[Cryptococcosis not associated with AIDS. Clinical study of seven patients].

BACKGROUND

The aim of the present was to study the clinical characteristics, the diagnostic methods, response to treatment and the evolution of cryptococcosis not associated with AIDS.

METHODS

Seven cases studied in the Hospital Ramon y Cajal of Madrid, Spain over a 19-year period (1980-1998). Diagnosis was determined by LCR culture, blood or other clinical samples.

RESULTS

Four patients were males with a mean age of 45.1 years (range: 23-69 years). All except one case presented a predisposing disease and three received corticoids and/or immunosuppressive drugs. Six patients presented meningitis and one pneumonia. The meningitis showed a subacute course with pleocytosis, hypoglycorrhachia and hyperproteinorrhachia in most of the patients. Chinese ink staining, culture and the cryptococcic antigen of LCR were positive in all the cases of meningitis evaluated. All the patients were initially treated with amphotericin and fluorocytosin. This schedule was substituted in two cases by amphotericin lipid formulas because of adverse effects and by fluconazol as an elective choice in one case. The evaluation was favorable in all the patients. One patient presented meningeal and cutaneous recurrence. Three patients died, although none did so during the acute episode or as a consequence of the infection.

CONCLUSIONS

Cryptococcosis not associated with AIDS is rare in Sapin. It usually evolves with subacute hypoglucorrhachic meningitis and the conventional diagnostic techniques (Chinese ink staining, cryptococcic antigen and culture) provide adequate profitability. Response to treatment with amphotericin and fluorocytosis is usually favorable, although there are therapeutic alternatives which are adequate for selected cases.