Criptococosis: Revisión de la enfermedad con énfasis en las lesiones cutáneas de pacientes con sida
Palabras clave:
criptococosis, criptococosis cutánea, criptococosis y sidaResumen
La criptococosis es una micosis multisistémica causada por Cryptococcus neoformans, que se ha convertido en una de las primeras causas de enfermedad en inmunosuprimidos.
Nuestro objetivo es revisar la criptococosis en Colombia, enfatizando las características del hongo, las condiciones predisponentes de la enfermedad y su expresión en la piel, especialmente en pacientes con sida.
Revisamos la literatura nacional e internacional, incluyendo los datos del grupo colombiano de estudio de la criptococosis, aunados a la experiencia institucional de los autores.
La causa predisponente más frecuente en nuestro medio es la inmunosupresión por sida, seguida del uso de corticoides y del lupus eritematoso sistémico. Hay un porcentaje importante de casos sin causa predisponente conocida. La criptococosis es la principal causa de meningoencefalitis micótica en el mundo y puede comprometer otros órganos como pulmón, ganglios linfáticos, riñón, hueso y próstata. La piel se afecta en un 10% de los casos, compromiso que puede preceder o acompañar las manifestaciones multisistémicas. El diagnóstico se confirma con el estudio del LCR y otras secreciones corporales infectadas. El examen directo con tinta china y el cultivo muestran tasas de sensibilidad y especificidad cercanas al 90%. Los estudios de aglutinación de látex en LCR y suero son rápidos, sensibles y específicos, en especial en infecciones diseminadas. El diagnóstico de las lesiones cutáneas se puede hacer con la tinción negativa con tinta china y con la biopsia que demuestran las levaduras. Los tratamientos incluyen: anfotericina B, fluconazol e itraconazol; en pacientes inmunosuprimidos es necesario instaurar terapia supresiva con triazoles mientras persista el estado de inmunosupresión.
Biografía del autor/a
René A. Rodríguez, Universidad El Bosque
Docente Dermatología, Universidad El Bosque, Bogotá.
Perla Furman
Residente Dermatología, Universidad El Bosque, Bogotá.
Gerzaín Rodríguez, Instituo Nacional de Salud
Laboratorio de Patología, Instituto Nacional de Salud; Docente Patología, Universidad Nacional, Bogotá.
Referencias bibliográficas
Kovacs JA, Kovacs AA, Polis M, et al. Cryptococcosis in the acquired inmunodeficiency syndrome. Ann Int Med 1985; 103:533-538.
https://doi.org/10.7326/0003-4819-103-4-533
Kirchner J. Opportunistic fungal infections in patients with HIV disease. Combating cryptococcosis and histoplasmosis. Postgrad Med 1996; 99:209-216.
https://doi.org/10.1080/00325481.1996.11946145
Chandler FW, Watts JC. Cryptococcosis. Chap 106. pp 989- 997. En Connor OH, Chandler FW Pathology of lnfectious disease. Appleton & Lange, Stanford, Conn 1997.
Collins DN, Oppenheim IA, Edwards M. Cryptococcosis associated with systemic lupus erythematous. Light and electron microscopic observations on a morphologic variant. Arch Path 1971; 91:78-88.
Franzot S, Salkin I, Casadevall A. Cryptococcus neoformans var. grubii: Separate varietal status for Cryptococcus neoformans serotype A isolates. J Clin Microbiol 1999; 37:838-841.
Lizarazo J, Cstañeda E. Criptococosis. En: Velez H, Rojas W, Barrero J, et al. Fundamentos de Medicina. Enfermedades Infecciosas, Medellín, CIB 2003:275-282.
Hunger RE, Paredes BE, Quattroppani C, et al. Primary cutaneous cryptococcosis in a patient with systemic immunosuppression after liver transplantation. Dermatology 2000; 200: 352-355.
https://doi.org/10.1159/000018409
Sorrell TC. Cryptococcus neoformans variety gattii. Med Micol 2001; 39:155-168.
https://doi.org/10.1080/mmy.39.2.155.168
Lizarazo J, Rodríguez MC, Ordóñez N, et al. Criptococosis meníngea en el Hospital Erasmo Meoz de Cúcuta. Acta Neurol Col 1995; 11:259-267.
