Perfect John R, Bicanic Tihana
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, United States.
Institute of Infection and Immunity, St. George's, University of London, London, UK.
Fungal Genet Biol. 2015 May;78:49-54. doi: 10.1016/j.fgb.2014.10.003. Epub 2014 Oct 13.
Cryptococcosis has evolved into a major invasive fungal disease over the last century. Its primary epidemiology has been focused on three major outbreaks of disease that reflects both changing environmental exposures and growth of host risk factors. The molecular understandings of yeast pathobiology have been bolstered by identification of the yeast's dynamic genomic structures and functions. It is during these new insights into epidemiology and pathobiology that we have also improved our diagnosis of this infection with a new point-of-care, simple, cheap test which utilizes a lateral flow assay for antigen detection. With methods for effective identification of Cryptococcus in the host, the principles for management of this deadly infection include both use of old drugs and new insights into treatment strategies to improve outcome. In this review there are a series of recent insights, opinions, and facts which attempt to summarize our present knowledge base for this deadly fungal central nervous system infection with a particular emphasis on its diagnosis and management.
在过去的一个世纪里,隐球菌病已演变成一种主要的侵袭性真菌疾病。其主要流行病学集中在三次重大疾病暴发上,这既反映了环境暴露的变化,也反映了宿主风险因素的增加。对酵母病理生物学的分子理解因酵母动态基因组结构和功能的鉴定而得到加强。正是在对流行病学和病理生物学有了这些新认识的过程中,我们也通过一种新的即时检测、简单且廉价的测试改进了对这种感染的诊断,该测试利用侧向流动分析法检测抗原。随着在宿主体内有效鉴定隐球菌的方法出现,管理这种致命感染的原则包括使用旧药物以及对治疗策略的新认识以改善治疗结果。在这篇综述中,有一系列近期的见解、观点和事实,试图总结我们目前关于这种致命真菌性中枢神经系统感染的知识基础,特别强调其诊断和管理。