Cryptococcosis in pregnancy and the postpartum period: Case series and systematic review with recommendations for management.
Cryptococcosis in pregnancy and the postpartum period: Case series and systematic review with recommendations for management.
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妊娠期和产后期的隐球菌病：病例系列和系统评价以及管理建议。
DOI：
10.1093/mmy/myz084
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发表时间：
2020
期刊：
影响因子：
2.9
通讯作者：
Rajasingham,R
中科院分区：
文献类型：
--
作者：
Pastick,KatelynA;Nalintya,Elizabeth;Tugume,Lillian;Ssebambulidde,Kenneth;Stephens,Nicole;Evans,EmilyE;Ndyetukira,JaneFrances;Nuwagira,Edwin;Skipper,Caleb;Muzoora,Conrad;Meya,DavidB;Rhein,Joshua;Boulware,DavidR;Rajasingham,R
与艾滋病相关的死亡中有15%是由隐球菌性脑膜炎引起的。患有隐球菌病的孕妇的最佳治疗和临床结果仅限于病例报告，因为孕妇往往被排除在研究之外。在患有无症状隐球菌病的孕妇中，没有治疗指南。我们前瞻性地确定了怀孕或最近怀孕的患有隐球菌病的艾滋病毒感染妇女，这些妇女是在2012年至2018年乌干达一系列脑膜炎研究期间进行筛查的。在571名接受隐球菌病筛查的妇女中，13人怀孕，1人哺乳，3人产后14天内，2人最近流产。在这19名妇女中(3.3%)，12名患有隐球菌性脑膜炎，6名患有隐球菌抗原血症，1名有隐球菌性脑膜炎病史并正在接受二级预防。所有患有脑膜炎的女性都接受了两性霉素B脱氧胆酸盐(0.7-1.0 mg/kg)。其中5人在怀孕期间接触了200-800毫克的氟康唑。在这五人中，三人生下了健康的婴儿，出生时没有严重的身体异常，一人死于脑膜炎，一人结局不明。出院时母体脑膜炎存活率为75%(9/12)，存活母体新生儿/胎儿存活率为44%(4/9)。流产和死产常见(n=4)。在6名患有隐球菌抗原血症的女性中，2人接受氟康唑治疗，1人每周接受两性霉素B治疗，3人疗程不明。所有患有抗原血症的女性都存活了下来，没有一人出现临床脑膜炎。我们报告了在妊娠早期使用两性霉素B而不使用氟康唑治疗隐球菌性脑膜炎的母体结局良好，但胎儿结局较差，并且每周使用两性霉素B代替氟康唑治疗隐球菌抗原血症。
Cryptococcal meningitis causes 15% of AIDS-related deaths. Optimal management and clinical outcomes of pregnant women with cryptococcosis are limited to case reports, as pregnant women are often excluded from research. Amongst pregnant women with asymptomatic cryptococcosis, no treatment guidelines exist. We prospectively identified HIV-infected women who were pregnant or recently pregnant with cryptococcosis, screened during a series of meningitis research studies in Uganda from 2012 to 2018. Among 571 women screened for cryptococcosis, 13 were pregnant, one was breastfeeding, three were within 14 days postpartum, and two had recently miscarried. Of these 19 women (3.3%), 12 had cryptococcal meningitis, six had cryptococcal antigenemia, and one had a history of cryptococcal meningitis and was receiving secondary prophylaxis. All women with meningitis received amphotericin B deoxycholate (0.7–1.0 mg/kg). Five were exposed to 200–800 mg fluconazole during pregnancy. Of these five, three delivered healthy babies with no gross physical abnormalities at birth, one succumbed to meningitis, and one outcome was unknown. Maternal meningitis survival rate at hospital discharge was 75% (9/12), and neonatal/fetal survival rate was 44% (4/9) for those mothers who survived. Miscarriages and stillbirths were common (n= 4). Of six women with cryptococcal antigenemia, two received fluconazole, one received weekly amphotericin B, and three had unknown treatment courses. All women with antigenemia survived, and none developed clinical meningitis. We report good maternal outcomes but poor fetal outcomes for cryptococcal meningitis using amphotericin B, without fluconazole in the first trimester, and weekly amphotericin B in place of fluconazole for cryptococcal antigenemia.
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DOI：
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发表时间：
1977
期刊：
Teratology
影响因子：
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作者：
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DOI：
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发表时间：
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期刊：
Teratology
影响因子：
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影响因子：
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