Epidemiological Findings of Neurocryptococcosis in Immunocompetent Patients: Case Reports from a Public Hospital in Joinville, Brazil
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng por |
Título da fonte: | Revista de Epidemiologia e Controle de Infecção |
Texto Completo: | https://online.unisc.br/seer/index.php/epidemiologia/article/view/15283 |
Resumo: | Background and Objectives: Neurocryptococcosis is a fungal disease that affects mainly immunocompromised patients. Cases in immunocompetent patients have been described in some case reports. However, as its reporting was not mandatory in Brazil until 2020, little is known about its epidemiology in the South Region of the country. The present study had the objective of describing epidemiological aspects related to the disease in presumably immunocompetent patients. Methods: A retrospective and observational study was developed, based on cases of patients who received care in a public hospital in Joinville, Santa Catarina, Brazil, between 2018 and 2019. Patients with a clinical diagnosis confirmed by the presence of the fungus Cryptococcus spp. in cerebrospinal fluid by means of the Chinese ink staining were evaluated regarding clinical aspects, treatment, and complications during hospitalization. Results: The diagnosis of the disease was confirmed for two patients in 2018 and six patients in 2019. All of them showed no apparent factors for immunodeficiency and no evident environmental risk factors. Most were men with an average age of 39 years. Fever and mental confusion were the most common symptoms at admission. The variant C. neoformans was found in 75% of the cases. All patients received amphotericin B for at least 13 days with or without combined fluconazole. Six patients had nephrotoxicity due to amphotericin B, two evolved to in-hospital death, and two had neurological sequelae. Conclusion: Mortality and complications related to the treatment of neurocryptococcosis in immunocompetent people showed high rates in the studied sample. The recent inclusion of this disease as a mandatory reporting pathology can improve epidemiological data, which will be used to achieve better understanding and prevention of this problem. |
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Epidemiological Findings of Neurocryptococcosis in Immunocompetent Patients: Case Reports from a Public Hospital in Joinville, BrazilAchados Epidemiológicos de Neurocriptococose em Pacientes Imunocompetentes: Relato de Casos de um Hospital Público de Joinville, BrasilCryptococcal Meningitis. Meningitis. Epidemiology. Immunocompetence.Meningite CriptocócicaMeningite FúngicaEpidemiologiaImunocompetênciaBackground and Objectives: Neurocryptococcosis is a fungal disease that affects mainly immunocompromised patients. Cases in immunocompetent patients have been described in some case reports. However, as its reporting was not mandatory in Brazil until 2020, little is known about its epidemiology in the South Region of the country. The present study had the objective of describing epidemiological aspects related to the disease in presumably immunocompetent patients. Methods: A retrospective and observational study was developed, based on cases of patients who received care in a public hospital in Joinville, Santa Catarina, Brazil, between 2018 and 2019. Patients with a clinical diagnosis confirmed by the presence of the fungus Cryptococcus spp. in cerebrospinal fluid by means of the Chinese ink staining were evaluated regarding clinical aspects, treatment, and complications during hospitalization. Results: The diagnosis of the disease was confirmed for two patients in 2018 and six patients in 2019. All of them showed no apparent factors for immunodeficiency and no evident environmental risk factors. Most were men with an average age of 39 years. Fever and mental confusion were the most common symptoms at admission. The variant C. neoformans was found in 75% of the cases. All patients received amphotericin B for at least 13 days with or without combined fluconazole. Six patients had nephrotoxicity due to amphotericin B, two evolved to in-hospital death, and two had neurological sequelae. Conclusion: Mortality and complications related to the treatment of neurocryptococcosis in immunocompetent people showed high rates in the studied sample. The recent inclusion of this disease as a mandatory reporting pathology can improve epidemiological data, which will be used to achieve better understanding and prevention of this problem.Justificativa e Objetivos: Neurocriptococose é uma doença fúngica que acomete principalmente pacientes imunocomprometidos. Casos em pacientes imunocompetentes têm sido descritos em alguns relatos de casos; no entanto, por não ser uma doença de notificação compulsória