Criptococosis diagnosticada en pacientes del Hospital San Juan de Dios durante el decenio comprendido entre el 2009 y 2018: comparación de aspectos clínicos, de laboratorio y de estatus inmunológico, entre pacientes VIH positivos y VIH negativos
Fecha
2020
Tipo
tesis
Autores
Romero Solano, Alexander
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Resumen
ANTECEDENTES: La criptococosis en una infección fúngica que está asociada a una importante morbimortalidad. Origina gran cantidad de síndromes clínicos, afectando cualquier órgano o sistema, siendo los más frecuentes la meningitis, cuadros diseminados, pulmonares, tejidos blandos y osteoarticulares. La mayoría de los casos se describen en población VIH, no obstante, en los últimos años se ha dado un aumento en población no VIH, fundamentalmente en pacientes con comorbilidades u condiciones inmunosupresoras. La mortalidad sigue siendo alta en regiones de bajos recursos, debido a limitaciones diagnósticas y terapéuticas.
MÉTODOS: Estudio retrospectivo, realizado en el Hospital San Juan de Dios; incluye casos de criptococosis diagnosticados durante el decenio 2009-2018. Se buscó registros de cultivos positivos por Cryptococcus spp. en el laboratorio de micología del HSJD, obteniéndose 120 registros, de los cuales se tuvo acceso a la información de 119 expedientes, cuyos datos se emplearon durante la investigación. Para el análisis de datos se empleó estadística descriptiva, comparación de variables cualitativas por la prueba mid-p exacto y las cuantitativas por prueba t student. Para el análisis de sobrevida se empleó curvas de sobrevida de Kaplan-Meier, y para la comparación de dichas curvas se usó la prueba de log-rank. El nivel de significancia estadística fue de 0.05.
RESULTADOS: El 64% de los casos de criptococosis se presentó en población VIH, mientras que el 36% restante es en población no VIH. La mayoría de los casos en pacientes VIH positivos corresponde a hombres jóvenes, mientras que en los no VIH son hombres de mayor edad. Los síndromes clínicos más frecuentes en el grupo VIH son los cuadros diseminados con afección meníngea y meníngea, mientras que en los no VIH son la meníngea y los cuadros diseminados sin afección meníngea. Las técnicas empleadas en el diagnóstico de la criptococosis muestran mayor sensibilidad en los VIH en comparación con los no VIH. En cuanto a la población VIH, la mayoría de los pacientes tenía un conteo de linfocitos CD4 menor a 50 células/mm3 al momento del diagnóstico de la micosis y en más del 70%, el diagnóstico del VIH era reciente o el diagnóstico fue al momento de la detección de la micosis. En aquellos casos con diagnóstico reciente de VIH, el promedio de tiempo de inicio de terapia antirretroviral es de 69 días después del diagnóstico de la criptococosis. La sobrevida a los 6 meses fue mayor en la población VIH en comparación con los no VIH, pero los casos con meningitis criptocócica, la sobrevida fue mayor en los no VIH.
CONCLUSIONES: El VIH continúa siendo el principal factor de riesgo para el desarrollo de esta micosis, siendo el sexo masculino el más afectado. No existen diferencias significativas en el análisis de LCR entre población VIH y no VIH con diagnóstico de criptococosis meníngea. La determinación de tinta china y detección de antígenos es más sensible en la población VIH. La sobrevida en población VIH a los 6 meses es mayor que la población no VIH, a excepción de los casos con afección meníngea, donde esta tendencia se invierte.
