Pappas P G, Perfect J R, Cloud G A, Larsen R A, Pankey G A, Lancaster D J, Henderson H, Kauffman C A, Haas D W, Saccente M, Hamill R J, Holloway M S, Warren R M, Dismukes W E
University of Alabama at Birmingham Medical Center, Birmingham, AL 35294-0006, USA.
Clin Infect Dis. 2001 Sep 1;33(5):690-9. doi: 10.1086/322597. Epub 2001 Jul 26.
We conducted a case study of human immunodeficiency virus (HIV)-negative patients with cryptococcosis at 15 United States medical centers from 1990 through 1996 to understand the demographics, therapeutic approach, and factors associated with poor prognosis in this population. Of 306 patients with cryptococcosis, there were 109 with pulmonary involvement, 157 with central nervous system (CNS) involvement, and 40 with involvement at other sites. Seventy-nine percent had a significant underlying condition. Patients with pulmonary disease were usually treated initially with fluconazole (63%); patients with CNS disease generally received amphotericin B (92%). Fluconazole was administered to approximately two-thirds of patients with CNS disease for consolidation therapy. Therapy was successful for 74% of patients. Significant predictors of mortality in multivariate analysis included age > or =60 years, hematologic malignancy, and organ failure. Overall mortality was 30%, and mortality attributable to cryptococcosis was 12%. Cryptococcosis continues to be an important infection in HIV-negative patients and is associated with substantial overall and cause-specific mortality.
1990年至1996年期间，我们在美国15家医疗中心对人类免疫缺陷病毒（HIV）阴性的隐球菌病患者进行了一项病例研究，以了解该人群的人口统计学特征、治疗方法以及与预后不良相关的因素。在306例隐球菌病患者中，109例有肺部受累，157例有中枢神经系统（CNS）受累，40例有其他部位受累。79%的患者有严重的基础疾病。肺部疾病患者最初通常用氟康唑治疗（63%）；中枢神经系统疾病患者一般接受两性霉素B治疗（92%）。约三分之二的中枢神经系统疾病患者接受氟康唑巩固治疗。74%的患者治疗成功。多变量分析中死亡的显著预测因素包括年龄≥60岁、血液系统恶性肿瘤和器官衰竭。总体死亡率为30%，隐球菌病所致死亡率为12%。隐球菌病在HIV阴性患者中仍然是一种重要的感染，与较高的总体死亡率和特定病因死亡率相关。
