Pulmonary cryptococcosis in patients without HIV infection: factors associated with disseminated disease
Pulmonary cryptococcosis in patients without HIV infection: factors associated with disseminated disease
复制标题
DOI：
10.1007/s10096-008-0529-z
复制
发表时间：
2008-10-01
影响因子：
4.5
通讯作者：
Pappas, P. G.
中科院分区：
文献类型：
--
作者：
Baddley, J. W.;Perfect, J. R.;Pappas, P. G.
新生隐球菌是HIV阴性患者肺炎的罕见病因。由于它有扩散到脑膜和其他部位的倾向，建议肺隐球菌病患者进行腰椎穿刺术，而不考虑其他危险因素。这项研究探索了临床和实验室特征，以帮助预测哪些患者只有肺部疾病，哪些患者有肺外疾病。从1990年到2000年，在15个医学中心对所有HIV阴性的肺部隐球菌病患者进行了回顾性图表回顾。对人口统计学、临床、放射学和实验室特征进行评估，以确定区分肺外疾病患者的因素。在166例肺部隐球菌病患者中，122例仅有肺部感染，44例合并肺外(播散性)疾病。血清隐球菌抗原滴度阴性在仅患有肺部疾病的患者中更为常见(p<；0.01)。多因素分析显示，与仅有肺部疾病的患者相比，患有播散性疾病的患者更有可能出现肝硬变(p=0.049)、头痛(p<；0.001)、体重减轻(p=0.003)、发热(p=0.035)、精神状态改变(p<；0.001)以及接受大剂量皮质类固醇治疗(p=0.008)。在这一大群HIV阴性的肺部隐球菌病患者中，单独患有肺部疾病的患者与患有肺外疾病的患者相比，很容易区分出临床和实验室特征。这些发现可能有助于评估HIV阴性的肺隐球菌病患者是否需要进行腰椎穿刺术或寻找播散性疾病。
Cryptococcus neoformans is an uncommonly recognized cause of pneumonia in HIV-negative patients. Because of its propensity to disseminate to the meninges and other sites, a lumbar puncture is recommended for patients with pulmonary cryptococcosis, regardless of other risk factors. This study explored clinical and laboratory features to help predict which patients had pulmonary disease alone versus those who had pulmonary plus extrapulmonary disease. A retrospective chart review at 15 medical centers was performed from 1990 to 2000 of all HIV-negative patients who had pulmonary cryptococcosis. Demographic, clinical, radiographic, and laboratory features were evaluated to determine factors that differentiated those patients who had extrapulmonary disease. Among 166 patients who had pulmonary cryptococcosis, 122 had pulmonary infection only and 44 had pulmonary plus extrapulmonary (disseminated) disease. A negative serum cryptococcal antigen titer was more common in patients with pulmonary disease alone (p < 0.01). Multivariate analysis demonstrated that patients who had disseminated disease were more likely than those who only had pulmonary disease to have cirrhosis (p=0.049), headache (p < 0.001), weight loss (p=0.003), fever (p=0.035), altered mental status (p < 0.001), and to be receiving high-dose corticosteroids (p=0.008). In this large cohort of HIV-negative patients with pulmonary cryptococcosis, there were easily distinguished clinical and laboratory features among patients with pulmonary disease alone versus those with pulmonary plus extrapulmonary disease. These findings may be helpful in the evaluation of HIV-negative patients with pulmonary cryptococcosis with regard to the need for lumbar puncture or to search for disseminated disease.