Meningite criptocócica em gestantes
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Apr 5, 2025
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Resumo
Objetivo: Revisar os aspectos epidemiológicos e clínicos da meningite criptocócica (MC) em gestantes, com enfoque no manejo diagnóstico, terapêutico e das complicações. Métodos: Trata-se de uma revisão integrativa com busca de alta sensibilidade nas bases de dados Medline (PubMed), Biblioteca Virtual em Saúde (BVS), Web Of Science, Cochrane Library e Embase (Elsevier). Para isso, usamos os descritores Meningitis, Cryptococcal e Pregnancy. Resultados: A inclusão de 13 estudos resultou em 24 relatos de gestantes acometidas pela MC, com idade média de 26,7 anos. Entre elas, metade foi infectada no segundo trimestre (n=12). A maioria das gestantes apresentou a sorologia para o HIV positiva na admissão hospitalar (n=13, 54%). Os principais achados clínicos foram cefaleia, náuseas, vômitos e comemorativos de hipertensão intracraniana. O C. neoformans foi o responsável por 100% das infecções. A taxa de mortalidade materna foi de 18,2%, enquanto que a taxa de mortalidade fetal/neonatal foi mais elevada (42,1%). Considerações finais: A MC apresenta-se como uma condição grave na gestante, conferindo-lhe alta morimortalidade. A anfotericina B é a droga de escolha, com o período de indução perfazendo quatro semanas. O período de consolidação, manutenção e profilaxia depende da resposta clínica e de condições de base.
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Como Citar
FariasJ. P. V. M., SilvaN. M. da, AndradeM. F. de, GurjãoM. C., SouzaC. C. de, Stolp Ângela M. V., & MaiaA. M. L. R. (2025). Meningite criptocócica em gestantes. Revista Eletrônica Acervo Saúde, 25, e19530. https://doi.org/10.25248/reas.e19530.2025
Seção
Revisão Bibliográfica
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Referências
1. ABASSI M, et al. Cryptococcal Meningitis: Diagnosis and Management Update. Curr Trop Med Rep, 2015; 2(2): 90-99.
2. AITKEN GW e SYMONDS EM. Cryptococcal meningitis in pregnancy treated with amphotericin B. A case report. J Obstet Gynaecol Br Emp, 1962; 69: 677-9.
3. AYE C, et al. Cryptococcosis-the impact of delay to diagnosis. Clin Microbiol Infect, 2016; 22(7): 632-5.
4. BEARDSLEY J, et al. CryptoDex Investigators. Adjunctive Dexamethasone in HIV-Associated Cryptococcal Meningitis. N Engl J Med, 2016; 374(6): 542-54.
5. BRIGHT PD, et al. The treatment of a pregnant HIV positive patient with cryptococcal meningitis in Malawi. Case report and review of treatment options. Med Mycol Case Rep, 2017; 19: 9-12.
6. CHEN CP e WANG KG. Cryptococcal meningitis in pregnancy. Am J Perinatol, 1996; 13(1): 35-6.
7. CHERIAN J, et al. Shunting in cryptococcal meningitis. J Neurosurg, 2016; 125(1): 177-86.
8. CORREA EA. Identificação, resistência e sensibilidade de cepas de Cryptococcus neoformans e de Candidas sp., presentes em excretas de pombos no município de Porto Velho, RO – BRASIL. South American Journal of Basic Education, Technical and Technological, 2019; 6(1).
9. COSTA ML, et al. Cryptococcal meningitis in HIV negative pregnant women: case report and review of literature. Rev Inst Med Trop Sao Paulo, 2009; 51(5): 289-94.
10. ELY EW, et al. Cryptococcal pneumonia complicating pregnancy. Medicine (Baltimore), 1998; 77(3): 153-67.
11. FAVALESSA OC, et al. Molecular typing and in vitro antifungal susceptibility of Cryptococcus spp from patients in Midwest Brazil. J Infect Dev Ctries, 2014; 8(8): 1037-43.
12. FISHER KM, et al. Cryptococcal meningitis: a review for emergency clinicians. Intern Emerg Med, 2021; 16(4): 1031-1042.
