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Cryptococcosis

机译：隐球菌病

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Cryptococcosis is a systemic fungal infection, caused by encapsulated yeast of the genus Cryptococcus, C neoformans and C gattii. These environmental microorganisms live in pigeon and other bird droppings, as well as in the fruit and bark of various trees. Infection in humans and other animal species usually occurs by inhalation and less frequently through the skin and by ingestion of the fungus. Most infections have a benign course and resolve spontaneously; however, the incidence of cryptococcosis has increased considerably, mainly due to diverse causes of immunodeficiency, particularly AIDS. Cryptococcus neoformans infections are common, worldwide, and severe forms are seen in immunocompromised patients. Cases caused by C gattii predominate in tropical or subtropical regions. Cryptococcosis may present as an acute, subacute, or chronic lung disease, as a nonpurulent cerebrospinal fluid meningitis, or as a severe infection with fever, anemia, lymphadenopathy, and hepatosplenomegaly. The eye can be affected, with partial or total loss of vision. Diagnosis is by direct observation of the causative agent, in histopathologic studies, by isolation in culture, and by the presence of capsular antigen. Treatment is the intravenous administration of amphotericin B deoxycholate, alone or combined with 5-fluorocytosine or fluconazole, which can be given orally or intravenously. Itraconazole is less effective when the central nervous system is affected. Voriconazole appears to be a drug that can be used in these patients. In AIDS patients, secondary prophylaxis is administered with fluconazole or amphotericin B and is continued until CD4 cell counts exceed 200 cells/μL. Evaluation of intracranial pressure is important in the first weeks after diagnosis in AIDS patients.
机译：隐球菌病是一种系统性真菌感染，是由隐球菌属，新孢子虫和加蒂氏菌的封装酵母引起的。这些环境微生物生活在鸽子和其他鸟类的粪便中，以及各种树木的果实和树皮中。人类和其他动物物种的感染通常是通过吸入发生的，而很少通过皮肤和真菌的感染发生。大多数感染具有良性病程并自发消退。然而，隐球菌病的发病率已大大增加，这主要是由于免疫缺陷尤其是艾滋病的多种原因造成的。新型隐球菌感染在世界范围内很普遍，在免疫功能低下的患者中见到严重的形式。由加蒂氏菌引起的病例在热带或亚热带地区居多。隐球菌病可表现为急性，亚急性或慢性肺部疾病，非化脓性脑脊液性脑膜炎或严重的发烧，贫血，淋巴结病和肝脾肿大感染。眼睛会受到影响，部分或全部视力丧失。诊断是通过直接观察病原体，进行组织病理学研究，通过培养分离以及存在荚膜抗​​原来进行的。治疗是单独或与5-氟胞嘧啶或氟康唑联用的两性霉素B脱氧胆酸盐静脉内给药，可以口服或静脉内给药。当中枢神经系统受到影响时，伊曲康唑的疗效较差。伏立康唑似乎是可以在这些患者中使用的药物。在艾滋病患者中，给予氟康唑或两性霉素B进行二次预防，并持续进行直至CD4细胞计数超过200细胞/μL。在艾滋病患者诊断后的头几周内，评估颅内压很重要。

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