喀麦隆杜阿拉人类免疫缺陷病毒/获得性免疫缺陷综合征患者的隐球菌性脑膜脑炎：一项横断面研究

Cryptococcal meningoencephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome in douala, cameroon: a cross sectional study.

作者信息

Luma Henry Namme, Temfack Elvis, Halle Marie Patrice, Tchaleu Benjamin Clet Nguenkam, Mapoure Yacouba Njankouo, Koulla-Shiro Sinata

机构信息

Department of Internal Medicine, Douala General Hospital, Douala, Yaounde, Cameroon ; Department of Infectious Diseases, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon.

出版信息

N Am J Med Sci. 2013 Aug;5(8):486-91. doi: 10.4103/1947-2714.117318.

DOI:10.4103/1947-2714.117318

PMID:24083225

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3784927/

Abstract

BACKGROUND

Cryptococcal meningoencephalitis (CM) kills about half a million human immunodeficiency virus (HIV) patients per year, mostly in Africa.

AIM

The aim of this study was to determine the prevalence, clinical presentation and in-hospital outcome of CM among HIV-infected patients in Douala.

MATERIALS AND METHODS

A cross-sectional clinical note review of 672 HIV-1 patients' files admitted from January 1 (st) 2004 to December 31 (st) 2009 at the Internal Medicine unit of the Douala General Hospital, Cameroon was performed. Only patients diagnosed of CM by microscopy of Indian ink stained cerebrospinal fluid (CSF) were studied.

RESULTS

The prevalence of CM in the study was 11.2%. Mean age of patients was 36.9 ΁ 12.7 years. Median cluster of differentiation 4 (CD4) cell count was 23 cells/μL, (interquartile range [IQR]: 10-61) and 62.7% of CD4 cell counts were >50 cells/μL. The most prevalent symptom was headache in 97.3% of patients. In CSF, median proteins was 0.9 g/L (IQR: 0.6-1); median glucose 0.2 g/L (IQR: 0.1-0.3) and median leucocyte count 54 cells/μL (IQR: 34-76) mostly of mixed cellularity. The case fatality rate was 52% and low CD4 cell count was strongly associated with death, odd ratio 4.6 (95% confidence interval: 2.6-8.0, P > 0.001).

CONCLUSION

The high case fatality of CM in Douala warrants adequate diagnostic measures and optimization of standardized treatment to reduce mortality.

摘要

背景

隐球菌性脑膜脑炎（CM）每年导致约50万人类免疫缺陷病毒（HIV）患者死亡，其中大多数在非洲。

目的

本研究旨在确定杜阿拉HIV感染患者中CM的患病率、临床表现及住院结局。

材料与方法

对喀麦隆杜阿拉总医院内科2004年1月1日至2009年12月31日收治的672例HIV-1患者病历进行横断面临床记录回顾。仅对通过印度墨汁染色脑脊液（CSF）显微镜检查诊断为CM的患者进行研究。

结果

本研究中CM的患病率为11.2%。患者平均年龄为36.9±12.7岁。分化簇4（CD4）细胞计数中位数为23个/μL（四分位间距[IQR]：10-61），62.7%的CD4细胞计数>50个/μL。最常见的症状是97.3%的患者出现头痛。CSF中，蛋白质中位数为0.9 g/L（IQR：0.6-1）；葡萄糖中位数为0.2 g/L（IQR：0.1-0.3），白细胞计数中位数为54个/μL（IQR：34-76），大多为混合细胞类型。病死率为52%，低CD4细胞计数与死亡密切相关，比值比为4.6（95%置信区间：2.6-8.0，P>0.001）。