Investigação de danos visuais em pacientes diagnosticados com meningite criptocócica não associada à imunossupressão

Abstract

Cryptococcal meningitis is a severe infectious disease caused by Cryptococcus spp., which has high lethality and causes sensorial sequels. The most important sequels are visual impairments. The aim of this study was to describe the visual losses suffered by patients without immunosupression history, diagnosed with cryptococcal meningitis in order to indicate a possible mechanism and risk factors for the visual sequels. The work was composed by a case series study with cryptococcal meningitis without immunosupression history (n =7 patients, 14 = eyes) and an epidemiological study of all the cases of cryptococcal meningitis without immunosupression history notified during 14 years in the reference hospital of Para State (n = 113 cases). In the case series study, the visual functions of a sample of patients were studied by ophthalmological, psychophysical, and electrophysiological evaluation. The epidemiological study analyzed the medical records data focusing on visual impairment. It was observed that the studied patients in the case series study had visual acuity impairment. Even in patients without clinical complaints, color discrimination, luminance contrast sensitivity, and visual field were impaired. The results indicated central retina commitment as the principal responsible for a cascade of alterations that prevented the normal upstream image processing, at the visual cortex level. It is suggested that the observed visual dysfunction was due not only to optic nerve damage. The principal risk factors for the visual alterations observed in the epidemiological study were disease time before the beginning of the treatment and patient immunological response.