13. FORD N, et al. CD4 Cell Count Threshold for Cryptococcal Antigen Screening of HIV-Infected Individuals: A Systematic Review and Meta-analysis. Clin Infect Dis, 2018; 66(2): 152-159.
14. HADDOW LJ, et al. Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions. The Lancet infectious diseases, 2010; 10(11): 791-802.
15. HENAO-MARTÍNEZ AF, et al. Treatment of cryptococcosis in non-HIV immunocompromised patients. Curr Opin Infect Dis, 2018; 31(4): 278-285.
16. HONG N, et al. Cryptococcosis in HIV-negative Patients with Renal Dialysis: A Retrospective Analysis of Pooled Cases. Mycopathologia, 2017; 182(9-10): 887-896.
17. JONES JM e CRAIG WA. Cryptococcal meningitis: resolution eight months after antifungal therapy. South Med J, 1983; 76(12): 1567-9.
18. KHOO CS, et al. Cerebral Lupus and Cryptococcal Meningitis in a Pregnant Woman. J Neurosci Rural Pract, 2020; 11(1): 183-186.
19. KIGGUNDU R, et al. Unmasking cryptococcal meningitis immune reconstitution inflammatory syndrome in pregnancy induced by HIV antiretroviral therapy with postpartum paradoxical exacerbation. Med Mycol Case Rep, 2014; 29(5): 16-9.
20. MS. MINISTÉRIO DA SAÚDE. 2019. In: Guia de Vigilância em Saúde: volume único [recurso eletrônico] / Ministério da Saúde, Secretaria de Vigilância em Saúde, Coordenação-Geral de Desenvolvimento da Epidemiologia em Serviços. – 3ª. ed. – Brasília. Disponível em: https ://bvsms.saude.gov.br/ bvs/publica coes/guia_vigilancia_saude_3ed.pdf Acesso em: 22 mar. 2024.
21. NATH R, et al. Cryptococcus neoformans var. grubii Infection in HIV-Seronegative Patients from Northeast India: Report of Two Cases with Review of Literature. Mycopathologia, 2016; 181(3-4): 315-21.
22. NAYAK SU, et al. Cryptococcal Meningitis in an HIV-Positive Pregnant Woman. J Int Assoc Physicians AIDS Care (Chic), 2011; 10(2): 79-82.
23. NUNES JO, et al. Cryptococcal meningitis epidemiology: 17 years of experience in a State of the Brazilian Pantanal. Rev Soc Bras Med Trop, 2018; 51(4): 485-492.
24. OREFICE RR. Immunology and the immunological response in pregnancy. Best Pract Res Clin Obstet Gynaecol, 2020; 76: 3-12.
25. OUZZANI M, et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev, 2016; 5(1): 210.
26. Park BJ, et al. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. Aids, 2009; 23(4): 525-530.
27. PASTICK KA, et al. Cryptococcosis in pregnancy and the postpartum period: Case series and systematic review with recommendations for management. Medical mycology, 2020; 58(3): 282-292.
28. PEREIRA CAP, et al. Cryptococcal meningitis in pregnancy: review of the literature. Report of two cases. Revista do Instituto de Medicina Tropical de São Paulo, 1993; 35: 367-371.
29. PERFECT JR e BICANIC T. Cryptococcosis diagnosis and treatment: What do we know now. Fungal Genetics and Biology, 2015; 78: 49-54.
30. PHILPOT CR e LO D. Cryptococcal meningitis in pregnancy. Med J Aust, 1972; 2(18): 1005-7.
31. PYRGOS V, et al. Epidemiology of cryptococcal meningitis in the US: 1997-2009. PLoS One, 2013; 8(2): 56269.
32. RAJASINGHAM R, et al. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis, 2017; 17(8): 873-881.
33. ROBALO NUNES T, et al. Cryptococcal Meningitis in an HIV-Negative Puerperal Woman. Case Rep Infect Dis, 2021; 6665624.
34. SANGARÉ I, et al. Prevalence of vulvovaginal candidiasis in pregnancy at three health centers in Burkina Faso. J Mycol Med, 2018; 28(1): 186-192.