BACKGROUND: Cryptococcosis in a fungal infection that is associated with significant morbidity and mortality. It originates many clinical syndromes, affecting any organ or system, with meningitis, disseminated, pulmonary, soft and osteoarticular tissues being the most frequent. Most cases are described in HIV population, however, in recent years there has been an increase in non-HIV population, mainly in patients with comorbidities or immunosuppressive conditions. Mortality remains high in low-income regions, due to diagnostic and therapeutic limitations. METHODS: Retrospective study, conducted at the San Juan de Dios Hospital; It includes cases of cryptococcosis diagnosed during the 2009-2018 decade. Records of positive cultures were searched for Cryptococcus spp. in the mycology laboratory of the HSJD, obtaining 120 records, of which we had access to the information of 119 files, whose data were used during the investigation. For the data analysis descriptive statistics were used, comparison of qualitative variables by the exact mid-p test and the quantitative variables by t-student test. Kaplan-Meier survival curves were used for the survival analysis, and the log-rank test was used to compare these curves. The level of statistical significance was 0.05. RESULTS: 64% of cases of cryptococcosis occurred in the HIV population, while the remaining 36% is in the non-HIV population. Most cases in HIV positive patients correspond to young men, while in non-HIV patients they are older men. The most frequent clinical syndromes in the HIV group are disseminated cases with meningeal and meningeal conditions, while non-HIV patients are meningeal and disseminated cases without meningeal involvement. The techniques used in the diagnosis of cryptococcosis show greater sensitivity in HIV compared to non-HIV. As for the HIV population, the majority of patients had a CD4 lymphocyte count less than 50 cells / mm3 at the time of diagnosis of mycosis and in more than 70%, the diagnosis of HIV was recent, or the diagnosis was at the time of Mycosis detection. In those cases, with a recent diagnosis of HIV, the average time to start antiretroviral therapy is 69 days after the diagnosis of cryptococcosis. Survival at 6 months was higher in the HIV population compared to non-HIV, but cases with cryptococcal meningitis, survival was higher in non-HIV. CONCLUSIONS: HIV continues to be the main risk factor for the development of this mycosis, with the male sex being the most affected. There are no significant differences in the CSF analysis between HIV and non-HIV population diagnosed with meningeal cryptococcosis. The determination of Chinese ink and antigen detection is more sensitive in the HIV population. Survival in the HIV population at 6 months is greater than the non-HIV population, except for cases with meningeal disease, where this trend is reversed.
BACKGROUND: Cryptococcosis in a fungal infection that is associated with significant morbidity and mortality. It originates many clinical syndromes, affecting any organ or system, with meningitis, disseminated, pulmonary, soft and osteoarticular tissues being the most frequent. Most cases are described in HIV population, however, in recent years there has been an increase in non-HIV population, mainly in patients with comorbidities or immunosuppressive conditions. Mortality remains high in low-income regions, due to diagnostic and therapeutic limitations. METHODS: Retrospective study, conducted at the San Juan de Dios Hospital; It includes cases of cryptococcosis diagnosed during the 2009-2018 decade. Records of positive cultures were searched for Cryptococcus spp. in the mycology laboratory of the HSJD, obtaining 120 records, of which we had access to the information of 119 files, whose data were used during the investigation. For the data analysis descriptive statistics were used, comparison of qualitative variables by the exact mid-p test and the quantitative variables by t-student test. Kaplan-Meier survival curves were used for the survival analysis, and the log-rank test was used to compare these curves. The level of statistical significance was 0.05. RESULTS: 64% of cases of cryptococcosis occurred in the HIV population, while the remaining 36% is in the non-HIV population. Most cases in HIV positive patients correspond to young men, while in non-HIV patients they are older men. The most frequent clinical syndromes in the HIV group are disseminated cases with meningeal and meningeal conditions, while non-HIV patients are meningeal and disseminated cases without meningeal involvement. The techniques used in the diagnosis of cryptococcosis show greater sensitivity in HIV compared to non-HIV. As for the HIV population, the majority of patients had a CD4 lymphocyte count less than 50 cells / mm3 at the time of diagnosis of mycosis and in more than 70%, the diagnosis of HIV was recent, or the diagnosis was at the time of Mycosis detection. In those cases, with a recent diagnosis of HIV, the average time to start antiretroviral therapy is 69 days after the diagnosis of cryptococcosis. Survival at 6 months was higher in the HIV population compared to non-HIV, but cases with cryptococcal meningitis, survival was higher in non-HIV. CONCLUSIONS: HIV continues to be the main risk factor for the development of this mycosis, with the male sex being the most affected. There are no significant differences in the CSF analysis between HIV and non-HIV population diagnosed with meningeal cryptococcosis. The determination of Chinese ink and antigen detection is more sensitive in the HIV population. Survival in the HIV population at 6 months is greater than the non-HIV population, except for cases with meningeal disease, where this trend is reversed.
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Palabras clave
criptococosis, meningitis criptocócica, VIH, sobrevida, LCR, pacientes VIH negativos