CSF in patients with AIDS associated cryptococcosis

Se analizaron retrospectivamente los líquidos céfalorraquídeos (LCR) de 44 pacientes con criptococosis asociada al SIDA, internados en la Sala XI del Hospital Muñiz, entre enero de 2000 y diciembre de 2004. Se tuvieron en cuenta en cada caso las características físico-químicas, citológicas y micológicas de los LCR obtenidos por punción lumbar al momento de la admisión. La microscopia con tinta china fue positiva en 38 (90.5%) de 42 pacientes con ese dato disponible. Los 6 pacientes restantes se diagnosticaron por cultivos y/o determinación de antígeno de Cryptococcus neoformans. En el examen físico, 29 (69%) de 42 muestras disponibles, presentaron aspecto límpido y las 13 restantes fueron hemorrágicas (n=3), opalescentes (n=6), xantocrómicas (n=3) o turbias (n=1). Del análisis químico, se obtuvo para la proteinorraquia una mediana de 0,7 g/L (rango 0,1-3,5), de 38 mg/dL (rango 12-75) para la glucorraquia y de 127 meq/L (rango 130-143) para la clorurorraquia. La determinación del antígeno capsular, disponible para 7 muestras de LCR y sangre, mostró una mediana de 1/1.000, con valores más elevados en sangre. Las características del LCR de los pacientes examinados con criptococosis asociada al SIDA no revelaron, al menos en los parámetros evaluados, alteraciones diferentes a las mencionadas en la literatura.Cerebrospinal fluids (CSF) of 44 patients with cryptococcosis associated with Acquired Immunodeficiency Syndrome (AIDS), treated in the Ward XI of the Muñiz Hospital from January 2000 to December 2004, were retrospectively analyzed. The physical, chemical, cytological and mycological characteristics of CSF obtained by lumbar puncture at the moment of admission were taken into account in each case. India ink microscopy was positive in 38 (90.5%) out of 42 patients and the remainning 6 patients were diagnosed by cultures and/or determination of capsular antigen of Cryptococcus neoformans. At physical examination, 29 (69%) out of 42 samples showed a limpid aspect and the remaining 13 were hemorrhagic (n=3), opalescent (n=6), xanthochromic (n=3) or turbid (n=1). Chemically, the median of proteinorraquia was 0.7 g/L (range 0.1-3.5 g/L), 38 g/L (range 12-75 g/L) for glycorrhachia and 127 meq/L (range 130-143 mEq/L) for clorurorrachia. The capsular antigen of Cryptococcus neoformans, available for 7 CSF and blood samples, showed a median of 1/1.000 in both, with higher values in blood than in CSF. The CSF of patients with AIDS associated cryptococcosis evaluated in the present study did not reveal important differences, at least in the evaluated parameters, with respect to those cited in the literature.Facultad de Ciencias Exacta

CSF in patients with AIDS associated cryptococcosis

Se analizaron retrospectivamente los líquidos céfalorraquídeos (LCR) de 44 pacientes con criptococosis asociada al SIDA, internados en la Sala XI del Hospital Muñiz, entre enero de 2000 y diciembre de 2004. Se tuvieron en cuenta en cada caso las características físico-químicas, citológicas y micológicas de los LCR obtenidos por punción lumbar al momento de la admisión. La microscopia con tinta china fue positiva en 38 (90.5%) de 42 pacientes con ese dato disponible. Los 6 pacientes restantes se diagnosticaron por cultivos y/o determinación de antígeno de Cryptococcus neoformans. En el examen físico, 29 (69%) de 42 muestras disponibles, presentaron aspecto límpido y las 13 restantes fueron hemorrágicas (n=3), opalescentes (n=6), xantocrómicas (n=3) o turbias (n=1). Del análisis químico, se obtuvo para la proteinorraquia una mediana de 0,7 g/L (rango 0,1-3,5), de 38 mg/dL (rango 12-75) para la glucorraquia y de 127 meq/L (rango 130-143) para la clorurorraquia. La determinación del antígeno capsular, disponible para 7 muestras de LCR y sangre, mostró una mediana de 1/1.000, con valores más elevados en sangre. Las características del LCR de los pacientes examinados con criptococosis asociada al SIDA no revelaron, al menos en los parámetros evaluados, alteraciones diferentes a las mencionadas en la literatura.Cerebrospinal fluids (CSF) of 44 patients with cryptococcosis associated with Acquired Immunodeficiency Syndrome (AIDS), treated in the Ward XI of the Muñiz Hospital from January 2000 to December 2004, were retrospectively analyzed. The physical, chemical, cytological and mycological characteristics of CSF obtained by lumbar puncture at the moment of admission were taken into account in each case. India ink microscopy was positive in 38 (90.5%) out of 42 patients and the remainning 6 patients were diagnosed by cultures and/or determination of capsular antigen of Cryptococcus neoformans. At physical examination, 29 (69%) out of 42 samples showed a limpid aspect and the remaining 13 were hemorrhagic (n=3), opalescent (n=6), xanthochromic (n=3) or turbid (n=1). Chemically, the median of proteinorraquia was 0.7 g/L (range 0.1-3.5 g/L), 38 g/L (range 12-75 g/L) for glycorrhachia and 127 meq/L (range 130-143 mEq/L) for clorurorrachia. The capsular antigen of Cryptococcus neoformans, available for 7 CSF and blood samples, showed a median of 1/1.000 in both, with higher values in blood than in CSF. The CSF of patients with AIDS associated cryptococcosis evaluated in the present study did not reveal important differences, at least in the evaluated parameters, with respect to those cited in the literature.Facultad de Ciencias Exacta

Immune dysfunction in cirrhosis: distinct cytokines phenotypes according to cirrhosis severity