35. SCHUTZ C, et al. Acute Kidney Injury and Urinary Biomarkers in Human Immunodeficiency Virus-Associated Cryptococcal Meningitis. Open Forum Infect Dis, 2017; 4(3): 127.
36. SLOAN DJ e PARRIS V. Cryptococcal meningitis: epidemiology and therapeutic options. Clin Epidemiol, 2014; 6: 169-82.
37. URSI ES e GAVÃO CM. Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura [Perioperative prevention of skin injury: an integrative literature review]. Rev Lat Am Enfermagem, 2006; 14(1): 124-31.
38. VIDAL JE, et al. Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America. Braz J Infect Dis, 2013; 17(3): 353-62.
39. WHO. WORLD HEALTH ORGANIZATION, 2018. Guidelines for The Diagnosis, Prevention and Management of Cryptococcal Disease in HIV-Infected Adults, Adolescents and Children: Supplement to the 2016 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Geneva: World Health Organization; 2018. PMID: 30285342. Disponível em: https ://www.who.int/pu blications/i/item/9789241550277.
2. AITKEN GW e SYMONDS EM. Cryptococcal meningitis in pregnancy treated with amphotericin B. A case report. J Obstet Gynaecol Br Emp, 1962; 69: 677-9.
3. AYE C, et al. Cryptococcosis-the impact of delay to diagnosis. Clin Microbiol Infect, 2016; 22(7): 632-5.
4. BEARDSLEY J, et al. CryptoDex Investigators. Adjunctive Dexamethasone in HIV-Associated Cryptococcal Meningitis. N Engl J Med, 2016; 374(6): 542-54.
5. BRIGHT PD, et al. The treatment of a pregnant HIV positive patient with cryptococcal meningitis in Malawi. Case report and review of treatment options. Med Mycol Case Rep, 2017; 19: 9-12.
6. CHEN CP e WANG KG. Cryptococcal meningitis in pregnancy. Am J Perinatol, 1996; 13(1): 35-6.
7. CHERIAN J, et al. Shunting in cryptococcal meningitis. J Neurosurg, 2016; 125(1): 177-86.
8. CORREA EA. Identificação, resistência e sensibilidade de cepas de Cryptococcus neoformans e de Candidas sp., presentes em excretas de pombos no município de Porto Velho, RO – BRASIL. South American Journal of Basic Education, Technical and Technological, 2019; 6(1).
9. COSTA ML, et al. Cryptococcal meningitis in HIV negative pregnant women: case report and review of literature. Rev Inst Med Trop Sao Paulo, 2009; 51(5): 289-94.
10. ELY EW, et al. Cryptococcal pneumonia complicating pregnancy. Medicine (Baltimore), 1998; 77(3): 153-67.
11. FAVALESSA OC, et al. Molecular typing and in vitro antifungal susceptibility of Cryptococcus spp from patients in Midwest Brazil. J Infect Dev Ctries, 2014; 8(8): 1037-43.
12. FISHER KM, et al. Cryptococcal meningitis: a review for emergency clinicians. Intern Emerg Med, 2021; 16(4): 1031-1042.
13. FORD N, et al. CD4 Cell Count Threshold for Cryptococcal Antigen Screening of HIV-Infected Individuals: A Systematic Review and Meta-analysis. Clin Infect Dis, 2018; 66(2): 152-159.
14. HADDOW LJ, et al. Cryptococcal immune reconstitution inflammatory syndrome in HIV-1-infected individuals: proposed clinical case definitions. The Lancet infectious diseases, 2010; 10(11): 791-802.
15. HENAO-MARTÍNEZ AF, et al. Treatment of cryptococcosis in non-HIV immunocompromised patients. Curr Opin Infect Dis, 2018; 31(4): 278-285.
16. HONG N, et al. Cryptococcosis in HIV-negative Patients with Renal Dialysis: A Retrospective Analysis of Pooled Cases. Mycopathologia, 2017; 182(9-10): 887-896.
17. JONES JM e CRAIG WA. Cryptococcal meningitis: resolution eight months after antifungal therapy. South Med J, 1983; 76(12): 1567-9.
18. KHOO CS, et al. Cerebral Lupus and Cryptococcal Meningitis in a Pregnant Woman. J Neurosci Rural Pract, 2020; 11(1): 183-186.
