Cryptococcosis
Cryptococcosis
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DOI：
10.1016/j.clindermatol.2012.01.005
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发表时间：
2012-11-01
影响因子：
2.7
通讯作者：
Negroni, Ricardo
中科院分区：
文献类型：
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作者：
Negroni, Ricardo
隐球菌病是一种全身性真菌感染，由隐球菌属、新型隐球菌和格特隐球菌属的有囊酵母引起。这些环境微生物生活在鸽子和其他鸟类的粪便中，以及各种树木的果实和树皮中。人类和其他动物物种的感染通常通过吸入发生，较少通过皮肤和摄入真菌发生。大多数感染具有良性过程并自发消退;然而，隐球菌病的发病率显著增加，主要是由于免疫缺陷的多种原因，特别是艾滋病。新型隐球菌感染在世界范围内很常见，严重的形式见于免疫功能低下的患者。隐球菌病可表现为急性、亚急性或慢性肺部疾病，也可表现为非化脓性脑脊髓液脑膜炎，或严重感染，伴有发热、贫血、淋巴结病和肝脾肿大。眼睛可能会受到影响，部分或完全丧失视力。诊断是通过直接观察病原体，在组织病理学研究中，通过分离培养，并通过荚膜抗原的存在。治疗是静脉内给药阿替霉素B脱氧胆酸盐，单独或与5-氟胞嘧啶或氟康唑，可以口服或静脉内给药。当中枢神经系统受到影响时，伊曲康唑的效果较差。伏立康唑似乎是一种可用于这些患者的药物。在AIDS患者中，二级预防用氟康唑或阿替霉素B给药，并持续至CD 4细胞计数超过200个细胞/μ L。在艾滋病患者确诊后的第一周内，评估颅内压是很重要的。(C)2012 Elsevier Inc. All rights reserved.
Cryptococcosis is a systemic fungal infection, caused by encapsulated yeast of the genus Cryptococcus, C neoformans and C gattii. These environmental microorganisms live in pigeon and other bird droppings, as well as in the fruit and bark of various trees. Infection in humans and other animal species usually occurs by inhalation and less frequently through the skin and by ingestion of the fungus. Most infections have a benign course and resolve spontaneously; however, the incidence of cryptococcosis has increased considerably, mainly due to diverse causes of immunodeficiency, particularly AIDS. Cryptococcus neoformans infections are common, worldwide, and severe forms are seen in immunocompromised patients. Cases caused by C gattii predominate in tropical or subtropical regions.Cryptococcosis may present as an acute, subacute, or chronic lung disease, as a nonpurulent cerebrospinal fluid meningitis, or as a severe infection with fever, anemia, lymphadenopathy, and hepatosplenomegaly. The eye can be affected, with partial or total loss of vision. Diagnosis is by direct observation of the causative agent, in histopathologic studies, by isolation in culture, and by the presence of capsular antigen.Treatment is the intravenous administration of amphotericin B deoxycholate, alone or combined with 5-fluorocytosine or fluconazole, which can be given orally or intravenously. Itraconazole is less effective when the central nervous system is affected. Voriconazole appears to be a drug that can be used in these patients. In AIDS patients, secondary prophylaxis is administered with fluconazole or amphotericin B and is continued until CD4 cell counts exceed 200 cells/mu L. Evaluation of intracranial pressure is important in the first weeks after diagnosis in AIDS patients. (C) 2012 Elsevier Inc. All rights reserved.