De Bedout C, Ordóñez N, Gómez B, et al. In vitro antifungal susceptibility of clinical isolates of Cryptococcus neoformans var. neoformans and C. neoformans var. gattii. Rev Iber Micol 1999; 16: 36-39.
Ordóñez N, Castañeda E. Varieties and serotypes of Cryptococcus neoformans clinical isolates in Colombia. Rev lber Micol 2001; 18:128-130.
Krockenberger MB, Canfield PJ, Kozel TR, et al. An immunohistochemical method that differentiates Cryptococcus neoformans varieties and serotypes in formalin-fixed paraffin-embedded tissues. Med Micol 2001; 39:523-533.
https://doi.org/10.1080/mmy.39.6.523.533
Meyer W, Castañeda A, Jackson S, et al. Molecular typing of Ibero-American Cryptococcus neoformans isolates. Emerg Infec Dis 2003; 9:189-195.
https://doi.org/10.3201/eid0902.020246
Kumlin U, Olsen B, Granlund M, et al. Cryptococosis and starling nests. Lancet 1998; 351:1181.
https://doi.org/10.1016/S0140-6736(05)79126-1
Callejas A, Ordóñez N, Castañeda E. First isolation of Cryptococcus neoformans var. gattii serotype C, from the environment in Colombia. Med Mycol 1998; 36:341-344.
https://doi.org/10.1080/02681219880000531
Kappe R, Levitz S, Harrison TS, et al. Recent advances in cryptococcosis, candida and coccidioidomycosis complicating HIV infection. Med Mycol 1998; 36:207- 215.
Noble RC, Fajardo LP. Primary cutaneous cryptococcosis. Review and morphologic study. Am J Clin Pathol 1972; 57: 13-26.
https://doi.org/10.1093/ajcp/57.1.13
Ng WF, Loo KT. Cutaneous cryptococcosis - Primary versus secondary disease. Report of two cases with review of literature. Am J Dermatopathol 1993; 15:372- 377.
https://doi.org/10.1097/00000372-199308000-00016
Hernández AD. Cutaneous cryptococcosis. Dermatol Clin 1989; 7:269-273.
https://doi.org/10.1016/S0733-8635(18)30598-9
Tomasini C, Caliendo V, Puiatti P, et al. Granulomatous-ulcerative vulvar cryptoccosis in a palient with advanced HIV disease. J Am Acad Dermatol 1997; 37:116- 117.
https://doi.org/10.1016/S0190-9622(97)70222-6
Sorvillo F, Beall G, Turner P, et al. lncidence and factors associated with extrapulmonary cryptococcosis among persons with HIV infection in Los Angeles County. AIDS 1997; 11: 673-679.
https://doi.org/10.1097/00002030-199705000-00016
Pema K, Diaz J, Guerra LG, et al. Disseminated cutaneous cryptococcosis. Comparision of clinical manifestations in the pre AIDS and AIDS eras. Arch Intern Med 1994; 154:1032-1034.
https://doi.org/10.1001/archinte.1994.00420090124014
Pietrella D, Monari C, Retini C, et al. Human immunodeficiency virus type 1 envelope protein gp 120 impairs intracellular antifungal mechanisms in human monocytes. J lnf Dis 1998; 177:347-354.
https://doi.org/10.1086/514195
Levitz S, Harrison TS, Tabuni A, et al. Chloroquine induces human mononuclear phagocytes to inhibit and kili Cryptococcus neoformans by a mechanism independent of iron deprivation. J Clin lnvest 1997; 100:1640-1646.
https://doi.org/10.1172/JCI119688
Lecomte I, Meyohan MC, De Sa M. Relation between decreasing serie CD4 lymphocytes acount and outcome of cryptococcosis in AIDS patients: a basis for new diagnosis strategy. Int Conf AIDS 1990; 6: 20-23.
