Comparison and temporal trends of three groups with cryptococcosis: HIV-infected, solid organ transplant, and HIV-negative/non-transplant.
Comparison and temporal trends of three groups with cryptococcosis: HIV-infected, solid organ transplant, and HIV-negative/non-transplant.
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DOI：
10.1371/journal.pone.0043582
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Perfect JR
中科院分区：
文献类型：
--
作者：
Bratton EW;El Husseini N;Chastain CA;Lee MS;Poole C;Stürmer T;Juliano JJ;Weber DJ;Perfect JR
美国传染病学会(IDSA)《2010年隐球菌病管理临床实践指南》概述了三个面临疾病风险的关键人群：(1)艾滋病毒感染者、(2)移植接受者和(3)艾滋病毒阴性/非移植人群。然而，还没有对这些群体的管理、严重性和结果进行直接比较。记录了诊断隐球菌病的频率、与隐球菌病有关的死亡率和死亡率的年度变化。在三组背景下考察了严重和非严重疾病之间的差异，包括：人口统计学、症状、微生物学、临床管理和治疗。平均每年有近15名患者在杜克大学医学中心(DUMC)就诊，患有隐球菌病。在207名研究患者中，86名(42%)艾滋病毒阳性，42名(20%)接受移植，79名(38%)艾滋病毒阴性/未接受移植。HIV感染者有严重的CD4淋巴细胞减少，大多数人颅内压升高。移植受者通常(38%)有肾功能障碍。近四分之一(24%)的人停止或改变了他们的免疫抑制方案。HIV阴性/非移植人群报告的症状持续时间比HIV阳性或移植接受者更长，28%(22/79)有肝功能不全或潜在的血液系统恶性肿瘤。艾滋病毒阳性和艾滋病毒阴性/非移植患者占严重疾病隐球菌病所致死亡的89%，占全因死亡的86%。在这项单中心研究中，隐球菌病的频率在过去20年中没有变化，尽管潜在的病例组合发生了变化(艾滋病毒阳性病例减少，移植病例稳定，两者都没有的病例更多)。隐球菌病有相对统一和知情的治疗策略，但可归因于疾病的死亡仍然很常见。
The Infectious Disease Society of America (IDSA) 2010 Clinical Practice Guidelines for the management of cryptococcosis outlined three key populations at risk of disease: (1) HIV-infected, (2) transplant recipient, and (3) HIV-negative/non-transplant. However, direct comparisons of management, severity and outcomes of these groups have not been conducted. Annual changes in frequency of cryptococcosis diagnoses, cryptococcosis-attributable mortality and mortality were captured. Differences examined between severe and non-severe disease within the context of the three groups included: demographics, symptoms, microbiology, clinical management and treatment. An average of nearly 15 patients per year presented at Duke University Medical Center (DUMC) with cryptococcosis. Out of 207 study patients, 86 (42%) were HIV-positive, 42 (20%) were transplant recipients, and 79 (38%) were HIV-negative/non-transplant. HIV-infected individuals had profound CD4 lymphocytopenia and a majority had elevated intracranial pressure. Transplant recipients commonly (38%) had renal dysfunction. Nearly one-quarter (24%) had their immunosuppressive regimens stopped or changed. The HIV-negative/non-transplant population reported longer duration of symptoms than HIV-positive or transplant recipients and 28% (22/79) had liver insufficiency or underlying hematological malignancies. HIV-positive and HIV-negative/non-transplant patients accounted for 89% of severe disease cryptococcosis-attributable deaths and 86% of all-cause mortality. In this single-center study, the frequency of cryptococcosis did not change in the last two decades, although the underlying case mix shifted (fewer HIV-positive cases, stable transplant cases, more cases with neither). Cryptococcosis had a relatively uniform and informed treatment strategy, but disease-attributable mortality was still common.
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