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Fecha Publicación: 2002-12-20
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Pérez Cárdenas, J. E. (2002). La criptococosis: de enfermedad esporádica a reemergente. Parte II: diagnóstico por el laboratorio, diagnóstico dieferencial, tratamiento, pronóstico y prevención. Biosalud, 2, 37–50. Recuperado a partir de https://revistasojs.ucaldas.edu.co/index.php/biosalud/article/view/6500
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La criptococosis es una de las principales enfermedades micóticas sistémicas que se generan cuando hay un debilitamiento del sistema inmune; la frecuencia de la enfermedad ha aumentando en los últimos años a nivel mundial, paralelamente con el síndrome de inmunodeficiencia adquirida, razón por la cual se considera como una enfermedad marcadora del comienzo del mismo. En el primer artículo se hizo una revisión de los aspectos relacionados con el hongo, con la epidemiología de la enfermedad y las manifestaciones clínicas que se generan al estar infectado con este hongo. En esta segunda parte, se hace una descripción de los métodos de laboratorio más utilizados en el diagnóstico de la enfermedad; de las alternativas de tratamiento; de los factores relacionados con el prónostico de la evolución de la misma y con los aspectos de la prevención, importantes para evitar recaidas o reinfecciones.
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ARANGO, Myrtha; CASTAÑEDA, Elizabeth. Micosis humanas. Procedimientos diagnósticos. Examenes directos. Corporación para Investigaciones Biológicas, Medellín, Colombia, 1995. pp: 105-109.
BOLAÑOS, B., MITCHELL, T.G. Phagocytosis of Cryptococcus neoformans by rat alveolar macrophages J. Med. Vet. Mycol, 1989. 27:203-217.
CAMPBELL, C.K. PAYNE, A.L., TEALL, A.J., BROWNELL, A. et al. Cryptococcal latex antigen test positive in patient with Trichosporon beigelii infection. Lancet, 1985. ii:43-44.
CHANOCK, S.J., TOLTZIS, P., and WILSON, C. Cross reactivity between Stomatococcus mucilagínosus and latex agglutination for Cryptococcal antigen. Lancet, 1993. 342:1119-1120.
CHUCK, S.L., SANDE, M.A. Infections with Cryptococcus neoformans in the adquired immunodeficiency syndrome. N. Eng. J. Med, 1989. 321:794-799.
DE BEDOUT, C., ORDOÑEZ, N., GÓMEZ, B.L., RODRÍGUEZ, M. et al. Sensibilidad a los antimicóticos de aislamientos clínicos de Cryptococcus neoformans var neoformans y var. gattii Biomédica, 1997; 17(Supl 1):106-107.
DE REPENTYGNY, Louis. Serodiagnosis of Candidiasis, Aspergilosis and Cryptococcosis. Clin. Inf. Dis, 1992. 14 (Suppl 1):S11-S22.
de GANS, J; EEFTINCK SCHATTENKERK JK; VAN KETEL RJ; Itraconazole as maintenance treatment for Cryptococcal meningitis in the acquired immune deficiency syndrome. Br. Med. J. Clin. Res., 1988. 296:339.
DENNING, D.W., ARMSTRONG R.W., FISHMAN, M., and STEVENS, D.A. Endophthalmitis in a patient with disseminated cryptococcosis and AIDS who was treated with itraconazole. Rev. Infect. Dis., 1991. 13:1126-1130.
DENNING DW; TUCKER RM; HANSON LH; et al. Itraconazole therapy for cryptococcal meningitis and cryptococcosis. Arch Intern Med 1989; 149:2301-2308.
DENNING DW, ARMSTRONG, RW; LEWIS BH, et al. elevated cerebrospinal fluid pressures in patients with Cryptococcal meningitis and acquired immunodeficiency syndrome. Am J. Med , 1991. 91:267-272.
