Aspectos microbiológicos de la criptococosis en la era post-TARGA
Microbiological aspects of the cryptococcosis in the post-HAART era
Estrella Martín Mazuelos
, Ana Isabel Aller García
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Unidad de Gestión Clínica de Microbiología, Hospital Universitario de Valme, Sevilla, España
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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.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:44 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Criptococosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Martín-Mazuelos" 1 => "J.M. 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Guarro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.42.10.4815-4817.2004" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2004" "volumen" => "42" "paginaInicial" => "4815" "paginaFinal" => "4817" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15472349" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib44" "etiqueta" => "44." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "In vitro susceptibility of <span class="elsevierStyleItalic">Cryptococcus gattii</span> clinical isolates" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Gomez-Lopez" 1 => "O. Zaragoza" 2 => "D.A. Martins" 3 => "C. Melhem" 4 => "J.L. Rodriguez-Tudela" 5 => "M. Cuenca Estrella" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1469-0691.2008.02021.x" "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "727" "paginaFinal" => "739" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18558948" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/0213005X/00000028000000S1/v1_201305090227/S0213005X10700070/v1_201305090227/es/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/0213005X/00000028000000S1/v1_201305090227/S0213005X10700070/v1_201305090227/es/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X10700070?idApp=UINPBA00004N" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 0 | 5 |
| 2024 Octubre | 22 | 9 | 31 |
| 2024 Septiembre | 28 | 11 | 39 |
| 2024 Agosto | 26 | 7 | 33 |
| 2024 Julio | 25 | 9 | 34 |
| 2024 Junio | 18 | 7 | 25 |
| 2024 Mayo | 40 | 5 | 45 |
| 2024 Abril | 22 | 8 | 30 |
| 2024 Marzo | 11 | 10 | 21 |
| 2024 Febrero | 11 | 6 | 17 |
| 2024 Enero | 15 | 7 | 22 |
| 2023 Diciembre | 16 | 0 | 16 |
| 2023 Noviembre | 22 | 19 | 41 |
| 2023 Octubre | 25 | 5 | 30 |
| 2023 Septiembre | 25 | 6 | 31 |
| 2023 Agosto | 12 | 3 | 15 |
| 2023 Julio | 8 | 3 | 11 |
| 2023 Junio | 20 | 2 | 22 |
| 2023 Mayo | 26 | 5 | 31 |
| 2023 Abril | 30 | 6 | 36 |
| 2023 Marzo | 40 | 11 | 51 |
| 2023 Febrero | 31 | 8 | 39 |
| 2023 Enero | 33 | 7 | 40 |
| 2022 Diciembre | 37 | 16 | 53 |
| 2022 Noviembre | 38 | 9 | 47 |
| 2022 Octubre | 32 | 19 | 51 |
| 2022 Septiembre | 37 | 20 | 57 |
| 2022 Agosto | 65 | 14 | 79 |
| 2022 Julio | 49 | 10 | 59 |
| 2022 Junio | 24 | 13 | 37 |
| 2022 Mayo | 46 | 18 | 64 |
| 2022 Abril | 20 | 14 | 34 |
| 2022 Marzo | 21 | 14 | 35 |
| 2022 Febrero | 38 | 9 | 47 |
| 2022 Enero | 26 | 8 | 34 |
| 2021 Diciembre | 15 | 13 | 28 |
| 2021 Noviembre | 29 | 7 | 36 |
