CRYPTOCOCCOSIS (cryptococcosis; synonym: the zymonematosis is European, Busse — Bushke a deep zymonematosis, a saccharomycosis, torulez) — subacutely or chronically proceeding deep mycosis caused by a fungus of Cryptococcus neoformans.
The disease is described by Busse (O. Busse) and A. Bushke in 1894; meets seldom.
The etiology and epidemiology
the Causative agent of mycosis — Cryptococcus neoformans Sanfelice (1894) — an aerobe, quite well grows on a plain and sugar agar, Saburo's circle, a beer must and other environments; optimum temperature of growth 37 °. In patol, material fungi represent double-circuit yeast cells of roundish, is more rare than an oval form, to dia, from 5 to 20 microns surrounded with the transparent zhelatinoobrazny capsule; do not form chains and usually have one kidney with a narrow isthmus (see. Fungi parasitic ).
The cryptococcus often is found in places of nesting of pigeons, in their dung. Believe that infection of the person occurs in the air way though the possibility of infection through mucous membranes and the injured skin is not denied.
Pathogeny finally it is not revealed; durable immunity is not formed.
development of granulomas with necrotic disintegration, caseous or myxomatous changes, multiple micro abscesses Is characteristic; cryptococci are located usually in the center of the broken-up granulomas. At damages of a brain the picture hron prevails, and epitet inflammations with existence of huge noidny cells, macrophages, lymphocytes. The centers of an inflammation in lungs can be single and multiple, localized and extended.
The clinical picture
the Disease proceeds subacutely or chronically with preferential damage of a brain, is more rare than lungs, skin and mucous membranes. Most often the cryptococcal encephalomeningitis beginning sometimes in the form of attacks of a headache of the increasing intensity meets; at some patients dizziness, vomiting, drowsiness, loss of memory is observed. Rigidity of a nape and Kernig's signs and Brudzinsky are often positive; infrequent pulse, body temperature subfebrile. Damage of lungs develops more often at patients with a cryptococcal encephalomeningitis (primary To. lungs — an unusual occurrence); changes in lungs are very diverse and do not differ in peculiar features; weight of a current varies in wide limits (see. Pneumomycoses ).
Damage of skin is observed approximately at 10% of patients. Distinguish primary To. skin and secondary (metastatic). To. skin it is shown in the form of aknepodobny elements, large infiltrirovanny plaques, abscesses, furunkulopodobny elements, ulcers with the subdug edges. More often rashes are painless and many months and years remain. Damage of mucous membranes has knotty, papillomatous or ulcer character and also can be primary and secondary (more often).
Approximately at 10% of patients the bone system is involved in process, bones of a skull generally are surprised. At dissimination practically any body — heart, kidneys, a liver, a spleen, adrenal glands, joints can be involved in process.
the Diagnosis is difficult. Klien, a picture shall be confirmed with detection of the activator in patol, material and obtaining culture of a fungus; investigate cerebrospinal liquid, a phlegm, pus from the centers, blood, urine and biopsirovanny and autopsirovanny material. It is better to watch instained preparations in a droplet of ink; mucicarmine is most suitable for coloring. Reactions are used agglutinations (see), precipitations (see), reaction of binding complement (see) and immunofluorescence (see) with the adsorbed anticryptococcal serums, an inoculation patol, material a lab. animal. The differential diagnosis at a meningeal form is carried out with tubercular meningitis (see), tumors and abscess of a brain, subdural hematoma and hernia, encephalitis (see). At pulmonary manifestations — with pneumonia of other etiology (see. Pneumonia ), tuberculosis (see. Tuberculosis of a respiratory organs ), histoplasmosis (see). To. kozhn differentiate with other deep mycoses (see), hron, pyoderma (see) and tertiary syphilis (see).
At the meningeal and disseminated forms K. — Amphotericinum In (intravenously, to the spinal canal, in covers of a spinal cord); there are messages on successful use of a 5-flyuortsitozin, and also its combination with V. Vozmozhno's Amphotericinum operational removal of the localized centers To. in lungs. Outwardly ointment of Amphotericinum In, Castellani's liquid, 1 — 2% spirit and water solutions of aniline dyes. Suralimentation with restriction of the products rich with thiamin is recommended.
Forecast at the meningeal and disseminated forms K. remains serious, at localized, especially skin, forms the forecast is much better.
Prevention it is not developed; timely sanitation of injuries of skin and mucous membranes has a certain value.
Bibliography: Cat's P.N. and Sheklakov of N. D. Rukoyaodstvo on a medical mycology, M., 1978; Tropical diseases, under the editorship of E. P. Shuvalova, page 296, L., 1973; With about n a n t N. F. and. lake of Manual of clinical mycology, Philadelphia, 1971; S with h o-1 e r H. J. Grundlagen und Ergebnisse der antimykotischen Chemotheraoie mit 5-Fluorocytosin, Chemotherapia (Basel), Bd 22, Suppl. 1, S. 103, 1976, Bibliogr.
H. D. Sheklakov.