Clinical features of pulmonary cryptococcosis in non-HIV patients in Japan
Clinical features of pulmonary cryptococcosis in non-HIV patients in Japan
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DOI：
10.1016/j.jiac.2014.08.025
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发表时间：
2015-01-01
影响因子：
2.2
通讯作者：
Ashizawa, Kazuto
中科院分区：
文献类型：
--
作者：
Kohno, Shigeru;Kakeya, Hiroshi;Ashizawa, Kazuto
目的：了解日本非hiv人群肺隐球菌病的临床特点。方法：对我院1977 ~ 2012年收治的151例肺隐球菌病病例进行回顾性调查。检查基础疾病（UDs）、加重因素、放射学特征和治疗。结果：67例（44.4%）患者无UDs。最常见的疾病是糖尿病（32.1%），其次是血液病（22.6%）和胶原蛋白病（22.6%）。周围分布的肺结节/肿块最常见。合并UDs的患者右肺中叶病变（p = 0.01）和支气管气征病变（p = 0.05）发生率明显高于未合并UDs的患者。非脑膜脑炎患者主要选用唑类药物。有无UDs患者的平均治疗时间分别为6.64个月和2.87个月。治疗后肺结节改善的患者继续经历隐球菌抗原滴度的逐渐降低，即使在停止治疗时抗原滴度为阳性。停止治疗后抗原滴度变为阴性的平均时间，有UDs和没有UDs的患者分别为13.1和10.7个月。当根据脑膜脑炎并发症、死亡和存活情况对各组进行比较时，影响隐球菌病预后的因素包括较高的年龄、低蛋白血症、低白蛋白血症、类固醇使用、高c反应蛋白水平和脑膜脑炎并发症。结论：非hiv隐球菌病患者在选择抗真菌药物和治疗时间时应考虑是否存在UDs和脑膜脑炎。对于伴有或不伴有UDs的肺隐球菌病，分别给予3个月和6个月的唑类药物治疗是合理的。(C) 2014年，日本化疗学会和日本传染病学会。Elsevier Ltd.出版。版权所有。
Objective: To clarify the clinical features of pulmonary cryptococcosis in Japanese non-HIV population.Methods: Retrospective investigation of 151 pulmonary cryptococcosis cases between 1977 and 2012 was executed. The underlying disease (UDs), aggravating factors, radiological characteristics, and treatment were examined.Results: Sixty-seven patients (44.4%) had no UDs. The common UDs were diabetes (32.1%) followed by hematologic disease (22.6%), and collagen disease (22.6%). Peripherally distributed pulmonary nodules/masses were most commonly seen. Lesions in the right middle lobe (p = 0.01) and air bronchogram (P = 0.05) were significantly more frequent, respectively, in patients with UDs than patients without them. Azoles were mainly selected for the patients without meningoencephalitis. Mean treatment duration for patients with and without UDs was 6.64 and 2.87 months, respectively. Patients whose pulmonary nodules improved after treatment continued to experience gradual reduction of cryptococcosis antigen titers, even if antigen titers were positive at the time of treatment cessation. The average time for antigen titers to become negative after treatment cessation was 13.1 and 10.7 months for patients with and without UDs, respectively. When groups were compared according to the presence of meningoencephalitis complications, deaths, and survivals, factors contributing to cryptococcosis prognosis included higher age, hypoproteinemia, hypoalbuminemia, steroid use, high C-reactive protein levels, and meningoencephalitis complications.Conclusions: It is crucial to consider the presence of UDs and meningoencephalitis for the choice of antifungals and treatment duration for cryptococcosis in non-HIV patients. Three- and six months-administration of azoles for pulmonary cryptococcosis with or without UDs, respectively is reasonable. (C) 2014, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.