Hypoxemic Respiratory Failure and Coccidioidomycosis-Associated Acute Respiratory Distress Syndrome.
Hypoxemic Respiratory Failure and Coccidioidomycosis-Associated Acute Respiratory Distress Syndrome.
复制标题
低氧性呼吸衰竭和球孢子菌病相关的急性呼吸窘迫综合征。
DOI：
10.1093/ofid/ofad679
复制
发表时间：
2024
影响因子：
4.2
通讯作者：
Thompson,GeorgeR
中科院分区：
文献类型：
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作者：
Heidari,Arash;Kaur,Simmer;Pearson,SkylerJ;Munoz,Augustine;Sandhu,Harleen;Mann,Gursimran;Schivo,Michael;Zeki,AmirA;Bays,DerekJ;Wilson,Machelle;Albertson,TimothyE;Johnson,Royce;Thompson,GeorgeR
以呼吸衰竭为表现的严重球孢子菌病是一种罕见的疾病。目前对这种情况的了解仅限于病例报告和小病例系列。方法对球虫菌病相关急性呼吸窘迫综合征（CA-ARDS）患者进行回顾性多中心分析。该研究评估了患者出现时的临床和实验室变量，回顾了治疗过程，并将该队列与非球虫真菌病ARDS患者的国家数据库进行了比较。还比较了球孢子菌病的幸存者和非幸存者，以确定预后因素。结果在本研究中，CA-ARDS （n = 54）在男性、西班牙裔和合并糖尿病患者中最为常见。与PETAL网络数据库（Prevention and Early Treatment of Acute Lung Injury; n = 1006）相比，球虫菌病患者年龄更小，合并症更少，中毒程度更低。球虫病患者的90天死亡率为15.4%，非球虫病ARDS患者的90天死亡率为42.6% （P< 0.0001）。与存活的患者相比，死亡的球孢子菌病患者年龄较大，APACHE II评分较高（急性生理和慢性健康评估），并且未接受皮质类固醇治疗。结论sca - ards是一种少见但病态的感染表现。当与国家数据库进行比较时，与其他原因的ARDS相比，总的死亡率似乎是有利的。CA-ARDS患者总体死亡率较低，但需要长期抗真菌治疗。皮质类固醇在这种情况下的效用仍未得到证实。
BackgroundSevere coccidioidomycosis presenting with respiratory failure is an uncommon manifestation of disease. Current knowledge of this condition is limited to case reports and small case series.MethodsA retrospective multicenter review of patients with coccidioidomycosis-associated acute respiratory distress syndrome (CA-ARDS) was conducted. It assessed clinical and laboratory variables at the time of presentation, reviewed the treatment course, and compared this cohort with a national database of patients with noncoccidioidomycosis ARDS. Survivors and nonsurvivors of coccidioidomycosis were also compared to determine prognostic factors.ResultsIn this study, CA-ARDS (n = 54) was most common in males, those of Hispanic ethnicity, and those with concurrent diabetes mellitus. As compared with the PETAL network database (Prevention and Early Treatment of Acute Lung Injury; n = 1006), patients with coccidioidomycosis were younger, had fewer comorbid conditions, and were less acidemic. The 90-day mortality was 15.4% for patients with coccidioidomycosis, as opposed to 42.6% (P< .0001) for patients with noncoccidioidomycosis ARDS. Patients with coccidioidomycosis who died, as compared with those who survived, were older, had higher APACHE II scores (Acute Physiology and Chronic Health Evaluation), and did not receive corticosteroid therapy.ConclusionsCA-ARDS is an uncommon but morbid manifestation of infection. When compared with a national database, the overall mortality appears favorable vs other causes of ARDS. Patients with CA-ARDS had a low overall mortality but required prolonged antifungal therapy. The utility of corticosteroids in this condition remains unconfirmed.