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Criptococosis diseminada en anciano con VIH Disseminated cryptococcosis in an elderly patient with HIV

Keywords: criptococosis pleural , criptococosis meníngea , VIH , SIDA en ancianos , pleural cryptococcosis , meningeal cryptococcosis , HIV , AIDS in the elderly

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Abstract:

Se presenta un paciente masculino de 79 a os con un cuadro clínico de síntomas constitucionales, asociado a pleuresía linfocítica, meningitis e hidrocefalia, confirmándose posteriormente criptococosis diseminada y VIH-SIDA, con complicaciones asociadas a la terapia con anfotericina B y desenlace fatal. La criptococosis es una de las infecciones más frecuentes del SNC en pacientes con VIH y se han identificado varios factores que confieren mal pronóstico. En infección por VIH, se considera paciente "anciano" a aquellos mayores de 50 a os. En general las características clínicas son similares a los pacientes más jóvenes, pero los adultos mayores, especialmente después de 65 a os de edad, tienen más probabilidad de desarrollar SIDA en uno a tres a os, mayor riesgo de diseminación de infecciones oportunistas y mayor mortalidad. En Colombia para el a o 2007, según registros del Ministerio de Protección Social, había 5283 personas con SIDA mayores de 45 a os (Acta Med Colomb 2011; 36: 85-89). We report the case of a 79-year-old male patient with a clinical picture of constitutional symptoms associated with lymphocytic pleurisy, meningitis, and hydrocephalus. Disseminated cryptococcosis and HIV/AIDS were later confirmed. Complications of therapy with amphotericin B arose and the patient died. Cryptococcosis is one of the most common CNS infections in patients with HIV. Several factors that indicate a poor prognosis have been identified. In HIV infection, the patient is considered "old" above 50 years of age. The clinical features of these patients are generally similar to those found in younger patients; however, especially after the age of 65 years, these patients are more prone to developing AIDS over a period of 1-3 years, and their risk of acquiring disseminated opportunistic infections is increased. Their mortality rates are also higher. In Colombia, during 2007, according to the records of the Ministry of Social Protection, there were 5283 people older than 45 years with AIDS (Acta Med Colomb 2011; 36: 85-89).

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