Carlos Andrés Agudelo1, Carolina Muñoz2, Alex Ramírez2, Angela María Tobón3, Catalina de Bedout Bact3, Luz Elena Cano3, Angela Restrepo3. 1. School of Health Sciences, Universidad Pontificia Bolivariana, Calle 78b No. 72(A)-109, Medellín, Colombia. Electronic address: carlosagudelo@yahoo.com. 2. School of Health Sciences, Universidad Pontificia Bolivariana, Calle 78b No. 72(A)-109, Medellín, Colombia. 3. Medical and Experimental Mycology Unit, Corporación para Investigaciones Biológicas, Carrera 72(A) No. 78(B)-141, Medellín, Colombia.
Abstract
BACKGROUND: The implications of the Cryptococcus neoformans resistance to fluconazole on patient therapy have not been fully elucidated due to the discordant results found in published studies. AIMS: To establish the influence of C. neoformans resistance to fluconazole in the therapy of individuals with cryptococcosis and AIDS. METHODS: This study retrospectively compared the clinical course of patients with cryptococcosis according to the level of fluconazole resistance of their C. neoformans isolates. RESULTS: This study included 71 episodes of cryptococcosis, defined as those isolates of C. neoformans obtained from patients with mycosis, of which 36 isolates were sensitive to fluconazole, 20 susceptible dose-dependent (SDD), and 15 were resistant. There were 5 treatment failures in the consolidation phase; two occurred in patients who had a susceptible strain, 2 in patients who had SDD strains, and one in a patient who had a resistant strain. During the maintenance treatment, relapses occurred in 4 of 33 patients (12%), seen during the follow-up period, none of which occurred in the group with resistant isolates. There were no significant differences in survival time free of treatment failure (p=0.65) or survival time free of failure or relapse (p=0.38). These results were not affected when tested in a Cox model that included age, CD4T lymphocyte counts, and use of antiretroviral therapy. CONCLUSIONS: In HIV patients with cryptococcosis, the resistance of C. neoformans appeared not to increase the risk of failure or relapse during treatment.
BACKGROUND: The implications of the Cryptococcus neoformans resistance to fluconazole on patient therapy have not been fully elucidated due to the discordant results found in published studies. AIMS: To establish the influence of C. neoformans resistance to fluconazole in the therapy of individuals with cryptococcosis and AIDS. METHODS: This study retrospectively compared the clinical course of patients with cryptococcosis according to the level of fluconazole resistance of their C. neoformans isolates. RESULTS: This study included 71 episodes of cryptococcosis, defined as those isolates of C. neoformans obtained from patients with mycosis, of which 36 isolates were sensitive to fluconazole, 20 susceptible dose-dependent (SDD), and 15 were resistant. There were 5 treatment failures in the consolidation phase; two occurred in patients who had a susceptible strain, 2 in patients who had SDD strains, and one in a patient who had a resistant strain. During the maintenance treatment, relapses occurred in 4 of 33 patients (12%), seen during the follow-up period, none of which occurred in the group with resistant isolates. There were no significant differences in survival time free of treatment failure (p=0.65) or survival time free of failure or relapse (p=0.38). These results were not affected when tested in a Cox model that included age, CD4T lymphocyte counts, and use of antiretroviral therapy. CONCLUSIONS: In HIVpatients with cryptococcosis, the resistance of C. neoformans appeared not to increase the risk of failure or relapse during treatment.
Authors: Erika Nascimento; Lucia Helena Vitali; Marcia Regina von Zeska Kress; Roberto Martinez Journal: Rev Inst Med Trop Sao Paulo Date: 2017-08-03 Impact factor: 1.846
Authors: Lidiane de Oliveira; Marcia de Souza Carvalho Melhem; Renata Buccheri; Oscar José Chagas; José Ernesto Vidal; Fredi Alexander Diaz-Quijano Journal: BMC Infect Dis Date: 2022-02-09 Impact factor: 3.090