[Microbiological aspects of the cryptococcosis in the post-HAART era].
Cryptococcosis is a mycoses that increased considerably with the AIDS epidemic. However, with the introduction in the late 90's of the highly active antiretroviral therapy (HAART), this incidence has significantly decreased, especially in developed countries, in contrast with that of developing countries. The introduction of HAART not only has affected the incidence rate, but also the clinical presentation as a consequence of the immune recovery of the host, leading to the description of the so called immune reconstitution inflammatory syndrome. In addition, some rare clinical manifestations of cyptococcosis are currently shown, such as lymphadenitis and cutaneous involvement. Besides clinical presentation, diagnostic tests have also changed, with a high percentage of cases with negative cerebrospinal fluid (CSF) and blood cultures, negative direct CSF microscopy, and delayed antigen positive results. Antifungal susceptibility patterns have also changed towards a recuperation of susceptibility, which is related to the decrease in both the incidence of cryptococcosis and less use of antifungal agents.
Mazuelos
Estrella Martín
EM
Hospital Universitario de Valme, Sevilla, España. e.martinmazuelos.sspa@juntadeandalucia.es <e.martinmazuelos.sspa@juntadeandalucia.es>
García
Ana Isabel Aller
AI
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000032:analysis / Q000097:blood; D023241:Antiretroviral Therapy, Highly Active; D002555:Cerebrospinal Fluid / Q000382:microbiology; D010856:Columbidae / Q000382:microbiology; D003453:Cryptococcosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D003454:Cryptococcus / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification*; D019049:Developed Countries; D003906:Developing Countries; D004197:Disease Reservoirs; D025141:Drug Resistance, Fungal; D016469:Fungemia / Q000175:diagnosis / Q000453:epidemiology; D015497:HIV-1; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000276:immunology; D015994:Incidence; D016919:Meningitis, Cryptococcal / Q000134:cerebrospinal fluid / Q000453:epidemiology
D000935:Antifungal Agents; D000946:Antigens, Fungal