A prospective descriptive study of cryptococcal meningitis in HIV uninfected patients in Vietnam - high prevalence of Cryptococcus neoformans var grubii in the absence of underlying disease.
A prospective descriptive study of cryptococcal meningitis in HIV uninfected patients in Vietnam - high prevalence of Cryptococcus neoformans var grubii in the absence of underlying disease.
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DOI：
10.1186/1471-2334-10-199
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发表时间：
2010-07-09
影响因子：
3.7
通讯作者：
Day JN
中科院分区：
文献类型：
--
作者：
Chau TT;Mai NH;Phu NH;Nghia HD;Chuong LV;Sinh DX;Duong VA;Diep PT;Campbell JI;Baker S;Hien TT;Lalloo DG;Farrar JJ;Day JN
大多数隐球菌脑膜炎病例发生在HIV感染患者中：对明显免疫功能正常的患者的病程和转归知之甚少。我们描述了一个队列的HIV未感染的隐球菌性脑膜炎的越南患者，其中潜在的疾病是不常见的，并涉及呈现的特点，患者和感染的物种的特点，结果。胡志明市热带病医院HIV阴性隐球菌脑膜炎患者的前瞻性描述性研究所有患者在基线时进行全面的临床评估，由专门的研究团队进行护理，并随访2年。通过感染分离株和结果比较临床表现。57名患者接受了研究。新生隐球菌Grubii变种分子型VN 1引起70%的感染;其余的都是gattii的大多数患者没有基础疾病（81%），基础疾病的发生率没有感染物种的差异。住院期间死亡11例（19.3%）。死亡的独立预测因素为年龄≥ 60岁和惊厥史（比值比和95%置信区间分别为8.7（1 - 76）和16.1（1.6 - 161））。残余视力损害是常见的，影响25 46幸存者（54.3%）。感染种属不影响临床表型或结果。氟胞嘧啶和阿替霉素B对C的最低抑菌浓度显著高于C。neoformans var grubii与C. Gattii（分别为p < 0.001和p = 0.01）。在越南未感染HIV的人群中，隐球菌脑膜炎主要发生在没有明确易感因素的人群中，最常见的是由于C。格鲁比新变型死亡率和视力丧失率很高，与感染的物种无关。不同物种对常用抗真菌药物的敏感性存在可检测的差异，但其临床意义尚不清楚。
Most cases of cryptococcal meningitis occur in patients with HIV infection: the course and outcome of disease in the apparently immunocompetent is much more poorly understood. We describe a cohort of HIV uninfected Vietnamese patients with cryptococcal meningitis in whom underlying disease is uncommon, and relate presenting features of patients and the characteristics of the infecting species to outcome. A prospective descriptive study of HIV negative patients with cryptococcal meningitis based at the Hospital for Tropical Diseases, Ho Chi Minh City. All patients had comprehensive clinical assessment at baseline, were cared for by a dedicated study team, and were followed up for 2 years. Clinical presentation was compared by infecting isolate and outcome. 57 patients were studied. Cryptococcus neoformans var grubii molecular type VN1 caused 70% of infections; C. gattii accounted for the rest. Most patients did not have underlying disease (81%), and the rate of underlying disease did not differ by infecting species. 11 patients died while in-patients (19.3%). Independent predictors of death were age ≥ 60 years and a history of convulsions (odds ratios and 95% confidence intervals 8.7 (1 - 76), and 16.1 (1.6 - 161) respectively). Residual visual impairment was common, affecting 25 of 46 survivors (54.3%). Infecting species did not influence clinical phenotype or outcome. The minimum inhibitory concentrations of flucytosine and amphotericin B were significantly higher for C. neoformans var grubii compared with C. gattii (p < 0.001 and p = 0.01 respectively). In HIV uninfected individuals in Vietnam, cryptococcal meningitis occurs predominantly in people with no clear predisposing factor and is most commonly due to C. neoformans var grubii. The rates of mortality and visual loss are high and independent of infecting species. There are detectable differences in susceptibility to commonly used antifungal drugs between species, but the clinical significance of this is not clear.
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影响因子：
11.8
作者：
Pappas, PG;Perfect, JR;Dismukes, WE
通讯作者：
Dismukes, WE
影响因子：
5
作者：
KWONCHUNG, KJ;BENNETT, JE
通讯作者：
BENNETT, JE
影响因子：
2.9
作者：
Kwon-Chung, KJ;Sorrell, TC;Levitz, SM
通讯作者：
Levitz, SM
影响因子：
168.9
作者：
Brouwer, AE;Rajanuwong, A;Harrison, TS
通讯作者：
Harrison, TS
DOI：
10.1111/j.1445-5994.1993.tb04726.x
发表时间：
1993-12-01
期刊：
AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE
影响因子：
--
作者：
FISHER, D;BURROW, J;CURRIE, B
通讯作者：
CURRIE, B