Presentation and Mortality of Cryptococcal Infection Varies by Predisposing Illness: A Retrospective Cohort Study
Presentation and Mortality of Cryptococcal Infection Varies by Predisposing Illness: A Retrospective Cohort Study
复制标题
DOI：
10.1016/j.amjmed.2019.04.026
复制
发表时间：
2019-08-01
影响因子：
5.9
通讯作者：
Spec, Andrej
中科院分区：
文献类型：
--
作者：
Hevey, Matthew A.;George, Ige A.;Spec, Andrej
背景：在现代抗逆转录病毒时代，隐球菌的流行病学正在发生变化，免疫状态决定了结果。我们描述了在抗逆转录病毒治疗的时代，隐球菌病的免疫状态的临床表现和死亡率的差异。 方法：我们对2002年至2017年诊断为隐球菌病的患者进行了单中心回顾性队列研究。数据包括人口统计学、临床特征、诊断和死亡率。 研究结果：我们确定了304例新型隐球菌感染患者：105例（35%）为人类免疫缺陷病毒（HIV）感染者，41例（13%）有移植史，158例（52%）为非HIV非移植（NHNT）。年龄分析显示，艾滋病毒感染者（40岁）比移植（53岁）和NHNT（61岁）年轻（P < .001）。发烧和头痛在艾滋病毒感染者中（70%和57%）比移植患者（49%和29%）和NHNT患者（49%和38%）更常见（P = .003和P = .001）。脑膜炎在HIV感染者（68%）中比移植受者（32%）或NHNT（39%，P <0.001）更常见。与移植（66%）或NHNT（73%）相比，播散性隐球菌病在HIV感染者中更常见（97%）（P <0.001）。与HIV感染者（中位数1天，IQR +/- 2天）相比，移植患者（中位数2天，四分位数范围[IQR] +/- 9天）和NHNT患者（中位数2天，IQR +/- 7天）从住院到诊断的时间更长（P = .003）。与HIV感染者相比，NHNT患者的90天死亡率风险更高（风险比3.3; 95%置信区间1.9-5.8）。结论：大多数隐球菌病发生在NHNT患者中。NHNT患者有更多的局限性肺隐球菌病和显着更高的90天死亡率。隐球菌病在NHNT患者似乎是一个独特的实体，需要进一步研究，并需要更高水平的临床怀疑比目前收到的。(C)2019爱思唯尔公司All rights reserved.
BACKGROUND: Cryptococcal epidemiology is changing in the modern antiretroviral era, and immune status informs outcomes. We describe the differences in clinical presentation and mortality of cryptococcosis by immune status in the antiretroviral therapy era. METHODS: We conducted a single-center retrospective cohort study of patients diagnosed with cryptococcosis from 2002 through 2017. Data included demographics, clinical features, diagnostics, and mortality. RESULTS: We identified 304 patients with Cryptococcus neoformans infections: 105 (35%) were people living with human immunodeficiency virus (HIV), 41 (13%) had a history of transplantation, and 158 (52%) were non-HIV nontransplant (NHNT). Age analysis showed that people living with HIV were younger (40 years) than transplant (53 years) and NHNT (61 years) (P < .001). Fevers and headache were more common in people living with HIV (70% and 57%) than in transplant (49% and 29%) and NHNT (49% and 38%) (P = .003 and P = .001), respectively. Meningitis was more common in people living with HIV (68%) than in transplant recipients (32%) or NHNT (39%, P < .001). Disseminated cryptococcosis was more common in people living with HIV (97%) as compared with transplant (66%) or NHNT (73%) (P < .001). Time to diagnosis from hospitalization was longer for transplant (median 2 days, interquartile range [IQR] +/- 9 days) and NHNT patients (median 2 days, IQR +/- 7 days) as compared with people living with HIV (median 1 day, IQR +/- 2 days) (P = .003). NHNT patients had a higher risk of 90-day mortality (hazard ratio 3.3; 95% confidence interval, 1.9-5.8) as compared with people living with HIV. CONCLUSIONS: The majority of cryptococcosis occurs in NHNT patients. NHNT patients had more localized pulmonary cryptococcosis and significantly higher 90-day mortality. Cryptococcosis in NHNT patients appears to be a distinct entity that needs further study and requires a higher level of clinical suspicion than it currently receives. (C) 2019 Elsevier Inc. All rights reserved.