DISMUKES, W.E., CLOUD, G.A., GALLIS, H.A. Treatment of systemic mycoses with Ketoconazole: Emphasis on toxicity and clinical response in 52 patients. Ann. Intern. Med., 1983. 98:13.
DROMER, F; GUEHO, E; RONIN, O; et al. Serotyping of Cryptococcus neoformans by using a monoclonal antibody specific for capsular polysaccharide. J. Clin. Microb. 1993; 31(2):359-363.
DURDEN, Faith. ELEWSKI, Boni. Cutaneous involvement with Cryptococcus neoformans in AIDS. Journal of the American Academy of Dermatology, 1994. 30(5 part 2):844 - 848.
FAN-HAVAR, P., YAMAGUCHI E., SMITH S.M., and ENG, R.H.K. Diastolic hypertension in AIDS patients with cryptococcal meningitis. Am. J. Med., 1992. 93:347-348.
GARZA-GARZA, D; BUENDIA-URIBE, JL; MARTÍNEZ-CRUZ, E; et al. Characterization of Cryptococcus neoformans strains isolated from patients with acquired immunodeficiency syndrome. Rev. Latinoam. Microb. 1995 Jul; 37(3):273-279.
GRANGER, D.L., PERFECT, J.R., DURAK, D.T. Virulence of Cryptococcus neoformans: regulation of capsule synthesis by carbon dioxide. J. Clin Invest, 1985. 76:508-516.
GRANT, IH; ARMSTRONG, D. Fungal infections in AIDS. Cryptococcosis. Infectious Diseases clinics of North America, 1988 Jun; 2(2):457-464.
GRAY, L.D., and ROBERTS, G.D. Experience with the use of pronase to eliminate interference factors in the latex agglutination test for Cryptococcal antigen. J. Clin. Microbiol, 1988. 26:2450-2451.
HARRISON, Michael J.G.; McARTHUR, Justin C. Cerebral infections in AIDS: Cryptococcal meningitis. Infect Med. 1998; 15(6):396-397, 401-407, 409.
HAGEAGE, G.J., HARRINGTON B.J. Use of Calcofluor white in clinical micology. Lab. Med., 1984. 15:109-112.
HEELAN, J.S., CARPUS, L., and KESS►MIAN, N. False positive reactions in the latex agglutination test for Cryptococcus neoformans antigen. J. Clin. Microbiol, 1991. 29:1260-1261.
HSU, M.M.; CHANG, J.C.; YOKOYAMA, K; et al. Serotypes and mating types of clinical strains of Cryptococcus neoformans isolated in Taiwan. Mycopathologia 1994, Feb; 125(2):77-81.
LARSEN, R.A.; BOZZETTE, S.A.; JONES, B.E.; et al. Fluconazole combined with fluycytosine for treatment of cryptococcal meningitis in patients with AIDS. Clinical infectious diseases 1994; 19:741-745.
LAZAR JT, et al. Efficacy and safety of AmBisome (liposomal Amphotericine B) in primary episodes of cryptococcosis in patients with HIV infection VII intl conf AIDS, Florence. 1991; 2:226.
LEVITZ, S.T., Macrophage Interactions with Cryptococcus neoformans. ASM News, 1998. 64(12): 693-699.
LI, A; NISHIMURA, K; TAGUCHI, H; et al. The isolation of Cryptococcus neoformans from pigeon droppings and serotyping of natural and clinically sourced isolates in China. Mycopathologia 1993, Oct; 124(1):1-5.
MADRENYS; De VROEY, C; RAES-WUYTACK, C, and TORRES-RODRIGUEZ, J.M. Identification of the perfect state of Cryptococcus neoformans from 195 clinical isolates including 84 from AIDS patients. Mycophatologia; 1993. 123(2):65-68.
MANFREDI R, MASTROIANNI A, CORONADO DV, et al. Fluconazole as prophylaxis against fungal infection in patients with advanced HIV infection. Arch Intern Med, 1997: 157:64-69.