| 2021 Octubre | 17 | 10 | 27 |
| 2021 Septiembre | 17 | 16 | 33 |
| 2021 Agosto | 16 | 9 | 25 |
| 2021 Julio | 17 | 7 | 24 |
| 2021 Junio | 8 | 6 | 14 |
| 2021 Mayo | 14 | 6 | 20 |
| 2021 Abril | 31 | 15 | 46 |
| 2021 Marzo | 15 | 10 | 25 |
| 2021 Febrero | 14 | 7 | 21 |
| 2021 Enero | 10 | 12 | 22 |
| 2020 Diciembre | 11 | 20 | 31 |
| 2020 Noviembre | 22 | 13 | 35 |
| 2020 Octubre | 15 | 7 | 22 |
| 2020 Septiembre | 18 | 10 | 28 |
| 2020 Agosto | 29 | 12 | 41 |
| 2020 Julio | 15 | 10 | 25 |
| 2020 Junio | 12 | 15 | 27 |
| 2020 Mayo | 23 | 8 | 31 |
| 2020 Abril | 8 | 4 | 12 |
| 2020 Marzo | 24 | 4 | 28 |
| 2020 Febrero | 24 | 6 | 30 |
| 2020 Enero | 13 | 10 | 23 |
| 2019 Diciembre | 14 | 9 | 23 |
| 2019 Noviembre | 7 | 4 | 11 |
| 2019 Octubre | 12 | 1 | 13 |
| 2019 Septiembre | 21 | 14 | 35 |
| 2019 Agosto | 9 | 9 | 18 |
| 2019 Julio | 11 | 21 | 32 |
| 2019 Junio | 48 | 24 | 72 |
| 2019 Mayo | 101 | 30 | 131 |
| 2019 Abril | 44 | 56 | 100 |
| 2019 Marzo | 11 | 12 | 23 |
| 2019 Febrero | 14 | 20 | 34 |
| 2019 Enero | 8 | 16 | 24 |
| 2018 Diciembre | 10 | 14 | 24 |
| 2018 Noviembre | 25 | 34 | 59 |
| 2018 Octubre | 12 | 12 | 24 |
| 2018 Septiembre | 24 | 26 | 50 |
| 2018 Agosto | 6 | 47 | 53 |
| 2018 Julio | 12 | 55 | 67 |
| 2018 Junio | 6 | 29 | 35 |
| 2018 Mayo | 4 | 31 | 35 |
| 2018 Abril | 6 | 18 | 24 |
| 2018 Marzo | 2 | 2 | 4 |
| 2018 Febrero | 16 | 3 | 19 |
| 2018 Enero | 9 | 0 | 9 |
| 2017 Diciembre | 17 | 1 | 18 |
| 2017 Noviembre | 10 | 10 | 20 |
| 2017 Octubre | 9 | 1 | 10 |
| 2017 Septiembre | 9 | 16 | 25 |
| 2017 Agosto | 6 | 6 | 12 |
| 2017 Julio | 5 | 7 | 12 |
| 2017 Junio | 7 | 25 | 32 |
| 2017 Mayo | 15 | 5 | 20 |
| 2017 Abril | 11 | 8 | 19 |
| 2017 Marzo | 18 | 13 | 31 |
| 2017 Febrero | 13 | 7 | 20 |
| 2017 Enero | 14 | 0 | 14 |
| 2016 Diciembre | 18 | 5 | 23 |
| 2016 Noviembre | 17 | 3 | 20 |
| 2016 Octubre | 25 | 8 | 33 |
| 2016 Septiembre | 31 | 10 | 41 |
| 2016 Agosto | 19 | 8 | 27 |
| 2016 Julio | 9 | 1 | 10 |
| 2016 Junio | 13 | 9 | 22 |
| 2016 Mayo | 14 | 5 | 19 |
| 2016 Abril | 13 | 5 | 18 |
| 2016 Marzo | 10 | 12 | 22 |
| 2016 Febrero | 14 | 6 | 20 |
| 2016 Enero | 12 | 11 | 23 |
| 2015 Diciembre | 6 | 7 | 13 |
| 2015 Noviembre | 9 | 5 | 14 |
| 2015 Octubre | 25 | 7 | 32 |
| 2015 Septiembre | 19 | 9 | 28 |
| 2015 Agosto | 7 | 11 | 18 |
| 2015 Julio | 7 | 6 | 13 |
| 2015 Junio | 7 | 4 | 11 |
| 2015 Mayo | 9 | 4 | 13 |
| 2015 Abril | 11 | 14 | 25 |
| 2015 Marzo | 12 | 6 | 18 |
| 2015 Febrero | 7 | 5 | 12 |
| 2015 Enero | 22 | 3 | 25 |
| 2014 Diciembre | 28 | 6 | 34 |
| 2014 Noviembre | 25 | 3 | 28 |
| 2014 Octubre | 35 | 2 | 37 |
| 2014 Septiembre | 41 | 2 | 43 |
| 2014 Agosto | 30 | 2 | 32 |
| 2014 Julio | 68 | 2 | 70 |
| 2014 Junio | 42 | 1 | 43 |
| 2014 Mayo | 30 | 4 | 34 |
| 2014 Abril | 27 | 3 | 30 |
| 2014 Marzo | 27 | 3 | 30 |
| 2014 Febrero | 28 | 0 | 28 |
| 2014 Enero | 24 | 3 | 27 |
| 2013 Diciembre | 34 | 3 | 37 |
| 2013 Noviembre | 24 | 3 | 27 |
| 2013 Octubre | 35 | 7 | 42 |
| 2013 Septiembre | 25 | 4 | 29 |
| 2013 Agosto | 22 | 2 | 24 |
| 2013 Julio | 19 | 3 | 22 |
| 2010 Enero | 548 | 0 | 548 |
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