Problemas clínicos en Micología Médica: problema número 55

Romero, Mercedes; Messina, Fernando; Depardo, Roxana; Marín, Emmanuel; Arechavala, Alicia; Lista, Nicolás; Rodríguez, A. Aguilar; Santiso, Gabriela

doi:10.1016/j.riam.2020.10.004

Cited by 1 publication

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“…Two patients died. One of them had proven severe PC and pneumocystosis [ 22 ] ( Figure 3 b), the other during secondary prophylaxis, after completing the probable PC scheme, due to a sarcoma in the pelvic region. The rest of the patients progressed favorably.…”

Section: Resultsmentioning

confidence: 99%

Preemptive Therapy in Cryptococcosis Adjusted for Outcomes

Messina

Santiso

Arechavala

et al. 2023

JoF

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Cryptococcosis is one of the most serious opportunistic diseases in patients living with HIV. For this reason, early diagnosis and appropriate treatment are important. Objectives. The aim of the study was to understand the development of patients diagnosed with cryptococcosis by detection of Cryptococcus antigen in serum by lateral flow assay (CrAg LFA) without nervous system involvement and with treatment in accordance with the results. Materials and Methods. A retrospective, longitudinal, analytical study was performed. Seventy patients with cryptococcosis initially diagnosed by serum CrAg LFA without meningeal involvement between January 2019 and April 2022 were analyzed for medical records. The treatment regimen was adapted to the results of blood culture, respiratory material, and pulmonary tomography imaging. Results. Seventy patients were included, 13 had probable pulmonary cryptococcosis, 4 had proven pulmonary cryptococcosis, 3 had fungemia, and 50 had preemptive therapy without microbiological or imaging findings compatible with cryptococcosis. Among the 50 patients with preemptive therapy, none had meningeal involvement or cryptococcosis recurrences to date. Conclusion. Preemptive therapy avoided progression to meningitis in CrAg LFA-positive patients. Preemptive therapy with dose adjustment of fluconazole in patients with the mentioned characteristics was useful despite the use of lower doses than recommended.

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Section: Resultsmentioning

confidence: 99%