MEYOHAS, M.C.; ROUX, P; BOLLENS, D, et al. Pulmonary cryptococcosis: Localized and disseminated infections in 27 patients with AIDS. Clin. Infect. Dis. 1995; 21:628-633.
MITCHELL DH, SORRELL TC, ALLWORTH AM, et al. Cryptococcal diseases of the CNS in immunocompetent hosts: Influence of Cryptococcal variety on clinical manifestations and autcome. Clin Infect Dis, 1995: 55:611-616.
MITCHELL, T.G., PERFECT, J.R. Cryptococcosis in the era of AIDS-100 years after discovery of Cryptococcus neoformans. Clin. Microbiol. Rev, 1995. 8(4):515-548.
MUKAMURANGWA, P; RAES-WUYTACK, C; De VROEY, C. Cryptococcus neoformans var gattii can be separated from var neoformans by its ability to assimilate D-tryptophan. J. Med. Vet. Mycol 1995, Nov; 33(6):419-420.
NELSON MR, BOWER M, SMITH D, et al. The value of serum cryptococcal antigen in the diagnosis of cryptococcal infection in patients infected with the human immunodeficiency virus. J. Infect 1990; 21:175-181.
NIGTHTINGALE, S et al. Primary prophylaxis with fluconazole against systemic fungal infections in HIV-positive patients. AIDS 1992; 6:191-194.
PEETERMANS, W; BOBBAERS, H; VERHAEGEN, J; Et al. Fluconazole resistant Cryptococcus neoformans var gattii in an AIDS patient. Acta Clin. Belg. 1993; 48(6):405-409.
PETTOELLO-MANTOVANI, M., CASADEVALL, A., KOLLMANN, T.R., RUBINSTEIN, A. et al. Enhacement of HIV-1 infection by the capsular polisaccharide of Cryptococcus neoformans. Lancet, 1992. 339:21-23.
POWDERLY, W.G.; SAAG, MS; CLOUD, G.A; et al. A controlled trial of fluconazole or amphoterícin B to prevent relapse cryptococcal meningitis in patients with acquired immune deficiency syndrome. New England Journal of Medicine, 1992; 326(12):793-798.
POWDERLY, W.G. Cryptococcal meningitis and AIDS. Clin. Infec. Dis., 1993. 17:837-842.
POWDERLY, W.G.; recent advances in the manegement of Cryptococcal meningitis in patients with AIDS. Clin, infect. Dis. 1996; 22(Suppl 2):S119-S123.
SAAG, M.S; POWDERLY, W.G.; CLOUD, GA; ROBINSON, P. et al. (NAID Mycoses study Group and the AIDS clinical Trials group). Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. New England Journal of Medicine 1992; 326(2):83-89.
__________. VAN DER HORST, C; CLOUD, G , et al. Randomized double blind comparison of Amphotericin B plus Flucytosine (AMB-FC) to AMB alone (STEP 1) followed by a comparison of fluconazole to itraconazole (STEP 2) in the treatment of acute Cryptococcal Meningitis in patients with AIDS. AIDS information newsletter-Cryptococcosis, Oportunistic infections. 1995; 126 (part 12): 8-9.
__________. CLOUD, G.C.; GRAYBILL, S.J.; et al. Comparison of fluconazole (FLU) Versus Itraconazole (ITRA) as Maintenance Therapy of AIDS-Associated Cryptococcal Meningitis (CM). AIDS information newsletter-Cryptococcosis, Oportunistic infections. 1995; 126( part 12): 8-9.
SHARKEY, P.K.; GRAYBILL, J.R.; JOHNSON, E.S.; et al. Amphotericin B lipid complex compared with amphotericin B in the treatment of cryptococcal meningitis in patients with AIDS. Clin, infect. Dis. 1996; 22:315-321.
SCHURMANN D; et al. Safety and efficacy of liposomal amphotericin B in treating AIDS-associated disseminated cryptococcosis. Journal of infectious diseases 1991 164: 620- 622.
