Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy
Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy
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DOI：
10.1086/322597
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发表时间：
2001-09-01
影响因子：
11.8
通讯作者：
Dismukes, WE
中科院分区：
文献类型：
--
作者：
Pappas, PG;Perfect, JR;Dismukes, WE
我们对 1990 年至 1996 年间美国 15 个医疗中心的人类免疫缺陷病毒 (HIV) 阴性隐球菌病患者进行了案例研究，以了解该人群的人口统计特征、治疗方法以及与不良预后相关的因素。 306 例隐球菌病患者中，109 例肺部受累，157 例中枢神经系统（CNS）受累，40 例其他部位受累。百分之七十九有严重的潜在疾病。肺部疾病患者最初通常接受氟康唑治疗（63%）；中枢神经系统疾病患者普遍接受两性霉素 B（92%）治疗。大约三分之二的中枢神经系统疾病患者接受氟康唑进行巩固治疗。 74% 的患者治疗成功。多变量分析中死亡率的重要预测因素包括年龄大于或等于 60 岁、血液恶性肿瘤和器官衰竭。总死亡率为 30%，隐球菌病死亡率为 12%。隐球菌病仍然是 HIV 阴性患者的一种重要感染，并与大量总体死亡率和特定原因死亡率相关。
We conducted a case study of human immunodeficiency virus (HIV)-negative patients with cryptococcosis at 15 United States medical centers from 1990 through 1996 to understand the demographics, therapeutic approach, and factors associated with poor prognosis in this population. Of 306 patients with cryptococcosis, there were 109 with pulmonary involvement, 157 with central nervous system (CNS) involvement, and 40 with involvement at other sites. Seventy-nine percent had a significant underlying condition. Patients with pulmonary disease were usually treated initially with fluconazole (63%); patients with CNS disease generally received amphotericin B (92%). Fluconazole was administered to approximately two-thirds of patients with CNS disease for consolidation therapy. Therapy was successful for 74% of patients. Significant predictors of mortality in multivariate analysis included age greater than or equal to 60 years, hematologic malignancy, and organ failure. Overall mortality was 30%, and mortality attributable to cryptococcosis was 12%. Cryptococcosis continues to be an important infection in HIV-negative patients and is associated with substantial overall and cause-specific mortality.