INFECTIONS COMPLICATING MYCOSIS-FUNGOIDES AND SEZARY-SYNDROME
INFECTIONS COMPLICATING MYCOSIS-FUNGOIDES AND SEZARY-SYNDROME
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DOI：
10.1001/jama.267.10.1354
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发表时间：
1992-03-11
影响因子：
120.7
通讯作者：
VONDERHEID, EC
中科院分区：
文献类型：
--
作者：
AXELROD, PI;LORBER, B;VONDERHEID, EC
目标。-确定真菌样霉菌病和Sezary综合征患者的感染发生率、医院感染的重要性以及与皮肤和内脏感染相关的流行病学因素。-在大学医学中心转诊诊所进行的回顾性队列研究。-356名真菌病或塞扎里综合征患者。主要预后指标。-特定感染的发病率，以及与感染相关的人口统计学和临床因素的多变量风险比。-皮肤细菌感染最为常见(每100人年感染17.0人)，其次是皮肤单纯疱疹病毒和带状疱疹病毒感染(每100人年3.8人感染)、菌血症(每100人年2.1人感染)、细菌性肺炎(每100人年1.7人感染)和尿路感染(每100人年1.4人感染)。27%的疱疹病毒感染在皮肤上传播，但没有传播到内脏。在死于感染的患者中，88%的患者存在肺炎或菌血症。只有3名患者有侵袭性真菌或原虫感染。医院感染占皮肤细菌感染的19%，细菌血症的59%，肺炎的62%，以及导致死亡的感染的88%。经Logistic回归和COX回归分析，皮肤外淋巴瘤是反复细菌性皮肤感染(RR)12，95%可信区间(CI)1.2~120，播散性疱疹病毒感染(RR，28；95%CI，2.7~290)，血液感染(RR，5.5；95%CI，1.7~18)，感染死亡(RR，15；95%CI，3.6，)的最重要的独立危险因素。-社区获得性细菌皮肤感染是真菌病和Sezary综合征患者发病的常见原因，但通常无需住院治疗。菌血症和肺炎通常是医院内的，是死亡的主要感染性原因。晚期疾病是皮肤和全身感染的最重要的危险因素，与皮质类固醇和其他治疗方法无关。
Objective. - To determine, in patients with mycosis fungoides and Sezary syndrome, the incidence of infections, the importance of nosocomial infections, and the epidemiologic factors associated with cutaneous and visceral infections.Design and Setting. - Retrospective inception cohort study at a university medical center referral clinic.Patients. - Three hundred fifty-six patients with mycosis fungoides or Sezary syndrome.Main Outcome Measures. - Incidence rates for specific infections, and multivariate risk ratios for demographic and clinical factors associated with infection.Results. - Cutaneous bacterial infection was most common (17.0 infections per 100 patient-years), followed by cutaneous herpes simplex virus and herpes zoster virus infection (3.8 infections per 100 patient-years), bacteremia (2.1 infections per 100 patient-years), bacterial pneumonia (1.7 infections per 100 patient-years), and urinary tract infection (1.4 infections per 100 patient-years). Twenty-seven percent of herpesvirus infections disseminated on the skin but none disseminated to internal organs. Pneumonia or bacteremia was present in 88% of patients who died of infection. Only three patients had invasive fungal or protozoal infection. Nosocomial infections accounted for 19% of cutaneous bacterial infections, 59% of bacteremias, 62% of pneumonias, and 88% of infections leading to death. By logistic and Cox regression, the presence of extracutaneous involvement with lymphoma was the most important independent risk factor for recurrent bacterial skin infection (risk ratio [RR], 12; 95% confidence interval [Cl], 1.2 to 120), disseminated herpesvirus infection (RR, 28; 95% Cl, 2.7 to 290), bloodstream infection (RR, 5.5; 95% Cl, 1.7 to 18), and death from infection (RR, 15; 95% Cl, 3.6 to 64).Conclusions. - Community-acquired bacterial skin infections are a common cause of morbidity in patients with mycosis fungoides and Sezary syndrome but are usually treated without hospital admission. Bacteremia and pneumonia, which are usually nosocomial, are the major infectious causes of death. Advanced disease stage, independent of corticosteroids and other therapies, is the most important risk factor for both cutaneous and systemic infections.