SHAUNAK S, SCHELL WA, PERFECT JR. Cryptococcal meningitis with normal cerebrospinal fluid. J. Infect Dis. 1989; 160:912.
SUGAR AM, SAUNDERS C: Oral fluconazole as suppressive therapy of disseminated cryptococcosis in patients with acquired immunodeficiency syndrome. Am. J. MED, 1988: 85;481-489.
SUGAR AM, STERN JJ, DUPONT B. Treatment of cryptococcal meningitis. Rev Infect Dis 1990; 12(Suppl 3):S338-S348.
TARRAND, J.J., GUILLOT, C., WENGLAR, M., JACKSO, J. et al. Clinical comparision of resin-containing BACTEC 26 Plus and the isolator 10 blood culturing systems. J. Clin. Microbiol., 1991. 29:2245-2249.
VAN DER HORST, C; CLOUD, G; et al. Randomized double blind comparison of Amphotericin B plus Flucytosine (AMB-FC) to AMB alone (STEP 1) followed by a comparison of fluconazole to itraconazole (STEP 2) in the treatment of acute Cryptococcal Meningitis in patients with AIDS. AIDS information newsletter-Cryptococcosis, Oportunistic infections. 1995; 126( part 12): 8-9.
__________. SAAG, M.S.; CLOUD, G.A.; et al. Treatment of Cryptococcal meningitis associated with the acquired immunodeficiency sindrome. N. Engl. J. Med. 1997: 333:15-21.
VARMA, A; SWINNE, D. STAIB, F; et al. Diversity of finggrprints in Cryptococcus neoformans. J.Clin. Microb. 1995, Jul; 33(7):1807-1814.
VARTIVARIAN, S.E., ANAISSIE, E.J., COWART, R.E., SPRIGG, H.A., et al. Regulation of Cryptococcal capsular polysaccharide by iron. J. Infect Dis, 1993. 167:186-190.
VINCENT M, WEBSTER MH, PETHER JV: Liposomal amphotericin B. Lancet 1992; 339:374-375.
ZERPA R, HUICHO L, GUILLEN A: Modified India ink preparation for C. neoformans in cerebrospinal fluid specimens. J. clin. microb 1996; 34:2290-2291.
ZHANG H, ZHONG, Z, PIROFSKI, L-A: Peptide epitopes recognised by a human anticryptococcal glucoronoxylomannan antibody. Infect Immun, 1997: 65:1158-1164.
ZLUPKO, G.M., FOCHLER, F.J., GALDSCHMIDT, Z.H. Pulmonary cryptococcosis presenting with multiple pulmonary nodules. Chest, 1980. 77:575.
BOLAÑOS, B., MITCHELL, T.G. Phagocytosis of Cryptococcus neoformans by rat alveolar macrophages J. Med. Vet. Mycol, 1989. 27:203-217.
CAMPBELL, C.K. PAYNE, A.L., TEALL, A.J., BROWNELL, A. et al. Cryptococcal latex antigen test positive in patient with Trichosporon beigelii infection. Lancet, 1985. ii:43-44.
CHANOCK, S.J., TOLTZIS, P., and WILSON, C. Cross reactivity between Stomatococcus mucilagínosus and latex agglutination for Cryptococcal antigen. Lancet, 1993. 342:1119-1120.
CHUCK, S.L., SANDE, M.A. Infections with Cryptococcus neoformans in the adquired immunodeficiency syndrome. N. Eng. J. Med, 1989. 321:794-799.
DE BEDOUT, C., ORDOÑEZ, N., GÓMEZ, B.L., RODRÍGUEZ, M. et al. Sensibilidad a los antimicóticos de aislamientos clínicos de Cryptococcus neoformans var neoformans y var. gattii Biomédica, 1997; 17(Supl 1):106-107.