no Brasil até 2020, ainda pouco se sabe sobre sua epidemiologia no sul do país. O presente estudo teve como objetivo descrever aspectos epidemiológicos relacionados à doença em pacientes supostamente imunocompetentes. Métodos: Estudo retrospectivo, observacional, baseado em uma série de casos atendidos entre 2018 e 2019 em um hospital público de Joinville, Santa Catarina, Brasil. Pacientes com diagnóstico clínico confirmado pela presença do fungo do gênero Cryptococcus spp. no líquido cefalorraquidiano pelo método tinta da China foram avaliados quanto aos aspectos clínicos, ao tratamento e às complicações durante o período de internação. Resultados: Houve dois pacientes em 2018 e seis pacientes em 2019 com diagnóstico confirmado. Todos sem fatores aparentes para imunocomprometimento e sem fator de risco ambiental evidente. A maioria eram homens com média de idade de 39 anos. Febre e confusão mental foram os achados mais comuns na apresentação. A variante C. neoformans foi encontrada em 75% dos casos. Todos receberam Anfotericina B, no mínimo, durante 13 dias, associado ou não a Fluconazol. Seis pacientes apresentaram nefrotoxicidade causada pela Anfotericina B, dois evoluíram para óbito intra-hospitalar e dois permaneceram com sequelas neurológicas. Conclusão: A mortalidade e as complicações relacionadas ao tratamento da neurocriptococose em pessoas imunocompetentes foram altas na amostra estudada. A recente inclusão da doença como uma patologia de notificação compulsória poderá aprimorar dados epidemiológicos para o melhor entendimento e a prevenção dessa doença. Resultados: Houve 2 pacientes em 2018 e 6 pacientes em 2019 com diagnóstico confirmado. Todos sem aparente fatores para imuncomprometimento e sem fator de risco ambiental evidente. A maioria eram homens e média de idade de 39 anos. Febre e confusão mental foi a achado mais comum na apresentação. A variante C. neoformans foi encontrada em 75% dos casos. Todos receberam Anfotericina B no mínimo por 13 dias associado ou não a fluconazol. Seis pacientes apresentaram nefrotoxicidade pela Anfotericina B, 2 evoluiram para óbtio intrahhospitalar e 2 permaneceram com sequela neurológica. Conclusão: Neurocriptococose em pacientes imunocompetentes apresenta mortalidade e complicações relevantes. A inclusão da doença entre as patologias de notificação compulsória poderia aprimorar dados epidemiológicos para melhor entendimento desta doença. Descritores: Meningite Criptocócica; Meningite Fúngica, Epidemiologia; Imunocompetência.Unisc2020-07-07info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://online.unisc.br/seer/index.php/epidemiologia/article/view/1528310.17058/jeic.v10i3.15283Revista de Epidemiologia e Controle de Infecção; Vol. 10 No. 3 (2020)Revista de Epidemiologia e Controle de Infecção; v. 10 n. 3 (2020)2238-3360reponame:Revista de Epidemiologia e Controle de Infecçãoinstname:Universidade de Santa Cruz do Sul (UNISC)instacron:UNISCengporhttps://online.unisc.br/seer/index.php/epidemiologia/article/view/15283/9394https://online.unisc.br/seer/index.php/epidemiologia/article/view/15283/9393Copyright (c) 2020 Helbert do Nascimento Limainfo:eu-repo/semantics/openAccessRudnik, Camila Ribeiro BatistaAlves, Jonatan FranciscoMerlos, Priscila Gabriella CararoLima, Helbert do Nascimento2022-08-08T12:58:04Zoai:ojs.online.unisc.br:article/15283Revistahttps://online.unisc.br/seer/index.php/epidemiologia/indexONGhttp://online.unisc.br/seer/index.php/epidemiologia/oai||liapossuelo@unisc.br|| julia.kern@hotmail.com||reci.unisc@gmail.com2238-33602238-3360opendoar:2022-08-08T12:58:04Revista de Epidemiologia e Controle de Infecção - Universidade de Santa Cruz do Sul (UNISC)false |
dc.title.none.fl_str_mv |
Epidemiological Findings of Neurocryptococcosis in Immunocompetent Patients: Case Reports from a Public Hospital in Joinville, Brazil Achados Epidemiológicos de Neurocriptococose em Pacientes Imunocompetentes: Relato de Casos de um Hospital Público de Joinville, Brasil |
title |
Epidemiological Findings of Neurocryptococcosis in Immunocompetent Patients: Case Reports from a Public Hospital in Joinville, Brazil |
spellingShingle |
Epidemiological Findings of Neurocryptococcosis in Immunocompetent Patients: Case Reports from a Public Hospital in Joinville, Brazil Rudnik, Camila Ribeiro Batista Cryptococcal Meningitis. Meningitis. Epidemiology. Immunocompetence. Meningite Criptocócica Meningite Fúngica Epidemiologia Imunocompetência |
title_short |
Epidemiological Findings of Neurocryptococcosis in Immunocompetent Patients: Case Reports from a Public Hospital in Joinville, Brazil |
title_full |
Epidemiological Findings of Neurocryptococcosis in Immunocompetent Patients: Case Reports from a Public Hospital in Joinville, Brazil |
title_fullStr |
