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Resumen
La criptococosis es una micosis que incrementó su incidencia considerablemente con la aparición del sida. Sin embargo, tras la instauración, a finales de los años noventa, del tratamiento antirretroviral de gran actividad (TARGA), esta incidencia ha experimentado una disminución significativa, especialmente en los países desarrollados, aunque no ocurre lo mismo en los países en vías de desarrollo. Con la introducción del TARGA, no sólo se ha visto afectada la tasa de incidencia, sino también las manifestaciones clínicas, que se han presentado en algunos casos de forma anómala, como consecuencia de una recuperación de la inmunidad, describiéndose un nuevo síndrome, el síndrome inflamatorio de reconstitución inmune, así como manifestaciones raras como la linfadenitis y la afectación cutánea. Por otra parte, las pruebas de diagnóstico también han experimentado cambios, y existe un alto porcentaje de casos con cultivos negativos, microscopia negativa y detección tardía del antígeno criptocócico. En cuanto a los patrones de sensibilidad, también se ha observado una recuperación de la sensibilidad en la mayoría de los casos, hecho relacionado, a su vez, con la disminución de casos de criptococosis y con el menor uso de antifúngicos.
Palabras clave:
Criptococosis
TARGA
Sida
Abstract
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.
Keywords:
Cryptococcosis
HAART
AIDS
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