 ) Muito embora a imunocompetência do hospedeiro também favoreça o padrão nodular de apresentação da criptococose pulmonar, os nódulos nessa última condição são tipicamente de localização subpleural e com dimensões mais reduzidas, segundo diretrizes de 2008. ( 11 ) O baixo grau de sintomas não é achado incomum, estando presente tanto na tuberculose ( 10 ) quanto em cerca de 25% dos casos de criptococose ( 11 ) em pacientes com imunidade preservada. Ainda assim, no presente caso, o achado de criptococose extensamente presente nos linfonodos mediastinais e com manifestações esparsas no parênquima pulmonar motivou uma reavaliação da imunidade do paciente, sendo essa imunidade reforçada pela negatividade do teste de ELISA para anti-HIV, pelos níveis normais de imunoglobulinas séricas, pela negatividade do fator antinuclear e do fator reumatoide, pelos níveis elevados no teste de nitroazul de tetrazólio (espontâneo, 55%; estimulado, 71%) e pelos níveis normais de linfócitos CD4 e CD8.…”

Section: Discussionunclassified

Cryptococcosis, silicosis, and tuberculous pseudotumor in the same pulmonary lobe

et al. 2013

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Tuberculosis and cryptococcosis are infectious diseases that can result in the formation of single or multiple nodules in immunocompetent patients. Exposure to silica is known to raise the risk of infection with Mycobacterium tuberculosis. We report the case of an elderly man with no history of opportunistic infections and no clinical evidence of immunodeficiency but with a six-month history of dry cough and nocturnal wheezing. A chest X-ray revealed a mass measuring 5.0 × 3.5 cm in the right upper lobe. The diagnostic approach of the mass revealed tuberculosis. The histopathological analysis of the surrounding parenchyma reveled silicosis and cryptococcosis. Cryptococcosis was also found in masses identified in the mediastinal lymph nodes. The surgical approach was indicated because of the degree of pleuropulmonary involvement, the inconclusive results obtained with the invasive and noninvasive methods applied, and the possibility of malignancy. This case illustrates the difficulty inherent to the assessment of infectious or inflammatory pulmonary pseudotumors, the differential diagnosis of which occasionally requires a radical surgical approach. Despite the presence of respiratory symptoms for six months, the first chest X-ray was performed only at the end of that period. We discuss the possible pathogenic mechanisms that might have led to the combination of three types of granulomatous lesions in the same lobe, and we emphasize the need for greater awareness of atypical presentations of pulmonary tuberculosis.

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“…laurentii, have been isolated from food, aquatic environments, soil, bird droppings and human skin [15].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Decreased Susceptibility of Cryptococcus spp. Isolates to Fluconazole in Urban Sources of Presidente Prudente

Marçon¹,

Moreira²,

Inocencio³

et al. 2017

JPP

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Abstract:The genus Cryptococcus is composed of encapsulated yeasts that have the ability to infect and cause disease in humans, as Cryptococcus gattii/Cryptococcus neoformans species complex. Facing the current research panel, few studies about cryptococcosis and epidemiological data have been carried out in the western region of Sao Paulo state. This study aimed to verify the occurrence of Cryptococcus spp. In public areas of the city of Presidente Prudente, using pigeon droppings and tree hollows as an environmental source. The samples were identified by conventional mycological methods. Were collected 54 samples from pigeon droppings and 62 samples from tree hollows of the genus Licania. And of these samples, 47 (87.0%) and 14 (22.5%) had positive growth of yeast from pigeon droppings and tree hollows, respectively. Cryptococcus was identified in 11 (20.4%) of the samples from pigeon droppings and 3 (21.4%) of those from tree hollows. The following species were identified: Cryptococcus neoformans (7.15%), Cryptococcus laurentti (14.28%), and Cryptococcus albidus (78.57%). Decreased susceptibility to fluconazole was observed for some isolates. Fluconazole exhibited a limited in vitro activity, particularly against Cryptococcus albidus and Cryptococcus laurentii. Identification and susceptibility testing of Cryptococcus spp. should be performed on a routine basis in view of their unpredictable susceptibility profiles.

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Consenso em criptococose: 2008

Cited by 60 publications

References 107 publications

Influence of Experimental Cryptococcal Meningitis in Wistar Rats on Voriconazole Brain Penetration Assessed by Microdialysis

Influence of Experimental Cryptococcal Meningitis in Wistar Rats on Voriconazole Brain Penetration Assessed by Microdialysis

Cryptococcosis, silicosis, and tuberculous pseudotumor in the same pulmonary lobe

Prevalence of Decreased Susceptibility of Cryptococcus spp. Isolates to Fluconazole in Urban Sources of Presidente Prudente

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