A prevalência de micose sistêmica entre 1.300 pacientes portadores de HIV/Aids de Cuiabá, Mato Grosso foi de 4,6%, no período de 2005-2008. As espécies de fungos isoladas foram o Cryptococcus neoformans (50%), Cryptococcus gattii (1,6%), Cryptococcus spp (6,6%), Histoplasma capsulatum (38,3%) e Paracoccidioides brasiliensis (3,3%). Óbito foi registrado em 32 (53,3%) pacientes, sendo a criptococose a principal causa. A contagem de linfócitos T CD4+ foi baixa e semelhante entre os pacientes que sobreviveram ou faleceram por micose sistêmica. O etilismo (OR:8,2; IC95%: 1,4-62,1; p=0,005) e o nível médio de desidrogenase lática [758 (182) U/L vs 416 (268) U/L; p<0,001] foram as características independentemente associadas ao óbito dos pacientes do estudo. Os resultados mostram alta letalidade por micoses sistêmicas em pacientes portadores de HIV/Aids de Cuiabá e sugerem que características clínico-laboratoriais tais como o etilismo e a elevação precoce da desidrogenase lática podem ser fatores relacionados ao pior prognóstico nessas condições.

Between 2005 and 2008, the prevalence of systemic mycosis among 1,300 HIV/AIDS patients in Cuiabá, Mato Grosso, was 4.6%. The fungus species isolated were Cryptococcus neoformans in 50%, Cryptococcus gattii in 1.6%, Cryptococcus spp in 6.6%, Histoplasma capsulatum in 38.3% and Paracoccidioides brasiliensis in 3.3%. Death was recorded in the cases of 32 patients (53.3%), and cryptococcosis was the main cause. The CD4+ T lymphocyte count was low and similar among patients who survived or died due to systemic mycosis. The factors independently associated with the deaths of these patients were alcoholism (OR: 8.2; 95% CI: 1.4-62.1; p = 0005) and the mean level of lactate dehydrogenase [758 (182) U/l vs. 416 (268) U/l; p < 0001]. The findings showed that systemic mycosis was highly lethal among the patients with HIV/AIDS in Cuiabá and suggested that clinical-laboratory characteristics such as alcoholism and early elevation of lactate dehydrogenase may be factors relating to worse prognosis under these conditions.

Foram avaliados 37 isolados de 10 pacientes HIV negativos e 26 positivos, em Mato Grosso. Exame direto, cultura e quimiotipagem de espécies foram realizados. Cetoconazol, itraconazol, voriconazol, fluconazol e anfotericina B foram avaliados. Foram identificadas 37 leveduras do gênero Cryptococcus spp sendo 26 de pacientes HIV- positivos (25 Cryptococcus neoformans e um Cryptococcus gattii) e 10 de HIV- negativos (cinco Cryptococcus neoformans e cinco Cryptococcus gattii). Considerando isolados clínicos (Cryptococcus neoformans) de HIV positivos observou-se resistência (8% e 8,7%) e susceptibilidade dose-dependência (20% e 17,4%) para fluconazol e itraconazol respectivamente. Para isolados de Cryptococcus neoformans oriundos de pacientes HIV negativos, observou-se susceptibilidade dose-dependência (40%) ao fluconazol. Os isolados de Cryptococcus gattii provenientes de pacientes HIV- negativos mostraram-se susceptíveis a todos os antifúngicos, exceto um isolado de Cryptococcus gattii que foi susceptível dose-dependente ao fluconazol (20%). O isolado proveniente do paciente HIV- positivo demonstrou resistência ao fluconazol (CIM > 256µg/mL) e itraconazol (CIM=3µg/mL).

Thirty-seven isolates from 10 HIV-negative and 26 HIV-positive patients in Mato Grosso were evaluated. Direct examination, culturing and chemotyping of species were performed. Ketoconazole, itraconazole, voriconazole, fluconazole and amphotericin B were evaluated. Thirty-seven yeasts of Cryptococcus spp were identified, of which 26 were from HIV-positive patients (25 Cryptococcus neoformans and one Cryptococcus gattii) and 10 from HIV-negative patients (five Cryptococcus neoformans and five Cryptococcus gattii). The Cryptococcus neoformans clinical isolates from HIV-positive patients showed resistance (8% and 8.7%) and dose-dependent susceptibility (20% and 17.4%) to fluconazole and itraconazole, respectively. Among the Cryptococcus neoformans isolates from HIV-negative patients, there was dose-dependent susceptibility (40%) to fluconazole. Cryptococcus gattii isolates from HIV-negative patients were shown to be susceptible to all antifungal agents, except for one isolate of Cryptococcus gattii that showed dose-dependent susceptibility to fluconazole (20%). The Cryptococcus gattii isolate from an HIV-positive patient showed resistance to fluconazole (MIC > 256 ¼g/ml) and itraconazole (MIC = 3 ¼g/ml).

Dapsone syndrome is a rare hypersensitivity reaction to dapsone and is characterized by high fever, papular or exfoliative dermatitis, progressing to liver toxicity and generalized lymphadenopathy, resembling a mononucleosis infection. We report a patient who developed acute renal failure, as well as other complications characteristic of dapsone syndrome, during leprosy treatment. Renal involvement had not been previously described as a dapsone syndrome feature.