CRYPTOCOCCUS-NEOFORMANS IN TROPICAL NORTHERN AUSTRALIA - PREDOMINANTLY VARIANT GATTII WITH GOOD OUTCOMES
CRYPTOCOCCUS-NEOFORMANS IN TROPICAL NORTHERN AUSTRALIA - PREDOMINANTLY VARIANT GATTII WITH GOOD OUTCOMES
复制标题
DOI：
10.1111/j.1445-5994.1993.tb04726.x
复制
发表时间：
1993-12-01
期刊：
影响因子：
--
通讯作者：
CURRIE, B
中科院分区：
文献类型：
--
作者：
FISHER, D;BURROW, J;CURRIE, B
背景资料。新生隐球菌感染在澳大利亚北领地很常见。目的：记录隐球菌感染的发病率、人口学、危险因素、临床特征和转归，并分析其与新生杆菌感染的差异。方法：对1976~1992年在皇家达尔文医院确诊的35例隐球菌感染病例进行回顾性分析。确定了患者的当前状况。结果：35例患者中，脑膜炎23例，肺炎10例，皮肤感染1例，菌血症1例，无明显病灶。12例(52%)脑膜炎和2例(20%)肺炎患者无易感疾病。13例(57%)脑膜炎患者合并肺隐球菌病。29名原住民和6名高加索人，与非原住民相比，原住民的相对风险为20.6(95%可信区间8.649.5)。阿恩亨兰是最常见的感染地点，土著居民的年发病率为0.14/1000。18株受试菌株中有14株(78%)为新生链球菌变种。加蒂尔。治疗的特点是经常需要辅助手术和长期或重复的系统性抗真菌治疗。尽管如此，长期结果是令人鼓舞的，总体死亡率为14%，脑膜炎患者死亡率为9%。河流红树胶(桉树)在阿恩亨兰的分布有限，正在进行的研究正在寻找新生革兰氏菌变种的替代环境来源。加蒂尔。
Background. Infection with Cryptococcus neoformans is common in the Northern Territory of Australia. Disease is life threatening and treatment is prolonged and often complicated by the need for surgery and difficulties with medical therapy.Aims: To document incidence, demography, risk factors, clinical features and outcomes of infection and to determine differences between gattii and neoformans varieties.Methods: Case records of all patients (n = 35) diagnosed with cryptococcal infection at the Royal Darwin Hospital between 1976 and 1992 were reviewed retrospectively. Current status of patients was ascertained. Variety identification of isolates was determined by growth in canavanine-glycine-bromthymol blue agar.Results: Of the 35 patients, 23 had meningitis, ten had pneumonia, one had a dermal infection and one had fungaemia with no obvious focus. Twelve (52%) meningitis cases and two (20%) pneumonia cases had no predisposing disease. Thirteen (57%) meningitis cases had concomitant pulmonary cryptococcosis. Twenty-nine patients were Aboriginal and six were Caucasian, with a relative risk for Aboriginals compared with non-Aboriginals of 20.6 (95% CI 8.649.5). Arnhemland was the commonest location of infection, with an annual incidence in Aboriginals of 0.14/1000. Fourteen (78%) of 18 isolates tested were C. neoformans var. gattii. Management was characterised by the frequent need for adjunctive surgery and prolonged or repeat courses of systemic antifungal therapy. Despite this, long-term outcomes are encouraging with a mortality of 14% overall and 9% in meningitis patients. The river red gum (Eucalyptus camaldulensis) has a limited distribution in Arnhemland and ongoing studies are seeking alternative environmental sources of C neoformans var. gattii.