Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment.
Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment.
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DOI：
10.1097/md.0000000000010245
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发表时间：
2018-03
期刊：
影响因子：
1.6
通讯作者：
Anderson A
中科院分区：
文献类型：
--
作者：
Wheat J;Myint T;Guo Y;Kemmer P;Hage C;Terry C;Azar MM;Riddell J;Ender P;Chen S;Shehab K;Cleveland K;Esguerra E;Johnson J;Wright P;Douglas V;Vergidis P;Ooi W;Baddley J;Bamberger D;Khairy R;Vikram HR;Jenny-Avital E;Sivasubramanian G;Bowlware K;Pahud B;Sarria J;Tsai T;Assi M;Mocherla S;Prakash V;Allen D;Passaretti C;Huprikar S;Anderson A
中枢神经系统（CNS）受累发生在5%至10%的个体弥散性组织胞浆菌病。大多数经验来自于小的单中心病例系列或病例报告文献综述。因此，需要对中枢神经系统（CNS）组织胞浆菌病进行更大规模的研究，以指导诊断和治疗方法。对77例中枢神经系统组织胞浆菌病感染患者的方便样本进行评估。收集的数据侧重于感染的识别、诊断技术和治疗结果。29%的患者没有免疫抑制。75%的患者脑脊液中检测到组织浆抗原或抗组织浆抗体。最初使用两性霉素B治疗的患者一年生存率为75%，使用脂质体或脱氧胆酸盐制剂的患者一年生存率最高。免疫功能低下患者和54岁及以上患者的死亡率更高。6%的患者复发，他们都患有获得性免疫缺陷综合征（艾滋病），并且治疗依从性差。虽然中枢神经系统组织胞浆菌病最常发生在免疫功能低下的个体中，但很大一部分患者以前是健康的。多数患者可通过脑脊液抗原和抗体检测、血清和尿液抗原检测来确诊。用两性霉素B （AMB-L）脂质体治疗至少1个月；随后服用伊曲康唑至少1年，结果大多数患者存活。患者应在停止治疗后至少随访1年以防复发。
Supplemental Digital Content is available in the text Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment. A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment. Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment. While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.