Development of secondary resistance to fluconazole in Cryptococcus neoformans isolated from a patient with AIDS

Cryptococcus neoformans is the fifth most common opportunistic agent of infection in patients with AIDS in the USA, exceeded only by Candida species, Pneumocystis carinii, cytomegalovirus and Mycobacterium avium1, 2, 6, 10, 11. In Brazil is the sixth, exceeded by Candida species, P. carinii, Mycobacterium species, Toxoplasma gondii, and herpes simplex virus (AIDS, Boletim Epidemiológico, set/nov 96, Ministério da Saúde, Brasil). During 30 years, the treatment of C. neoformans meningitis was based on the use of amphotericin B with or without flucytosine13. Nowadays, with the immunodepression caused by human immunodeficiency virus (HIV) infection and the availability of new antifungal drugs as the triazoles, the concept related to cure and relapses of cryptococcosis has been altered7, 20. Patients are treated with amphotericin B with or without flucytosine as initial therapy, but maintenance therapy is always necessary in AIDS patients with C. neoformans infections Relatamos um caso de meningite por Cryptococcus neoformans em paciente com Síndrome de Imunodeficiência Adquirida (SIDA). A terapia de manutenção com fluconazol não evidenciou melhora clínica e micológica, ao mesmo tempo em que o teste de suscetibilidade in vitro revelou aumento progressivo da concentração inibitória mínima (CIM). Estes resultados sugerem o desenvolvimento de resistência secundária ao fluconazol, todavia, resistência cruzada com outros derivados azólicos não foi constatada