Valoración cuantitava del cryptococcus neoformans en líquido céfalo raquídeo en pacientes con SIDA. Estudio enfocado en pacientes con inmunosupresión del Hospital de Especialidades Dr. Abel Gilbert Pontón durante el período 2017.
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2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Carrera de Medicina
Resumen
Se estima que a nivel mundial la criptococosis meníngeo encefálica es el causante del 15% de las muertes en pacientes con VIH; en el 2014 se estimó que 223100 pacientes con VIH tenían este hongo, y el 73% eran de países subdesarrollados. En Ecuador hasta el momento las estadísticas nacionales solo revelan la incidencia y prevalencia de casos de VIH/SIDA, pero no la tasa de mortalidad ni de morbilidad, siendo una de las primeras causas de muerte las enfermedades oportunistas. El objetivo de este análisis es determinar la incidencia de la criptococosis meníngeo encefálica en nuestro medio, de forma observacional indirecta y retrospectiva durante nuestro internado rotativo en pacientes con VIH; mediante que métodos cualitativos (características citológicas de líquido cefalorraquídeo) y cuantitativos (tinta china, cultivo, imagenológicos) se realizan los análisis y cuál de ellos presenta mejor tasa de diagnóstico. De un total de 132 casos registrados como población con VIH durante el 2017 - 2018, se obtuvo una incidencia de 23% (31/132 casos), 55% fueron hombres, con un promedio de edad poblacional de 24.8 años (3.7), case social baja en el 74% de los casos; grado de VIH B en el 40% y C 20%, el conteo CD4 inferior a 200 se presentó
XVII
en el 20%, replica viral superior a 5000 en el 35%; cuya clínica compatible con la patología fue dada en 31 casos de 132 (23%), en el líquido cefalorraquídeo el 5% de las muestras presentó glicemia inferior a 30 y proteínas elevadas en el 19% (77% fueron normales), y la tinta china detecto 31/132 casos con esporas en la muestra, mientras que el cultivo 25/132 fueron positivos.
It is estimated that worldwide encephalic meningogenic criptococosis is the cause of 15% of deaths in patients with HIV; in 2014 it was estimated that 22,300 HIV patients had this fungus, and 73% were from underdeveloped countries. In Ecuador until now, national statistics only reveal the incidence and prevalence of HIV / AIDS cases, but not the mortality or morbidity rate, with opportunistic diseases being one of the leading causes of death. The objective of this analysis is to determine the incidence of meningeal encephalic criptococosis in our setting, in an indirect and retrospective observational manner during our rotational internship in patients with HIV; by means of which qualitative methods (cytological characteristics of cerebrospinal fluid) and quantitative (ink, culture, imaging) the analyzes are carried out and which of them presents the best diagnostic rate. Out of a total of 132 cases registered as a population with HIV during 2017 - 2018, an incidence of 23% was obtained (31/132 cases), 55% were men, with an average age of 24.8 years (3.7), low XIX social case in 74% of cases; grade of HIV B in 40% and C 20%, CD4 count less than 200 was presented in 20%, viral replication superior to 5000 in 35%; whose clinical manifestations compatible with the pathology were given in 31 cases of 132 (23%), in the cerebrospinal fluid, 5% of the samples presented glycemia lower than 30 and high proteins in 19% (77% were normal), and the ink Chinese detected 31/132 cases with spores in the sample, while culture 25/132 were positive.
It is estimated that worldwide encephalic meningogenic criptococosis is the cause of 15% of deaths in patients with HIV; in 2014 it was estimated that 22,300 HIV patients had this fungus, and 73% were from underdeveloped countries. In Ecuador until now, national statistics only reveal the incidence and prevalence of HIV / AIDS cases, but not the mortality or morbidity rate, with opportunistic diseases being one of the leading causes of death. The objective of this analysis is to determine the incidence of meningeal encephalic criptococosis in our setting, in an indirect and retrospective observational manner during our rotational internship in patients with HIV; by means of which qualitative methods (cytological characteristics of cerebrospinal fluid) and quantitative (ink, culture, imaging) the analyzes are carried out and which of them presents the best diagnostic rate. Out of a total of 132 cases registered as a population with HIV during 2017 - 2018, an incidence of 23% was obtained (31/132 cases), 55% were men, with an average age of 24.8 years (3.7), low XIX social case in 74% of cases; grade of HIV B in 40% and C 20%, CD4 count less than 200 was presented in 20%, viral replication superior to 5000 in 35%; whose clinical manifestations compatible with the pathology were given in 31 cases of 132 (23%), in the cerebrospinal fluid, 5% of the samples presented glycemia lower than 30 and high proteins in 19% (77% were normal), and the ink Chinese detected 31/132 cases with spores in the sample, while culture 25/132 were positive.
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Pacientes incurables, Barrera hematoencefálica, Meningitis, Virus de inmunodeficiencia humana, Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón, Cantón Guayaquil, Ecuador, Líquido cefalorraquídeo, Síndrome de inmunodeficiencia adquirida, Cryptococcus neoformans, Inmunosupresión