Rozenbaum R, Ríos Goncalves AJ. Clinical epidemiological study of 171 cases of cryptococosis. Clin Infect Dis 1994; 18:369-380.
https://doi.org/10.1093/clinids/18.3.369
Hajjeh, RA, Conn LA, Stephens DS, et al. Cryptococosis: population-based multistate active surveillance and risk factors in human immunodeficiency virus-infected persons. J Infect Dis 1999; 179:449-454.
https://doi.org/10.1086/314606
Vergara I, Saavedra M, Saravia J, et aol. Criptococosis del sistema nervioso central. Estudio de 32 casos 1975-1991. Acta Med Col 1993; 18:199-210.
Laverma Al, Jeskanen L, Rantamen T, et al. Cryptococcosis during systemic glucocorticosteroid treatment. Dermatology 1999; 199:180-182.
https://doi.org/10.1159/000018234
Granier F, Kanitaks J, Hermier C, et al. Localyzed cutaneous cryptoccosis successfully treated with ketoconazole. J Am Acad Dermatol 1987; 16:243-249.
https://doi.org/10.1016/S0190-9622(87)80073-7
Castañeda E, Torrado E, Arango M, et al. Criptococosis en Colombia: estudio interinstitucional. IOEN 2000; 5:115-119.
Arango M, Cano LE, De Bedout C, et al. Histoplasmosis y criptococosis diseminada e pacientes con el síndrome de inmunodeficiencia adquirida (sida). Acta Med Col 1990; 15:84-91.
Bava AJ, Negroni N. Características epidemiológicas de 105 casos de criptococosis diagnosticados en la República Argentina entre 1981-1990. Rev Inst Med Trop Sao Paulo 1992; 34:335-340.
https://doi.org/10.1590/S0036-46651992000400011
Murakawa GJ, Kerschmann R, Berger T. Cutaneous cryptococcus infection and AIDS. Report of 12 cases and review of the literature. Arch Dermatol 1996; 132:545-548.
https://doi.org/10.1001/archderm.1996.03890290079010
Rodríguez G, Ordóñez N, Motta A. Histoplasma capsulatum var. capsulatum within cutaneous nerves in patients with disseminated histoplasmosis and AIDS. Br J Dermatol 2001; 144:186-221.
https://doi.org/10.1046/j.1365-2133.2001.03988.x
Motta A, Rodríguez G, Ordóñez N. Histoplasmosis diseminada con compromiso cutáneo en pacientes con sida. Acta Med Col 2001; 26:9-15.
Sarosi GA, Silberfard PM, Tosh FE. Cutaneous cryptococcosis: a sentinel of disseminated disease. Arch Dermatol 1971; 104:3-7.
https://doi.org/10.1001/archderm.1971.04000190003001
Sussman EJ, McMahon F, Wright D, et al. Cutaneous cryptococcosis without evidence of systemic involvement. J Am Acad Dermatol 1984; 11:371-374.
https://doi.org/10.1016/S0190-9622(84)70176-9
López S, Ordóñez N, Castañeda E. Criptococosis con manifestaciones cutáneas. Acta Med Col 1993; 18:229- 233.
Dimino EL, Gurevitch AW. Cutaneous manifestations of disseminated cryptococcosis. J Am Acad Dermatol 1995; 32: 844-850.
https://doi.org/10.1016/0190-9622(95)91544-3
Colmenero MA, Rodríguez-Pichardo A, Rodríguez-Piñero FS, et al. Disseminated cryptococcosis presenting as molluscum -like lesions as the first manifestation of AIDS. lnt J Dermatol 1996; 35: 646-647.
https://doi.org/10.1111/j.1365-4362.1996.tb03690.x
Manrique P, Mayo J, Alvarez JA, et al. Polymorphous cutaneous cryptococcosis: nodular, herpes-like, and molluscum-like lesions in a patient with the acquired immunodeficiency syndrome. J Am Acad Dermatol 1992; 26:122-124.
https://doi.org/10.1016/S0190-9622(08)80526-9
Borton LK, Wintroub BU. Disseminated cryptococcosis presenting as herpetiform lesions in a homosexual man with acquired immunodeficiency syndrome. J Am Acad Dermatol 1984; 10: 387-390.