19. KIGGUNDU R, et al. Unmasking cryptococcal meningitis immune reconstitution inflammatory syndrome in pregnancy induced by HIV antiretroviral therapy with postpartum paradoxical exacerbation. Med Mycol Case Rep, 2014; 29(5): 16-9.
20. MS. MINISTÉRIO DA SAÚDE. 2019. In: Guia de Vigilância em Saúde: volume único [recurso eletrônico] / Ministério da Saúde, Secretaria de Vigilância em Saúde, Coordenação-Geral de Desenvolvimento da Epidemiologia em Serviços. – 3ª. ed. – Brasília. Disponível em: https ://bvsms.saude.gov.br/ bvs/publica coes/guia_vigilancia_saude_3ed.pdf Acesso em: 22 mar. 2024.
21. NATH R, et al. Cryptococcus neoformans var. grubii Infection in HIV-Seronegative Patients from Northeast India: Report of Two Cases with Review of Literature. Mycopathologia, 2016; 181(3-4): 315-21.
22. NAYAK SU, et al. Cryptococcal Meningitis in an HIV-Positive Pregnant Woman. J Int Assoc Physicians AIDS Care (Chic), 2011; 10(2): 79-82.
23. NUNES JO, et al. Cryptococcal meningitis epidemiology: 17 years of experience in a State of the Brazilian Pantanal. Rev Soc Bras Med Trop, 2018; 51(4): 485-492.
24. OREFICE RR. Immunology and the immunological response in pregnancy. Best Pract Res Clin Obstet Gynaecol, 2020; 76: 3-12.
25. OUZZANI M, et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev, 2016; 5(1): 210.
26. Park BJ, et al. Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. Aids, 2009; 23(4): 525-530.
27. PASTICK KA, et al. Cryptococcosis in pregnancy and the postpartum period: Case series and systematic review with recommendations for management. Medical mycology, 2020; 58(3): 282-292.
28. PEREIRA CAP, et al. Cryptococcal meningitis in pregnancy: review of the literature. Report of two cases. Revista do Instituto de Medicina Tropical de São Paulo, 1993; 35: 367-371.
29. PERFECT JR e BICANIC T. Cryptococcosis diagnosis and treatment: What do we know now. Fungal Genetics and Biology, 2015; 78: 49-54.
30. PHILPOT CR e LO D. Cryptococcal meningitis in pregnancy. Med J Aust, 1972; 2(18): 1005-7.
31. PYRGOS V, et al. Epidemiology of cryptococcal meningitis in the US: 1997-2009. PLoS One, 2013; 8(2): 56269.
32. RAJASINGHAM R, et al. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis, 2017; 17(8): 873-881.
33. ROBALO NUNES T, et al. Cryptococcal Meningitis in an HIV-Negative Puerperal Woman. Case Rep Infect Dis, 2021; 6665624.
34. SANGARÉ I, et al. Prevalence of vulvovaginal candidiasis in pregnancy at three health centers in Burkina Faso. J Mycol Med, 2018; 28(1): 186-192.
35. SCHUTZ C, et al. Acute Kidney Injury and Urinary Biomarkers in Human Immunodeficiency Virus-Associated Cryptococcal Meningitis. Open Forum Infect Dis, 2017; 4(3): 127.
36. SLOAN DJ e PARRIS V. Cryptococcal meningitis: epidemiology and therapeutic options. Clin Epidemiol, 2014; 6: 169-82.
37. URSI ES e GAVÃO CM. Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura [Perioperative prevention of skin injury: an integrative literature review]. Rev Lat Am Enfermagem, 2006; 14(1): 124-31.
38. VIDAL JE, et al. Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America. Braz J Infect Dis, 2013; 17(3): 353-62.
39. WHO. WORLD HEALTH ORGANIZATION, 2018. Guidelines for The Diagnosis, Prevention and Management of Cryptococcal Disease in HIV-Infected Adults, Adolescents and Children: Supplement to the 2016 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Geneva: World Health Organization; 2018. PMID: 30285342. Disponível em: https ://www.who.int/pu blications/i/item/9789241550277.