Epidemiological Findings of Neurocryptococcosis in Immunocompetent Patients: Case Reports from a Public Hospital in Joinville, Brazil |
title_full_unstemmed |
Epidemiological Findings of Neurocryptococcosis in Immunocompetent Patients: Case Reports from a Public Hospital in Joinville, Brazil |
title_sort |
Epidemiological Findings of Neurocryptococcosis in Immunocompetent Patients: Case Reports from a Public Hospital in Joinville, Brazil |
author |
Rudnik, Camila Ribeiro Batista |
author_facet |
Rudnik, Camila Ribeiro Batista Alves, Jonatan Francisco Merlos, Priscila Gabriella Cararo Lima, Helbert do Nascimento |
author_role |
author |
author2 |
Alves, Jonatan Francisco Merlos, Priscila Gabriella Cararo Lima, Helbert do Nascimento |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Rudnik, Camila Ribeiro Batista Alves, Jonatan Francisco Merlos, Priscila Gabriella Cararo Lima, Helbert do Nascimento |
dc.subject.por.fl_str_mv |
Cryptococcal Meningitis. Meningitis. Epidemiology. Immunocompetence. Meningite Criptocócica Meningite Fúngica Epidemiologia Imunocompetência |
topic |
Cryptococcal Meningitis. Meningitis. Epidemiology. Immunocompetence. Meningite Criptocócica Meningite Fúngica Epidemiologia Imunocompetência |
description |
Background and Objectives: Neurocryptococcosis is a fungal disease that affects mainly immunocompromised patients. Cases in immunocompetent patients have been described in some case reports. However, as its reporting was not mandatory in Brazil until 2020, little is known about its epidemiology in the South Region of the country. The present study had the objective of describing epidemiological aspects related to the disease in presumably immunocompetent patients. Methods: A retrospective and observational study was developed, based on cases of patients who received care in a public hospital in Joinville, Santa Catarina, Brazil, between 2018 and 2019. Patients with a clinical diagnosis confirmed by the presence of the fungus Cryptococcus spp. in cerebrospinal fluid by means of the Chinese ink staining were evaluated regarding clinical aspects, treatment, and complications during hospitalization. Results: The diagnosis of the disease was confirmed for two patients in 2018 and six patients in 2019. All of them showed no apparent factors for immunodeficiency and no evident environmental risk factors. Most were men with an average age of 39 years. Fever and mental confusion were the most common symptoms at admission. The variant C. neoformans was found in 75% of the cases. All patients received amphotericin B for at least 13 days with or without combined fluconazole. Six patients had nephrotoxicity due to amphotericin B, two evolved to in-hospital death, and two had neurological sequelae. Conclusion: Mortality and complications related to the treatment of neurocryptococcosis in immunocompetent people showed high rates in the studied sample. The recent inclusion of this disease as a mandatory reporting pathology can improve epidemiological data, which will be used to achieve better understanding and prevention of this problem. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-07-07 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://online.unisc.br/seer/index.php/epidemiologia/article/view/15283 10.17058/jeic.v10i3.15283 |
url |
https://online.unisc.br/seer/index.php/epidemiologia/article/view/15283 |
identifier_str_mv |
10.17058/jeic.v10i3.15283 |
dc.language.iso.fl_str_mv |
eng por |
language |
eng por |
dc.relation.none.fl_str_mv |
https://online.unisc.br/seer/index.php/epidemiologia/article/view/15283/9394 https://online.unisc.br/seer/index.php/epidemiologia/article/view/15283/9393 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2020 Helbert do Nascimento Lima info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2020 Helbert do Nascimento Lima |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf application/pdf |
dc.publisher.none.fl_str_mv |
Unisc |
publisher.none.fl_str_mv |
Unisc |
dc.source.none.fl_str_mv |
Revista de Epidemiologia e Controle de Infecção; Vol. 10 No. 3 (2020) Revista de Epidemiologia e Controle de Infecção; v. 10 n. 3 (2020) 2238-3360 reponame:Revista de Epidemiologia e Controle de Infecção instname:Universidade de Santa Cruz do Sul (UNISC) instacron:UNISC |
instname_str |
Universidade de Santa Cruz do Sul (UNISC) |
instacron_str |
UNISC |
institution |
UNISC |
reponame_str |
Revista de Epidemiologia e Controle de Infecção |
collection |
Revista de Epidemiologia e Controle de Infecção |
repository.name.fl_str_mv |
Revista de Epidemiologia e Controle de Infecção - Universidade de Santa Cruz do Sul (UNISC) |
repository.mail.fl_str_mv |
||liapossuelo@unisc.br|| julia.kern@hotmail.com||reci.unisc@gmail.com |
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1800218811826176000 |