DE REPENTYGNY, Louis. Serodiagnosis of Candidiasis, Aspergilosis and Cryptococcosis. Clin. Inf. Dis, 1992. 14 (Suppl 1):S11-S22.
de GANS, J; EEFTINCK SCHATTENKERK JK; VAN KETEL RJ; Itraconazole as maintenance treatment for Cryptococcal meningitis in the acquired immune deficiency syndrome. Br. Med. J. Clin. Res., 1988. 296:339.
DENNING, D.W., ARMSTRONG R.W., FISHMAN, M., and STEVENS, D.A. Endophthalmitis in a patient with disseminated cryptococcosis and AIDS who was treated with itraconazole. Rev. Infect. Dis., 1991. 13:1126-1130.
DENNING DW; TUCKER RM; HANSON LH; et al. Itraconazole therapy for cryptococcal meningitis and cryptococcosis. Arch Intern Med 1989; 149:2301-2308.
DENNING DW, ARMSTRONG, RW; LEWIS BH, et al. elevated cerebrospinal fluid pressures in patients with Cryptococcal meningitis and acquired immunodeficiency syndrome. Am J. Med , 1991. 91:267-272.
DISMUKES, W.E., CLOUD, G.A., GALLIS, H.A. Treatment of systemic mycoses with Ketoconazole: Emphasis on toxicity and clinical response in 52 patients. Ann. Intern. Med., 1983. 98:13.
DROMER, F; GUEHO, E; RONIN, O; et al. Serotyping of Cryptococcus neoformans by using a monoclonal antibody specific for capsular polysaccharide. J. Clin. Microb. 1993; 31(2):359-363.
DURDEN, Faith. ELEWSKI, Boni. Cutaneous involvement with Cryptococcus neoformans in AIDS. Journal of the American Academy of Dermatology, 1994. 30(5 part 2):844 - 848.
FAN-HAVAR, P., YAMAGUCHI E., SMITH S.M., and ENG, R.H.K. Diastolic hypertension in AIDS patients with cryptococcal meningitis. Am. J. Med., 1992. 93:347-348.
GARZA-GARZA, D; BUENDIA-URIBE, JL; MARTÍNEZ-CRUZ, E; et al. Characterization of Cryptococcus neoformans strains isolated from patients with acquired immunodeficiency syndrome. Rev. Latinoam. Microb. 1995 Jul; 37(3):273-279.
GRANGER, D.L., PERFECT, J.R., DURAK, D.T. Virulence of Cryptococcus neoformans: regulation of capsule synthesis by carbon dioxide. J. Clin Invest, 1985. 76:508-516.
GRANT, IH; ARMSTRONG, D. Fungal infections in AIDS. Cryptococcosis. Infectious Diseases clinics of North America, 1988 Jun; 2(2):457-464.
GRAY, L.D., and ROBERTS, G.D. Experience with the use of pronase to eliminate interference factors in the latex agglutination test for Cryptococcal antigen. J. Clin. Microbiol, 1988. 26:2450-2451.
HARRISON, Michael J.G.; McARTHUR, Justin C. Cerebral infections in AIDS: Cryptococcal meningitis. Infect Med. 1998; 15(6):396-397, 401-407, 409.
HAGEAGE, G.J., HARRINGTON B.J. Use of Calcofluor white in clinical micology. Lab. Med., 1984. 15:109-112.
HEELAN, J.S., CARPUS, L., and KESS►MIAN, N. False positive reactions in the latex agglutination test for Cryptococcus neoformans antigen. J. Clin. Microbiol, 1991. 29:1260-1261.
HSU, M.M.; CHANG, J.C.; YOKOYAMA, K; et al. Serotypes and mating types of clinical strains of Cryptococcus neoformans isolated in Taiwan. Mycopathologia 1994, Feb; 125(2):77-81.
LARSEN, R.A.; BOZZETTE, S.A.; JONES, B.E.; et al. Fluconazole combined with fluycytosine for treatment of cryptococcal meningitis in patients with AIDS. Clinical infectious diseases 1994; 19:741-745.
