International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2005
Cryptococcosis in human immunodeficiency virus-negative patients.
СтатьяНазвание и аннотация: Перевод в очереди
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Kiertiburanakul Sasisopin, Wirojtananugoon Sirirat, Pracharktam Roongnapa, Sungkanuparph Somnuek
Аннотация
OBJECTIVE: To describe the clinical characteristics, treatment, and outcomes of cryptococcosis in HIV-negative patients.
METHODS: HIV-negative adult patients with positive culture for Cryptococcus neoformans who attended Ramathibodi Hospital between 1987 and 2003 were retrospectively reviewed.
RESULTS: During the 17 year review period, 40 HIV-negative patients with cryptococcosis were identified. Of these, 37 patients had medical records available for study. The mean age was 49+/-18 (range 16-83) years and 73% were female. Twenty-four patients (65%) had associated underlying conditions. The most common associated conditions included immunosuppressive drug treatment (41%), presence of systemic lupus erythematosus (16%), malignancies (16%), and diabetes mellitus (14%). C. neoformans was mainly recovered from cerebrospinal fluid (32%), blood (28%), and sputum/bronchoalveolar lavage/lung tissue (28%). Twenty-three patients (62%) had disseminated cryptococcosis. Six of 14 patients with cryptococcal meningitis were asymptomatic. About half of the patients were treated with amphotericin B and subsequent fluconazole. Five patients (14%) were initially misdiagnosed and treated for tuberculosis or bacterial infection. The overall mortality rate was 27%.
CONCLUSIONS: Cryptococcosis is not rare in HIV-negative patients. The mortality rate is high. Early recognition of cryptococcosis and use of appropriate antifungal therapy in these patients may improve clinical outcomes.
METHODS: HIV-negative adult patients with positive culture for Cryptococcus neoformans who attended Ramathibodi Hospital between 1987 and 2003 were retrospectively reviewed.
RESULTS: During the 17 year review period, 40 HIV-negative patients with cryptococcosis were identified. Of these, 37 patients had medical records available for study. The mean age was 49+/-18 (range 16-83) years and 73% were female. Twenty-four patients (65%) had associated underlying conditions. The most common associated conditions included immunosuppressive drug treatment (41%), presence of systemic lupus erythematosus (16%), malignancies (16%), and diabetes mellitus (14%). C. neoformans was mainly recovered from cerebrospinal fluid (32%), blood (28%), and sputum/bronchoalveolar lavage/lung tissue (28%). Twenty-three patients (62%) had disseminated cryptococcosis. Six of 14 patients with cryptococcal meningitis were asymptomatic. About half of the patients were treated with amphotericin B and subsequent fluconazole. Five patients (14%) were initially misdiagnosed and treated for tuberculosis or bacterial infection. The overall mortality rate was 27%.
CONCLUSIONS: Cryptococcosis is not rare in HIV-negative patients. The mortality rate is high. Early recognition of cryptococcosis and use of appropriate antifungal therapy in these patients may improve clinical outcomes.
Предметные рубрики MeSH
AdolescentAdultAgedAged, 80 and overAmphotericin BAntifungal AgentsCryptococcosisCryptococcus neoformansDiabetes ComplicationsFemaleFluconazoleHIV InfectionsHIV SeronegativityHealth SurveysHospitals, UniversityHumansImmunosuppression TherapyLupus Erythematosus, SystemicMaleMiddle AgedNeoplasmsRetrospective StudiesThailandTreatment Outcome