Torres Rafael Garcia, Etchebehere Renata Margarida, Adad Sheila Jorge, Micheletti Adilha Rua, Ribeiro Barbara de Melo, Silva Leonardo Eurípedes Andrade, Mora Delio Jose, Paim Kennio Ferreira, Silva-Vergara Mario León
Infectious Diseases Unit, Triângulo Mineiro Federal University, Minas Gerais, Brazil.
Discipline of Special Pathology, Triângulo Mineiro Federal University, Minas Gerais, Brazil.
Am J Trop Med Hyg. 2016 Oct 5;95(4):781-785. doi: 10.4269/ajtmh.16-0148. Epub 2016 Jul 25.
Cryptococcosis occurs in acquired immunodeficiency syndrome (AIDS) patients with poor compliance to antiretroviral therapy or unaware of their human immunodeficiency virus status who present severe immunosuppression at admission. Consequently, high mortality rates are observed due to disseminated fungal infection. This report presents clinical and postmortem data of AIDS patients with cryptococcosis in a teaching hospital in Brazil. Retrospectively, medical and necropsy records of AIDS patients with cryptococcosis clinically confirmed and/or postmortem verified were reviewed. Clinical data were compared with those of patients presenting a good outcome to evaluate disseminated fungal infection and the agreement between clinical and postmortem diagnosis. At admission, most of the 45 patients with cryptococcal meningitis who died, presented more altered consciousness (P = 0.0047), intracranial increased pressure (P = 0.047), and severe malnutrition (P = 0.0006) than the survivors. Of 29 (64.4%) patients with cryptococcal meningitis, 23 died before week 2 on antifungal therapy, and the other six during the next 3 months. The remaining 16 (35.6%) cases had other diagnoses and died soon after. At necropsy, 31 (68.9%) presented disseminated infection involving two or more organs, whereas 14 (31.1%) cases had meningeal or pulmonary localized infection. The agreement of 64.4% between clinical and postmortem diagnosis was similar to some studies. However, other reports have shown figures ranging from 34% to 95%. Currently, a progressive worldwide decrease of autopsies is worrying because the role of postmortem examination is pivotal to verify or identify the death causes, which contributes to improve the quality of clinical diagnosis and medical training.
隐球菌病发生于获得性免疫缺陷综合征（AIDS）患者，这些患者对抗逆转录病毒治疗依从性差或未意识到自己的人类免疫缺陷病毒感染状况，入院时呈现严重免疫抑制。因此，由于播散性真菌感染，观察到高死亡率。本报告介绍了巴西一家教学医院中患有隐球菌病的AIDS患者的临床和尸检数据。回顾性地审查了临床确诊和/或尸检证实的患有隐球菌病的AIDS患者的医疗和尸检记录。将临床数据与预后良好的患者的数据进行比较，以评估播散性真菌感染以及临床诊断与尸检诊断之间的一致性。入院时，45例死于隐球菌性脑膜炎的患者中大多数比幸存者意识改变更明显（P = 0.0047）、颅内压升高（P = 0.047）和严重营养不良（P = 0.0006）。29例（64.4%）隐球菌性脑膜炎患者中，23例在抗真菌治疗第2周前死亡，另外6例在接下来3个月内死亡。其余16例（35.6%）有其他诊断并在不久后死亡。尸检时，31例（68.9%）呈现累及两个或更多器官的播散性感染，而14例（31.1%）病例有脑膜或肺部局限性感染。临床诊断与尸检诊断之间64.4%的一致性与一些研究相似。然而其他报告显示的数字在34%至95%之间。目前，全球范围内尸检数量逐渐减少令人担忧，因为尸检检查对于核实或确定死亡原因至关重要有助于提高临床诊断质量和医学培训水平。