BACKGROUND/OBJECTIVES: Cirrhosis associated immune dysfunction has been proposed to switch from a pro-inflammatory phenotype in stable cirrhosis to an immunodeficient one in patients with decompensated cirrhosis and acute-on-chronic liver failure. The aim of the present study was to compare serum cytokine levels between healthy patients, stable cirrhosis, and decompensated cirrhotic patients with and without development of acute-on-chronic liver failure (ACLF); and to explore whether any of the measured cytokines is associated with cirrhosis severity and prognosis in ACLF patients. METHODS: Patients were enrolled from October 2013 to May 2014 in two hospitals located in Buenos Aires. Cirrhotic patients with an acute decompensating event were enrolled accordingly to the development of ACLF defined by the CANONIC study group. There were two control groups: healthy subjects (n=14) and stable cirrhotic patients (n=14). Demographic, clinical and biochemical data were obtained. Seventeen cytokines were measured using Bio-Plex Pro Human Cytokine 17-plex Assay. RESULTS: Of the 49 decompensated cirrhotic patients enrolled, 18 (36.7%) developed ACLF. Leukocyte count, MELD score at admission, Clif-SOFA at admission and day 7 were significantly higher in the ACLF group (p=0.046, p<0.001, p<0.001, p<0.001 respectively) as well as short-term mortality (p<0.001) compared to stable and decompensated cirrhotic patients. In comparison with healthy controls, stable cirrhotic and decompensated cirrhotic patients showed increased levels of pro-inflammatory and anti-inflammatory cytokines: IL-6, IL-7, IL-8, IL-10, IL 12, and TNF-α. Decompensated cirrhotic patients with the development of ACLF showed a significant decrease of IL-7, IL-10, IL-12, TNF-α, MCP-1 and IFN-γ, but a sustained response of IL-6 and IL-8. When evaluating cirrhosis severity, IL-6 and IL-8 correlated positively with MELD score, whereas only IL-6 correlated positively with Clif-SOFA score at day 7; IL-2 correlated negatively with Clif-SOFA at admission. In comparison with all scores, leukocyte count showed positive correlation and IFN-γ negative correlation with disease severity. When evaluating survival, only MELD and Clif-SOFA scores had a significant association with mortality. CONCLUSIONS: Pro-inflammatory cytokines and chemo-attractant elements are increased in cirrhosis in comparison with healthy subjects, and display higher values concomitantly with cirrhosis progression. However, in acute-on-chronic liver failure an opposite cytokine pattern that can be resumed as a combination of immune paresis and excessive inflammatory response was observed. Several pro-inflammatory cytokines (IL-2, IL-6, IL-8 and IFN-γ) showed correlation with disease severity; their utility as prognostic biomarkers needs to be further studied.Fil: Dirchwolf, Melisa. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Podhorzer, Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Marino, Mónica. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Shulman, Carolina. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Cartier, Mariano. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Zunino, Moira. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Paz, Silvia. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Muñoz, Alberto. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Bocassi, Andrea. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Gimenez, Juan. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Di Pietro, Lucía. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Romero, Gustavo. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Fainboim, Hugo. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Fainboim, Leonardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentin

Criptococosis meningea e infeccción por SARS-Cov 2 en personas que viven con VIH

Introduction: Fungal infections in patients with COVID-19 was one of the most debated topics during the pandemic. Objectives: To analyze the clinical characteristics and evolution of people living with Aids (PLWHA) who presented the association of meningeal cryptococcosis and COVID-19 (group A) and compare them with those PLWHA who suffered from meningeal cryptococcosis without COVID-19 infection (group B).Materials and methods: An analytical and retrospective study was carried out in which the medical records.Results: Sixty five PLWHA with cryptococcosis diagnosed from April 2020 to May 2021 were studied. Out of these, a total of 15 PLWHA suffered from cryptococcosis and COVID-19, 14 presented meningitis (group A). Twenty-eight patients suffered from meningeal cryptococcosis and didn\u27t have covid19 (group B).Conclusions: No significant differences were observed in relationship to intracranial hypertension, initial antigenorrachia, sensorium deterioration or mortality between both groups. The detection of Cryptococcus antigen (CrAg) in serum by lateral flow assay (LFA) was of great effectivity to rapidly diagnose PLWHA with COVID-19. It was also observed that patients in both groups were late in their consultation compared to pre-pandemic cases.Introducción. Las infecciones fúngicas en pacientes con COVID-19 fue uno de los temas más debatidos durante la pandemia.Objetivo. Analizar las características clínicas y evolución de las personas viviendo con sida (PVVS) que presentaron la asociación de criptococosis meníngea y COVID-19 (grupo A) y compararlas con aquellas PVVS que padecieron criptococosis meníngea sin infección por COVID-19 (grupo B).Materiales y métodos. Se realizó un estudio analítico y retrospectivo en el que se revisaron las historias clínicas de pacientes que padecieron criptococosis meníngea entre abril de 2020 y mayo de 2021.Resultados. Se estudiaron 65 PVVS con criptococosis diagnosticadas entre abril de 2020 y mayo de 2021 (63 eran PVVS y 2 eran HIV (-)). De estos, un total de 15 PVVS padecían criptococosis y COVID-19, 14 presentaban meningitis (grupo A). veintiocho enfermos padecieron criptococosis meningea y no tuvieron covid19 (grupo B)Conclusiones. No se observaron diferencias significativas en relación a hipertensión intracraneal, antigenorraquia inicial, deterioro del sensorio o mortalidad entre ambos grupos.La detección de antígeno de Cryptococcus (CrAg) en suero por LFA fue de gran efectividad para diagnosticar rápidamente a las PVVS con COVID-19. También se observó que los pacientes de ambos grupos llegaron tarde a su consulta en comparación con los casos prepandemia