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南方某地区医疗中心HIV感染患者的组织胞浆菌病:高效抗逆转录病毒治疗时代的不良预后

Histoplasmosis in HIV-infected patients in a southern regional medical center: poor prognosis in the era of highly active antiretroviral therapy.

作者信息

Baddley John W, Sankara Ishwara R, Rodriquez J Martin, Pappas Peter G, Many Wickliffe J

机构信息

Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-0006, USA.

出版信息

Diagn Microbiol Infect Dis. 2008 Oct;62(2):151-6. doi: 10.1016/j.diagmicrobio.2008.05.006. Epub 2008 Jul 1.

Abstract

Histoplasmosis is an important opportunistic infection among HIV-infected patients in endemic areas, and clinical outcomes are often poor. Additional data on factors associated with outcomes are needed to better identify patients who may require aggressive care. Using a cohort of 46 HIV-infected patients with histoplasmosis from an underserved city endemic for histoplasmosis, we explored epidemiology, outcomes, and prognostic factors. Histoplasmosis was the 1st recognized manifestation of HIV infection in 12 (26.1%) of 46 patients. Death occurred in 18 (39%) patients within 3 months of diagnosis of histoplasmosis. Fungemia (odds ratio [OR], 12.1; 95% confidence interval [CI], 1.9-76; P=0.008), renal insufficiency (OR, 11.3; 95% CI, 1.7-77.2; P=0.01), and age (OR, 0.9; 95% CI, 0.8-0.98; P=0.02) were independent predictors of poor prognosis. Histoplasmosis in HIV patients is associated with poor outcomes. Identification of prognostic factors may be helpful in identifying patients who require more aggressive care.

摘要

组织胞浆菌病是流行地区HIV感染患者中一种重要的机会性感染,临床结局往往较差。需要更多关于与结局相关因素的数据,以更好地识别可能需要积极治疗的患者。我们对来自一个组织胞浆菌病流行但医疗服务不足城市的46例HIV感染合并组织胞浆菌病患者进行了队列研究,探讨了其流行病学、结局及预后因素。在46例患者中,有12例(26.1%)的组织胞浆菌病是HIV感染的首个被识别的表现。18例(39%)患者在组织胞浆菌病诊断后3个月内死亡。真菌血症(比值比[OR],12.1;95%置信区间[CI],1.9 - 76;P = 0.008)、肾功能不全(OR,11.3;95% CI,1.7 - 77.2;P = 0.01)和年龄(OR,0.9;95% CI,0.8 - 0.98;P = 0.02)是预后不良的独立预测因素。HIV患者的组织胞浆菌病与不良结局相关。识别预后因素可能有助于识别需要更积极治疗的患者。

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