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------=_NextPart_01C338FC.CBF019D0 Content-Location: file:///C:/51781873/MICOSISPROFUNDAS_archivos/master19.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C338FC.CBF019D0 Content-Location: file:///C:/51781873/MICOSISPROFUNDAS_archivos/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C338FC.CBF019D0 Content-Location: file:///C:/51781873/MICOSISPROFUNDAS_archivos/slide0001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" MICOSIS PULMONARES
MICOSIS PROFUNDAS en SIDA
Prof. Dra. Adelina Braselli
- abril 2003 -
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file:///C:/51781873/MICOSISPROFUNDAS_archivos/slide0031.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" MICOSIS PULMONARES
INTRODUCCION
nLas 2 mic= osis profundas más frecuentes en nuestro medio en pacientes con SIDA son: histoplasmosis y criptococosis
nLa candidiasis se limita a lesiones de mucosas y piel
nLa asperg= ilosis fue registrada solamente en 2 de nuestros enfermos
nLa preval= encia de estas micosis  se relaciona a= la ecología regional, pero especialmente a la inmunodepresión celular que es la base de las infecciones oportunistas en estos enfermos
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CRIPTOCOCOSIS
nINTRODUCCION:=
nMicosis sistémica en SIDA
nMarcadora de inmunodepresión grave
nAlto riesgo de&nb= sp; padecerla cuando LCD4 < 100/mm3
n
nAGENTE ETIOLOGICO:
nCryptococcus neoformans, encontrado en las excretas <= /span>de ciertas aves <= /div>
n<= span style=3D'font-size:75%;mso-special-format:lastCR;display:none'>
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EPIDEMIOLOGIA
nAunque la infección es frecuente en la población general, és= ta raramente se enferma
nEl riesgo de criptococosis aumenta dramáticamente cuando se deteriora severamente la inmunidad celular
nEn pacientes con SIDA el rango de prevalencia es de 2,9 a13,3%
nOtros pacientes con riesgo aumentado de esta enfermedad son los transplantados de órganos, neoplásicos, pacientes con enfermedades linfoproliferativas y hematológicas malignas o que toman corticoides
nUltimamente la frecuencia de criptococosis en SIDA disminuyó en relación= al uso de ARV y de fluconazol para tratar la candidiasis
n
n<= span style=3D'font-size:75%;display:none'>
n
n
n
n
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PATOGENESIS
<= span style=3D'font-size:88%;visibility:hidden'>n
nCriptococo penetra por la vía respiratoria
nPrimariamente causa infección pulmonar, la que frecuentemente es asintomática
nEsta infección puede curar, transformarse en infección latente crónica o progresar a enfermedad. Incluso diseminarse
nLa diferente evolución depende del balance entre el tamaño del inóculo, el estado inmunitario del huésped y la virulencia d= e la cepa
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CRIPTOCOCOSIS - CLINICA
= nLOCALIZACIONES MAS FRECUENTES:
nMENINGOENCEFALICA=
nPULMONAR =
n<= b>
= nLOCALIZACIONES MENOS FRECUENTES:
nPiel: lesiones acneiformes, púrpura, placas, pápulas, vesículas, nódulos, tumores, abcesos, úlceras, lesiones simulando moluscum <= /span>
n= Próstata: considerada el san= tuario del hongo y el mayor reservorio responsable de recaídas <= /div>
nOjo
n= 3;
nOTRAS LOCALIZACIONES:
nganglios linfáticos, peritoneo (dializados peritoneales, cirróticos), hueso, articulación, tractos génitourinario y digestivo, corazón, etc.
n
n
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MENINGOENCEFALITIS
nInstalación habitualmente subaguda (2 a 4 semanas)
nSíntomas inespecíficos: = cefalea no constante, a veces intermitente= ; alteración del estado men= tal. Síndrome meníngeo l= eve o ausente en inmunodeprimido grave.
nLCR: claro, hipertenso, hiperproteinorraquia, hipoglucorraquia, celularidad aumentada. Falta de reactividad meníngea en inmunodeprimido grave.&= #13;
nTAC: habitualmente normal o atrofia cerebral vinculada al VIH. Hidrocefalia. Raramente criptococomas. Una segunda enfermedad del SNC (toxoplasmosis, linfoma).
nRM: más sensible
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ELEMENTOS DE MAL PRONOSTICO
nEstupor o coma
nTinta china +
nHipertensión del LCR
nHipoglucorraquia importante en LCR&= #13;
nPocos leucocitos en LCR =
nCriptococo aislado de sitio extraneural
nAusencia de anticuerpos específicos
nTítulo de antígeno en= LCR > 32
nUso de corticoides
nInicio tardío del tratamient= o
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CRIPTOCOCOSIS PULMONAR
nSíntomas respiratorios inespecíficos: fiebre, tos, expectoración, dol= or torácico, disnea, pérdida de peso
nPatrones radiológicos variados: (infiltrado alveolar o intersticial, nódulo único o múltiples, cavidad, siembra miliar, derrame pleural, adenomegalias hiliares)
nDiagn&= oacute;stico diferencial con pneumocistosis, tuberculosis, otras infecciones pulmonares más frecuentes= 3;
n90% de= casos se acompañan de infección del SNC, sintomática o no (necesidad de realizar PL)
nEn el = paciente con SIDA es frecuente que coexistan otras infecciones oportunistas<= span style=3D'font-size:75%;display:none'>
n
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CRIPTOCOCOSIS DISEMINADA