https://doi.org/10.1016/S0190-9622(84)80013-4
Carlson KC, Mehlmauer M, Evans S, et al. Cryptococcal cellulitis in renal transplant recipients. J Am Acad Dermatol 1987; 17:469-472.
https://doi.org/10.1016/S0190-9622(87)70231-X
Hall JC, Brewer JH, Crouch TT, et al. Cryptococcal cellulitis with multiple sites of involvement. J Am Acad Dermatol 1987; 17: 329-332.
https://doi.org/10.1016/S0190-9622(87)70206-0
Massa MC, Doyle JA. Cutaneous cryptococcosis simulating pyoderma gangrenosum. J Am Acad Dermatol 1981; 5:32-36.
https://doi.org/10.1016/S0190-9622(81)70074-4
Yantsos VA, Carney J, Greer DL. Review of the morphological variations in cutaneous cryptococcosis with a new case resembling varicella. Cutis 1994; 54: 343- 347.
Ingleton R, Koestenblatt E, Don P, et al. Cutaneous cryptococcosis mimicking basal cell carcinoma in a patient with AlDS. J Cutan Med Surg 1998; 3:43-45.
https://doi.org/10.1177/120347549800300112
Sampaio RN, Medeiros B, Milfort M, et al. Systemic cryptococosis with solitary cutaneous lesion in an immunocompetent patient. lnt J Dermatol 1999; 38: 773-775.
https://doi.org/10.1046/j.1365-4362.1999.00805.x
Glassman SJ, Hale MJ. Cutaneous cryptoccosis and Kaposi's sarcoma occurring in the same lesion in a patient with the acquired immunodeficiency syndrome. Clin Exp Oermatol 1995; 20:480-486.
https://doi.org/10.1111/j.1365-2230.1995.tb01383.x
Myres SA, Kamino H. Cutaneous cryptococcosis and histoplasmosis coinfection in a patient with AIOS. J Am Acad Oermatol 1996; 34: 898-900.
https://doi.org/10.1016/S0190-9622(96)90075-4
Pierard GE, Pierard-Franchimont C, Estrada JA, et al.
Cutaneous mixed infection in AIOS. Am J Oermatopathol 1990, 12:63-69.
https://doi.org/10.1097/00000372-199002000-00009
Sandler B, Potter TS, Hashimoto K. Cutaneous Pneumociystis carinii and Cryptococcus neoformans in AIOS. Br J Oermatol 1996; 134:159-163.
https://doi.org/10.1111/j.1365-2133.1996.tb07859.x
Gutiérrez F, Fu YS, Lurie HI. Cryptococcosis histologically resembling histoplasmosis. A light and electron microscopical study. Arch Pathol 1975; 99:347-352.
Leidel GO, Metcalf JS. Formation of palisading granulomas in a patient with chronic cutaneous cryptococcosis. Am J Oermatopathol 1989; 11 :560-562.
https://doi.org/10.1097/00000372-198912000-00009
Ordóñez N, Torrado E, Castañeda E. Criptococosis meníngea de 1990 a 1995: hallazgos de laboratorio. Biomédica 1996; 16:93-97.
https://doi.org/10.7705/biomedica.v16i2.898
Nightingale SO. lnitial therapy for acquired immunodeficiency syndrome associated cryptococcosis with fluconazole. Arch lntern Med 1995; 155:538-540.
https://doi.org/10.1001/archinte.1995.00430050118013
Parisi A, Calderon W, Capellini R, et al. Cryptococosis in AIOS: current prospects of therapy. lnt ConfAIOS 1996; 12:264.
Smith G. Treatment of infections in the patient with acquired immunodeficiency syndrome. Arch lntern Med 1994; 54: 949-973.
https://doi.org/10.1001/archinte.1994.00420090023004
Diamond RD, Bennet JE. Prognostic factors in cryptocococcal meningitis: a study in 111 cases. Ann Intern Med 1974; 80:176-181.
Cómo citar
Descargas
Descargas
Publicado
Cómo citar
Número
Sección
| Estadísticas de artículo | |
|---|---|
| Vistas de resúmenes | |
| Vistas de PDF | |
| Descargas de PDF | |
| Vistas de HTML | |
| Otras vistas | |