LAZAR JT, et al. Efficacy and safety of AmBisome (liposomal Amphotericine B) in primary episodes of cryptococcosis in patients with HIV infection VII intl conf AIDS, Florence. 1991; 2:226.
LEVITZ, S.T., Macrophage Interactions with Cryptococcus neoformans. ASM News, 1998. 64(12): 693-699.
LI, A; NISHIMURA, K; TAGUCHI, H; et al. The isolation of Cryptococcus neoformans from pigeon droppings and serotyping of natural and clinically sourced isolates in China. Mycopathologia 1993, Oct; 124(1):1-5.
MADRENYS; De VROEY, C; RAES-WUYTACK, C, and TORRES-RODRIGUEZ, J.M. Identification of the perfect state of Cryptococcus neoformans from 195 clinical isolates including 84 from AIDS patients. Mycophatologia; 1993. 123(2):65-68.
MANFREDI R, MASTROIANNI A, CORONADO DV, et al. Fluconazole as prophylaxis against fungal infection in patients with advanced HIV infection. Arch Intern Med, 1997: 157:64-69.
MEYOHAS, M.C.; ROUX, P; BOLLENS, D, et al. Pulmonary cryptococcosis: Localized and disseminated infections in 27 patients with AIDS. Clin. Infect. Dis. 1995; 21:628-633.
MITCHELL DH, SORRELL TC, ALLWORTH AM, et al. Cryptococcal diseases of the CNS in immunocompetent hosts: Influence of Cryptococcal variety on clinical manifestations and autcome. Clin Infect Dis, 1995: 55:611-616.
MITCHELL, T.G., PERFECT, J.R. Cryptococcosis in the era of AIDS-100 years after discovery of Cryptococcus neoformans. Clin. Microbiol. Rev, 1995. 8(4):515-548.
MUKAMURANGWA, P; RAES-WUYTACK, C; De VROEY, C. Cryptococcus neoformans var gattii can be separated from var neoformans by its ability to assimilate D-tryptophan. J. Med. Vet. Mycol 1995, Nov; 33(6):419-420.
NELSON MR, BOWER M, SMITH D, et al. The value of serum cryptococcal antigen in the diagnosis of cryptococcal infection in patients infected with the human immunodeficiency virus. J. Infect 1990; 21:175-181.
NIGTHTINGALE, S et al. Primary prophylaxis with fluconazole against systemic fungal infections in HIV-positive patients. AIDS 1992; 6:191-194.
PEETERMANS, W; BOBBAERS, H; VERHAEGEN, J; Et al. Fluconazole resistant Cryptococcus neoformans var gattii in an AIDS patient. Acta Clin. Belg. 1993; 48(6):405-409.
PETTOELLO-MANTOVANI, M., CASADEVALL, A., KOLLMANN, T.R., RUBINSTEIN, A. et al. Enhacement of HIV-1 infection by the capsular polisaccharide of Cryptococcus neoformans. Lancet, 1992. 339:21-23.
POWDERLY, W.G.; SAAG, MS; CLOUD, G.A; et al. A controlled trial of fluconazole or amphoterícin B to prevent relapse cryptococcal meningitis in patients with acquired immune deficiency syndrome. New England Journal of Medicine, 1992; 326(12):793-798.
POWDERLY, W.G. Cryptococcal meningitis and AIDS. Clin. Infec. Dis., 1993. 17:837-842.
POWDERLY, W.G.; recent advances in the manegement of Cryptococcal meningitis in patients with AIDS. Clin, infect. Dis. 1996; 22(Suppl 2):S119-S123.
SAAG, M.S; POWDERLY, W.G.; CLOUD, GA; ROBINSON, P. et al. (NAID Mycoses study Group and the AIDS clinical Trials group). Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. New England Journal of Medicine 1992; 326(2):83-89.
