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Cryptococcosis

The cryptococcosis (torulez), rather not often found TsNS infection, proceeds subacutely or chronically. Its activator — the encapsulated and budding drozhzhepodobny mushroom of Cryptococcus neoformans which feature consists that it has a polisakharidny capsule. Antigenic properties it allow to distinguish 4 serotypes from cryptococci: And, In, C and D.
Epidemiology. Cryptococci, eurysynusic in the nature, belong to saprophytes of soils. Favorable conditions for their growth are created in nests of birds, especially pigeons. At the persons which are in close contact with them is more often than others reveal positive skin reactions to specific antigens. The person catches at inhalation dispute of a mushroom which burgeon in tissue of a lung and with a blood flow can be carried on all organism, affecting a brain, a meninx, bones and skin. Cases of a cryptococcosis meet sporadic, it is noted what - or bonds with an occupation of the patient. In the same way dependence between the previous pulmonary diseases confirmed with anamnestic and radiographic data and the subsequent development of a cryptococcosis is noted. Mycosis meets more often at the persons receiving corticosteroids with malignant diseases of reticuloendothelial system (lymphogranulomatosis), patients with a sarcoidosis and insulin-dependent diabetes mellitus.
Patomorfologiya. In typical cases in internals the cystiform cavities filled with the zhelatinoobrazny contents representing generally cryptococcal capsular polysaccharide are formed. At microscopic examination in cysts find accumulations of cryptococci, the inflammatory reaction provided by macrophages, colossal cells and lymphocytes. In lungs often note subpleural granulomas. The cryptococcosis of TsNS is followed by formation of multiple cystiform cavities, generally in gray matter of bark of hemispheres and basal gangliya. Massive volume defeats meet seldom.
Clinical manifestations. The cryptococcosis of lungs seldom occurs at children, at the same time children with the suppressed immune responses at which the grippopodobny state develops get sick mainly, body temperature slightly increases, pains in a thorax of pleural character and cough with a scanty phlegm develop. At physical inspection reveal scattered rattles. On roentgenograms of a thorax it is possible to find a polymorphic picture, including focal shadows, cavities in apical segments, sites of an infiltration of fabric and symptoms of intersticial pneumonia. Usual laboratory methods of research do not promote detection of pathology. Crops of a phlegm and washing waters from bronchial tubes sometimes allow to find a cryptococcus, but it is necessary to resort to invasive methods for its allocation from fabrics more often.

Cryptococcal meningitis — the most common form of an infection at which the lethal outcome is possible. It can proceed subacutely or chronically. 73% have headaches, at 45% — disturbances of mentality, at 40% — a vision disorder, at 38% — nausea and vomiting, at 33% — pain and muscle tension of a back and neck, at 30% — a fever and fever, at 23% — drowsiness, weakness and feeling of an indisposition, at 20% — an ataxy and at 13% — aphasia and the inarticulate speech. At physical inspection find a papilledema, a hearing loss, muscular weakness, cerebellar disturbances and there comes the coma. In cerebrospinal fluid pressure and level of protein increase (at 90% of patients), glucose level decreases (at 55%), the number of one-nuclear cells, but no more than 300 in 1 ml increases. Death rate reaches 50%. Inefficiency of treatment and early the come lethal outcome are connected mainly with the accompanying malignant diseases of limforetikulyarny system, and also treatment of corticosteroids. In this case at the patient pressure of cerebrospinal fluid sharply increases, glucose level decreases, the insignificant cytosis is noted (less than 20 leukocytes in 1 ml). The cryptococcus is found in the smears prepared from cerebrospinal fluid in which increase of an antiserum capacity is defined allocate from abnerval spaces and blood. Residual neurologic changes register at 40% of the survived patients. They are expressed in sight loss, defects of hearing, damages of function of cranial nerves, deterioration in motor function, change of mentality and is rare — hydrocephaly.
The multiple papules, pustules or small hypodermic consolidations which are localized most often on a face or pilar part of the head belong to additional clinical manifestations. Over time they are exposed to a necrosis and ulcerate. Osteomyelites, purulent arthritises, lymphadenites, an endocarditis and a pericardis, renal abscess and prostatitis belong to rare complications of a cryptococcosis.
Diagnosis. Diagnosis of a cryptococcosis is based on: 1) histologic identification of the activator in bioptata or intercellular lymphs; 2) allocation by its method of crops on the corresponding mediums; 3) identification of cryptococcal antigens by means of serological methods. In tissue specimens appropriately painted cryptococci have an appearance of the drozhzhepodobny budding cells. The encapsulated drozhzhepodobny cells can be revealed at 50% of patients with cryptococcal meningitis when mixing a deposit of cerebrospinal fluid with an equal volume of the Chinese ink. The microorganisms allocated from it and also from a phlegm, blood, urine, etc., at crops on Saburo's circle within 10 days breed in the form of kremovatobely mucous colonies. Negative takes of crops of cerebrospinal fluid do not exclude the diagnosis of cryptococcal meningitis yet. Repeated crops as at large volumes of liquid there can be small amounts of microorganisms are necessary. Reaction latex agglutination allows to find polisakharidny capsular antigen in blood and cerebrospinal fluid in 90% of patients and more.
Treatment. A traditional method of treatment at hard proceeding, life-threatening cryptococcosis — Amphotericinum In which appoint for parenteral administration in a daily dose 0,3 mg/kg within not less than 6 weeks or until at repeated crops negative takes do not receive within 1 month. Concentration of drug in cerebrospinal fluid at intravenous administration is low, nevertheless intrathecal or its intra ventricular introduction is shown to the few patients. The combination of a 5-ftortsitozin in a daily dose of 200 mg/kg with Amphotericinum In is no more effective, than one Amphotericinum. The role of a 5-ftortsitozin at an abnerval cryptococcosis is not studied yet.

 
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