A meningite neutrofílica persistente é raramente diagnosticada e é caracterizada pelo predomínio neutrofílico na contagem diferencial do número de leucócitos nas amostras de líquido cefalorraquidiano retiradas após sete dias de tratamento adequado. O paciente aqui descrito é soropositivo para o HIV, apresentou febre e confusão mental durante 4 meses e pleocitose neutrofílica na análise liquórica por mais 5 meses. Foi tratado desde o início com tuberculostáticos. Durante três meses as reações imunológicas, as culturas e as pesquisas diretas foram negativas. No sexagésimo dia de internação, a pesquisa de bacilo álcool-ácido resistente (BAAR) no líquor foi positiva e a cultura confirmou a presença de Mycobacterium tuberculosis resistente à isoniazida. Vários fatores podem provocar esta evolução incomum. O comprometimento da imunidade celular, principalmente na liberação de citocinas pró-inflamatórias como a IL 8 e o FNT. O uso concomitante de medicações que poderiam alterar a concentração liquórica dos tuberculostáticos e o aparecimento crescente de cepas multirresistentes foram discutidos.

Persistent neutrophilic meningitis is rarely found and it is characterized by predominance of the number of neutrophilus in samples of C SF (cerebrospinal fluid) from the patient after seven days of treatment. The above patient in HIV positive; he has developed fever and mental disorder for 4 months and has presented neutrophilic pleocytosis in analysis of CSF for more than 5 months. Since the beginning or the treatment he has taken antituberculous drugs and corticosteroids. For 3 months, the serologic avaliation, smears and cultures were negative. On the 60th. day in hospital, the investigation of acid-fast bacilli in CSF was positive and culture confirmed the presence of Mycobacterium tuberculosis resistant to isoniazid. Several factors that may have caused this uncommon development were discussed: the disturbance of cell-mediated immunity, mainly in realse of IL 8 and TNF, the simultaneous use of medicines that could alter the CSF concentration of antituberculous drugs, and the increasing number of multiresistant strains.

Cento e doze aidéticos ou não com neurocriptococose, admitidos no Hospital Emílio Ribas - São Paulo, Brasil, receberam anfotericina B (AMB) - grupo III ou a associação AMB/ 5 fluorcitosina (5FC): grupos I e II. Testes de Goodman aplicados revelaram: 1. leuco e glicorraquia semelhantes nos três grupos eproteinorraquia inferior a 85mg/dlapós 1, 5g/AMB; 1. a coloração pelo método da tinta da China e a cultura para Cryptococcus neoformans, positivas até l,Og/AMB; 3. hipocalemia na monoterapia, hipo e hipercalemia durante a associação; 4. as reações adversas mais evidentes a > 0,7gAMB/250g 5FC; 5. óbitos (precoce e tardio) frequentes no grupo 1 e nos grupos I e III entre 2,5 a 4,0g de AMB; 6. remissão e morte semelhantes nos grupos. A associação terapêutica iniciale amanutençãopelo AMB conduziram à recaída tardia

A total of 112 AIDS and no AIDS cryptococcosis patients admitted at Emílio Ribas Hospital - São Paulo, Brazil, were treated with amphotericin B (AMB) or amphotericin B and 5 fluorcytosine (5FC). Age, race, predisposing and epidemiological factors, respiratory symptons were evaluated. Goodman tests applied in three patients groups (I, II and III) with associate or unique therapy revealed: 1. prognostic factors: leukocytes ang glucose showed similar response in groups I, II and 111 and protein spinal fluid after l.Sg/AMB; 2. India ink tests and Cryptococcus culture were often positive until l.Og/AMB; 3. significant hypokalemia during monotherapy. Hypo and hyperkalemia had similar data in associate therapy; 4. significant difference in adverse reactions often appeared above 0.7g AMB/250g 5FC; 5. early and late death were common in group 111 (unique) and group I (no AIDS) and III (2.5 to 4. Og) respectively; 6. similar remission and deaths were verified in AIDS/ cryptococosis. Conclusions: adverse reactions were observed above 0.75g/AMBplus 250g 5FC. Association was important in initial therapy and AMB maintenance permitted late relapses.