[Amphotericin B in the treatment of neurocryptococcosis in patients subjected to renal transplantation]

Abstract

Thirty-five cases of cryptococcosis of the central nervous system (CNS) were studied, 17 of them submitted to renal transplantation. The objective was to evaluate the therapeutic responses observed in the group of kidney transplant patients with CNS cryptococcosis. They were submitted to amphotericin B therapy, with emphasis to the renal function. The results in this group were compared with the outcome in the group of patients with the same infection, submitted to the same therapeutic scheme, but without previous impairment of renal function. Among the 35 patients, 20 were male; the age varied between 4 and 76 years. Associated clinical conditions were noticed in 25 patients, 17 of them with renal transplantation. Among 35 patients, 10 died in the first days of the treatment; 25 patients were effectively treated for CNS cryptococcosis, 18 of them with associated clinical conditions; 15 were kidney transplant patients. The drugs used in the treatment of CNS cryptococcosis were, as possible, the amphotericin B by intravenous and intrathecal route (lumbar puncture) associated with 5-fluorocytosine. Seven patients died during the treatment; then, of the 35 patients who were initially evaluated, 17 died and 18 were successfully treated, with a death rate of 48.57%. Various intercurrencies were observed with the use of amphotericin B and 5-fluorocytosine. The clinical and therapeutic results recorded in this study were compared with the information met in literature. The analysis of the results emphasizes the need of the discovery of better and less toxic drugs than those currently used. Amphotericin B still is the most important drug in the treatment of CNS cryptococcosis and the therapeutic scheme currently recommended consists in the association of amphotericin B and 5-fluorocytosine, and there has been also advantage in the simultaneous use of intravenous and intrathecal amphotericin B. Statistical analysis of the results showed that there is no harm with the use of intravenous amphotericin B in renal transplanted patients with cryptococcosis of the central nervous system.