Cryptococcosis in a renal unit

Wiley - Tập 20 Số 5 - Trang 645-649 - 1990
Norella Kong1, A B Suleiman2, W Shaariah3, Yick Hei Wong4, Z Morad5
1Lecturer and Nephrologist, Department of Medicine, National University of Malaysia, Malaysia.
2Consultant Nephrologist, Department of Nephrology, General Hospital Kuala Lumpur, Malaysia.
3Medical Officer, Department of Medicine, National University of Malaysia, Malaysia.
4Head, Division of Microbiology, General Hospital Kuala Lumpur, Malaysia.
5Director, Department of Nephrology, General Hospital Kuala Lumpur, Malaysia.

Tóm tắt

AbstractCryptococcosis is a known opportunistic infection in immunosuppressed hosts. We report our experience of all cases presenting to our Department between December 1975 and September 1988. Eight post‐renal transplant patients and three systemic lupus erythematosus (SLE) patients were affected. All were receiving treatment with steroids, in association with either azathioprine or cyclosporin. The diagnosis of cryptococcal meningitis was initially based on a positive cerebrospinal fluid (CSF) cryptococcal antigen, by latex agglutination test, and subsequently confirmed by cultures. Common clinical presentations, in descending order of frequency, included headaches, fever, mental confusion, epilepsy and papilloedema. Meningism was not a prominent feature. CT brain scans were obtained in eight patients and one showed a focal lesion and one showed cerebral atrophy. Four patients also had an abnormal chest X‐ray (CXR) and one had disseminated cryptococcosis. Amphotericin and 5‐fluorocytosine were the mainstay of therapy, although ketoconazole alone was subsequently used in three selected patients with cure. Four early deaths occurred in patients with delayed diagnosis and treatment, usually in association with other severe concurrent infections. We conclude that awareness of cryptococcosis is essential in immunocompromised hosts presenting with headaches with, or without, mental confusion or fever.

Từ khóa


Tài liệu tham khảo

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Thông tin
Thông tin xuất bản

Wiley

Tập 20 Số 5

645-649

Thông tin tác giả