Abordagem Diagnóstica da Neurocriptococose em Imunocompetentes

Revisão Integrativa de Literatura

Abstract

Introduction: Neurocryptococcosis is a worldwide disease with high mortality, triggered by fungal involvement of the central nervous system (CNS), with encapsulated strains of the Cryptococcus genus as the main pathogenic agents. Among the species of epidemiological relevance, Cryptococcus neoformans, an opportunistic pathogen, and Cryptococcus gattii, of more limited distribution and affecting specific groups of immunocompetent patients, stand out. However, the emergence of cases diagnosed in immunocompetent individuals has drawn attention to the diagnostic complexity of this condition, since this hypothesis is not usually considered among the initial diagnostic possibilities in individuals without classic risk factors. Objective: To describe reported cases of neurocryptococcosis in immunocompetent patients, highlighting the diagnostic approaches employed. Methodology: This is an integrative review based on the methodology proposed by Botelho, Cunha, and Macedo (2011), using the PICO strategy. The population consisted of immunocompetent patients diagnosed with neurocryptococcosis, and the intervention corresponded to the diagnostic investigation methods. The descriptors Neurocryptococcosis and Immunocompetent (in Portuguese and English) were used in the NLM, SciELO, and BVS databases. No time restriction was applied due to the rarity of the condition. Screening followed the PRISMA method, and studies were organized according to an adaptation of the instrument by Ursi (2005). Results and Discussion: The included articles show that the diagnosis is often made only when the patient presents clinical severity, and that imaging exams frequently suggest neoplasms or other etiologies, delaying the definitive diagnosis, which is primarily established through cerebrospinal fluid analysis, fungal investigation using India ink staining, cryptococcal antigen detection, culture, or biopsy with histopathological examination. Conclusion: The incorporation of care protocols that include fungal investigation in neurological conditions can significantly contribute to faster recognition of this disease, improving early diagnosis and reducing adverse outcomes.