__________. VAN DER HORST, C; CLOUD, G , et al. Randomized double blind comparison of Amphotericin B plus Flucytosine (AMB-FC) to AMB alone (STEP 1) followed by a comparison of fluconazole to itraconazole (STEP 2) in the treatment of acute Cryptococcal Meningitis in patients with AIDS. AIDS information newsletter-Cryptococcosis, Oportunistic infections. 1995; 126 (part 12): 8-9.
__________. CLOUD, G.C.; GRAYBILL, S.J.; et al. Comparison of fluconazole (FLU) Versus Itraconazole (ITRA) as Maintenance Therapy of AIDS-Associated Cryptococcal Meningitis (CM). AIDS information newsletter-Cryptococcosis, Oportunistic infections. 1995; 126( part 12): 8-9.
SHARKEY, P.K.; GRAYBILL, J.R.; JOHNSON, E.S.; et al. Amphotericin B lipid complex compared with amphotericin B in the treatment of cryptococcal meningitis in patients with AIDS. Clin, infect. Dis. 1996; 22:315-321.
SCHURMANN D; et al. Safety and efficacy of liposomal amphotericin B in treating AIDS-associated disseminated cryptococcosis. Journal of infectious diseases 1991 164: 620- 622.
SHAUNAK S, SCHELL WA, PERFECT JR. Cryptococcal meningitis with normal cerebrospinal fluid. J. Infect Dis. 1989; 160:912.
SUGAR AM, SAUNDERS C: Oral fluconazole as suppressive therapy of disseminated cryptococcosis in patients with acquired immunodeficiency syndrome. Am. J. MED, 1988: 85;481-489.
SUGAR AM, STERN JJ, DUPONT B. Treatment of cryptococcal meningitis. Rev Infect Dis 1990; 12(Suppl 3):S338-S348.
TARRAND, J.J., GUILLOT, C., WENGLAR, M., JACKSO, J. et al. Clinical comparision of resin-containing BACTEC 26 Plus and the isolator 10 blood culturing systems. J. Clin. Microbiol., 1991. 29:2245-2249.
VAN DER HORST, C; CLOUD, G; et al. Randomized double blind comparison of Amphotericin B plus Flucytosine (AMB-FC) to AMB alone (STEP 1) followed by a comparison of fluconazole to itraconazole (STEP 2) in the treatment of acute Cryptococcal Meningitis in patients with AIDS. AIDS information newsletter-Cryptococcosis, Oportunistic infections. 1995; 126( part 12): 8-9.
__________. SAAG, M.S.; CLOUD, G.A.; et al. Treatment of Cryptococcal meningitis associated with the acquired immunodeficiency sindrome. N. Engl. J. Med. 1997: 333:15-21.
VARMA, A; SWINNE, D. STAIB, F; et al. Diversity of finggrprints in Cryptococcus neoformans. J.Clin. Microb. 1995, Jul; 33(7):1807-1814.
VARTIVARIAN, S.E., ANAISSIE, E.J., COWART, R.E., SPRIGG, H.A., et al. Regulation of Cryptococcal capsular polysaccharide by iron. J. Infect Dis, 1993. 167:186-190.
VINCENT M, WEBSTER MH, PETHER JV: Liposomal amphotericin B. Lancet 1992; 339:374-375.
ZERPA R, HUICHO L, GUILLEN A: Modified India ink preparation for C. neoformans in cerebrospinal fluid specimens. J. clin. microb 1996; 34:2290-2291.
ZHANG H, ZHONG, Z, PIROFSKI, L-A: Peptide epitopes recognised by a human anticryptococcal glucoronoxylomannan antibody. Infect Immun, 1997: 65:1158-1164.
ZLUPKO, G.M., FOCHLER, F.J., GALDSCHMIDT, Z.H. Pulmonary cryptococcosis presenting with multiple pulmonary nodules. Chest, 1980. 77:575.
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