老年隐球菌性脑膜炎的临床特征和治疗结局：一项基于医院的研究。
The clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: a hospital-based study.
机构信息
Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan.
Department of Information Management, National Sun Yat-sen University, Kaohsiung, Taiwan.
出版信息
BMC Geriatr. 2019 Mar 25;19(1):91. doi: 10.1186/s12877-019-1108-0.
BACKGROUND
The elderly, and especially those with an immuno-compromised status, are vulnerable to infectious diseases. The purpose of this study was to examine the clinical characteristics and therapeutic outcomes of cryptococcal meningitis (CM) in elderly patients in Taiwan.
METHODS
Ninety-nine adult patients with CM were identified during a 15-year study period (2002-2016), of whom 38 elderly (≥ 65 years) patients (16 men and 22 women, median age 72.9 years; range 65-86 years) were included for analysis. The clinical characteristics and therapeutic outcomes of these patients were analyzed and compared to non-elderly adult patients (< 65 years) with CM.
RESULTS
Among the 38 patients, diabetes mellitus was the most common underlying condition (15), followed by adrenal insufficiency (7), malignancy (6), hematologic disorders (5), chronic obstructive pulmonary disease (5), autoimmune diseases (3), liver cirrhosis (3) and acquired immunodeficiency syndrome (1). Altered consciousness (29), fever (21) and headache (17) were the leading clinical manifestations. Positive cerebrospinal fluid and blood cultures for Cryptococcus (C.) neoformans were found in 26 and 9 patients, respectively. There were significant differences in gender, altered consciousness and recent cerebral infarction between the elderly and non-elderly groups. The elderly group had a high mortality rate (36.8%, 14/38), and the presence of cryptococcemia was the most significant prognostic factor.
CONCLUSIONS
This study offers a preliminary view of the clinical characteristics of CM in the elderly. The results suggest that elderly patients (≥ 65 years) are more vulnerable to CM than adults aged < 65 years. Compared to the non-elderly group, the elderly group had female predominance, higher rates of altered consciousness and recent cerebral infarction as the clinical presentation. The presence of cryptococcemia was a significant prognostic factor in the elderly group. This study is limited by the small number of patients, and further large-scale studies are needed to better delineate this specific infectious syndrome.
背景
老年人，尤其是免疫功能低下者，易患传染病。本研究旨在探讨台湾老年患者隐球菌性脑膜炎（CM）的临床特征和治疗结局。
方法
在一项为期 15 年的研究（2002-2016 年）中，共发现 99 例成人 CM 患者，其中纳入 38 例老年（≥65 岁）患者（男 16 例，女 22 例，中位年龄 72.9 岁；范围 65-86 岁）进行分析。分析并比较了这些患者的临床特征和治疗结局与非老年成人 CM 患者。
结果
在 38 例患者中，最常见的基础疾病是糖尿病（15 例），其次是肾上腺功能不全（7 例）、恶性肿瘤（6 例）、血液系统疾病（5 例）、慢性阻塞性肺疾病（5 例）、自身免疫性疾病（3 例）、肝硬化（3 例）和获得性免疫缺陷综合征（1 例）。意识改变（29 例）、发热（21 例）和头痛（17 例）是主要临床表现。26 例患者脑脊液和 9 例患者血液中均培养出新型隐球菌（C.）neoformans。老年组和非老年组在性别、意识改变和近期脑梗死方面存在显著差异。老年组死亡率较高（36.8%，14/38），隐球菌血症是最显著的预后因素。
结论
本研究初步探讨了老年 CM 的临床特征。结果表明，老年患者（≥65 岁）比<65 岁的成年患者更容易患 CM。与非老年组相比，老年组女性比例较高，意识改变和近期脑梗死的发生率较高。老年组中隐球菌血症是一个显著的预后因素。本研究的局限性在于患者数量较少，需要进一步进行大规模研究，以更好地阐明这一特定感染综合征。
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