Low CD4 count plus coma predicts cryptococcal meningitis in Tanzania
Low CD4 count plus coma predicts cryptococcal meningitis in Tanzania
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DOI：
10.1186/1471-2334-7-39
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发表时间：
2007-05-10
影响因子：
3.7
通讯作者：
Houpt, Eric R.
中科院分区：
文献类型：
--
作者：
Kisenge, Peter R.;Hawkins, Alexander T.;Houpt, Eric R.
背景资料：主要由于缺乏诊断试剂，坦桑尼亚隐球菌脑膜炎的患病率和临床表现知之甚少。这反过来又限制了增加氟康唑availability. Methods的影响：我们评估了一个队列的149个连续的HIV感染的成人住院患者头痛或改变精神状态的临床特征，CD4计数，隐球菌感染，和结果。隐球菌脑膜炎是通过印度墨水和乳胶凝集试验的CSF（n = 24和40阳性，分别）诊断。通过t检验评估隐球菌脑膜炎与临床特征之间的关联。结果：隐球菌脑膜炎与意识模糊、社交退缩、癫痫发作、发热、心动过速、脑膜炎、口腔念珠菌病、低格拉斯哥昏迷评分和CD 4计数相关。CD4计数<100/μ l为诊断提供了最高的灵敏度（93%），昏迷（格拉斯哥昏迷量表= 8）提供了最高的特异性（84%），并且联合提供了最高的阳性似然比（3.8）。所有隐球菌脑膜炎患者开始800毫克的氟康唑，每天和50%的存活出院，但没有临床或实验室检查结果与预后。结论：隐球菌脑膜炎是常见的坦桑尼亚艾滋病毒住院患者头痛或精神状态改变。Pastoris的临床特征对诊断或预后不敏感。我们主张扩大隐球菌抗原检测的实验室能力，以最大限度地提高生存率。
Background: Largely due to the lack of diagnostic reagents, the prevalence and clinical presentation of cryptococcal meningitis in Tanzania is poorly understood. This in turn is limiting the impact of increased fluconazole availability.Methods: We evaluated a cohort of 149 consecutive HIV-infected adult inpatients presenting with headache or altered mental status for clinical features, CD4 count, cryptococcal infection, and outcome. Cryptococcal meningitis was diagnosed via India ink and latex agglutination assay of CSF ( n = 24 and 40 positive, respectively). Associations between cryptococcal meningitis and clinical features were evaluated by t-test. The sensitivity, specificity, and positive likelihood ratio of such features were determined.Results: Cryptococcal meningitis was associated with confusion, social withdrawal, seizures, fever, tachycardia, meningismus, oral candidiasis, and low Glasgow coma scales and CD4 count. CD4 count < 100/mu l provided the highest sensitivity for the diagnosis ( 93%), coma ( Glasgow coma scale = 8) provided the highest specificity ( 84%), and the combination provided the highest positive likelihood ratio ( 3.8). All cryptococcal meningitis patients were initiated on 800 milligrams of fluconazole daily and 50% survived to discharge, however no clinical or laboratory findings correlated with prognosis.Conclusion: Cryptococcal meningitis is common among Tanzanian HIV inpatients presenting with headache or altered mental status. Purely clinical features are insensitive for establishing the diagnosis or prognosis. We advocate expanding laboratory capacity for cryptococcal antigen testing to maximize survival.