A prospective study of AIDS-associated cryptococcal meningitis in Thailand treated with high-dose amphotericin B
A prospective study of AIDS-associated cryptococcal meningitis in Thailand treated with high-dose amphotericin B
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DOI：
10.1053/jinf.2001.0916
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发表时间：
2001-11-01
影响因子：
28.2
通讯作者：
White, NJ
中科院分区：
文献类型：
--
作者：
Pitisuttithum, P;Tansuphasawadikul, S;White, NJ
目的：评估脑脊液（CSF）中隐球菌的动力学和大剂量阿替霉素B治疗后艾滋病相关性隐球菌性脑膜炎的结局。对患有与AIDS相关的隐球菌性脑膜炎的泰国成人（n = 106）进行了一项前瞻性研究，以确定CSF中隐球菌的动力学和影响高剂量阿替霉素B治疗后生存率的预后因素（0.7 mg/kg/天），然后口服唑治疗。每周采集脑脊液进行隐球菌计数和培养，持续至少2周或直至CSF培养为隐球菌阴性。所有患者每月随访1年或直至死亡，以检测复发或发生任何其他机会性infection.Results：共106例艾滋病隐球菌脑膜炎患者入组。入院时CSF中隐球菌总数和活菌计数的几何平均数（范围）分别为430000（1000 - 3.4 × 10（7））和31000（10 - 1.4 × 10（7））/ml。隐球菌总数和活菌数均呈单指数下降，消除半衰期为4天。第2周和第4周时CSF酵母菌累积清除率分别为38%和56%。分别早期死亡与既往体重减轻史显著相关[相对危险度（RR）= 2.2; 95%CI，1.2-3.9]，格拉斯哥昏迷评分
Objective: To assess kinetic of cryptococci in the cerebrospinal fluid (CSF) and outcome of AIDS-associated cyptococcal meningitis after high-dose amphotericin B.Patients and Methods: A prospective study involving Thai adults (n = 106) with cryptococcal meningitis associated with AIDS was conducted to determine the kinetic of cryptococci in CSF and prognostic factors affecting survival after high-dose amphotericin B (0.7 mg/kg/day) followed by oral azole treatment. Cerebrospinal fluids were collected for cryptococcal count and culture at weekly intervals for at least 2 weeks or until CSF cultures were negative for cryptococci. All patients were followed monthly for 1 year or untill death in order to detect relapse or occurrence of any other opportunistic infection.Results: A total of 106 AIDS patients with cryptococcal meningitis were enrolled. The geometric mean (range) total and viable cryptococcal counts in CSF on admission were 430000 (1000 to 3.4 x 10(7)) and 31000 (10 to 1.4 x 10(7)) per ml, respectively. Both total and viable cryptococcal counts declined monoexponentially with an elimination half life of 4 days. The cumulative CSF yeast clearance rates were 38% and 56% at 2 and 4 weeks. respectively. Early death was associated significantly with previous history of weight loss [relative risk (RR) = 2.2; 95% CI, 1.2-3.9], Glasgow Coma Score