Suppr超能文献

非 HIV 健康患者隐球菌性脑膜脑炎的听力学和耳科学并发症。

Audiologic and Otologic Complications of Cryptococcal Meningoencephalitis in Non-HIV Previously Healthy Patients.

机构信息

National Institute on Deafness and Other Communication Disorders.

Howard University College of Medicine.

出版信息

Otol Neurotol. 2019 Jul;40(6):e657-e664. doi: 10.1097/MAO.0000000000002242.

Abstract

OBJECTIVE

To identify audiologic and otologic outcomes in previously healthy non-HIV patients with cryptococcal meningoencephalitis (CM).

STUDY DESIGN

Retrospective case review of a subset of patients recruited in a prospective observational study following previously healthy individuals who developed CM.

SETTING

Tertiary referral center, National Institutes of Health Clinical Center.

PATIENTS

Previously healthy adult patients with CM without immune suppressive therapy before disease onset.

INTERVENTIONS

Diagnostic evaluations included audiometry, acoustic immittance, otoacoustic emissions, and auditory brainstem response studies, in addition to neurotologic assessment.

RESULTS

Twenty-nine patients (58 years) underwent audiologic evaluation between 6 months and 3.5 years after CM diagnosis; 21 patients were seen for longitudinal assessment with an average duration of follow up of 20.3 months. Nearly three-quarters (73%) of the cohort presented with hearing loss, most commonly (90%) sensorineural in origin. The most frequent degree of loss was mild and then moderate, although some patients had severe or profound impairment. Hearing loss improved (43%) or remained stable (38%) in most cases. Ears with internal auditory canal enhancement on magnetic resonance imaging (MRI) had significantly more hearing loss than those without enhancement, although a similar finding was not observed with gyral enhancement or the presence of ependymitis or ventricular volume expansion. Hearing loss was not associated with reduced cerebrospinal fluid (CSF) glucose, CSF total protein, cryptococcal antigen, or total cell count.

CONCLUSIONS

Hearing loss is a common manifestation of cryptococcal meningitis in previously healthy patients and may involve a cochlear or neural site of lesion, or both. Routine surveillance of hearing in patients is recommended, regardless of symptomatology, to ensure early and appropriate intervention and care.

摘要

目的

确定先前健康的非 HIV cryptococcal 脑膜脑炎 (CM) 患者的听力和耳科学结果。

研究设计

对前瞻性观察研究中招募的一组患者进行回顾性病例分析,这些患者是先前健康但患有 CM 的个体。

地点

三级转诊中心,美国国立卫生研究院临床中心。

患者

无免疫抑制治疗的先前健康成人 CM 患者。

干预措施

诊断评估包括听力计、声导抗、耳声发射和听觉脑干反应研究,以及听力学评估。

结果

29 例患者(58 岁)在 CM 诊断后 6 个月至 3.5 年内进行了听力评估;21 例患者接受了纵向评估,平均随访时间为 20.3 个月。近四分之三(73%)的患者出现听力损失,最常见的是(90%)感觉神经性起源。最常见的听力损失程度是轻度,然后是中度,尽管有些患者有严重或深度听力障碍。在大多数情况下,听力损失有所改善(43%)或保持稳定(38%)。内耳增强 MRI 患者的听力损失明显高于无增强患者,尽管在出现脑回增强或室管膜炎或脑室容积扩张时未观察到类似发现。听力损失与脑脊液 (CSF) 葡萄糖、CSF 总蛋白、 cryptococcal 抗原或总细胞计数无关。

结论

听力损失是先前健康患者 cryptococcal 脑膜炎的常见表现,可能涉及耳蜗或神经病变部位,或两者兼而有之。建议对患者进行听力常规监测,无论症状如何,以确保早期和适当的干预和护理。

相似文献

1
2
Down syndrome: an electrophysiological and radiological profile.
Laryngoscope. 2014 Apr;124(4):E141-7. doi: 10.1002/lary.24375. Epub 2013 Dec 17.
3
The mechanism of hearing loss in Paget's disease of bone.
Laryngoscope. 2004 Apr;114(4):598-606. doi: 10.1097/00005537-200404000-00002.
4
Auditory neuropathy characteristics in children with cochlear nerve deficiency.
Ear Hear. 2006 Aug;27(4):399-408. doi: 10.1097/01.aud.0000224100.30525.ab.
5
[Effect of inner ear hearing loss on delayed otoacoustic emissions (TEOAE) and distortion products (DPOAE)].
Laryngorhinootologie. 1996 Dec;75(12):709-18. doi: 10.1055/s-2007-997664.
7
Audiologic Manifestations of Marshall Syndrome.
Otol Neurotol. 2018 Sep;39(8):e691-e698. doi: 10.1097/MAO.0000000000001896.
8
The auditory characteristics of children with inner auditory canal stenosis.
Acta Otolaryngol. 2016 Jul;136(7):687-91. doi: 10.3109/00016489.2016.1152505. Epub 2016 Mar 16.
9
Association of Hearing Loss and Otologic Outcomes With Fibrous Dysplasia.
JAMA Otolaryngol Head Neck Surg. 2018 Feb 1;144(2):102-107. doi: 10.1001/jamaoto.2017.2407.
10
Audiological findings in Williams syndrome: a study of 69 patients.
Am J Med Genet A. 2012 Apr;158A(4):759-71. doi: 10.1002/ajmg.a.35241. Epub 2012 Mar 12.

引用本文的文献

本文引用的文献

2
Meta-analysis of adjunctive dexamethasone to improve clinical outcome of bacterial meningitis in children.
Childs Nerv Syst. 2018 Feb;34(2):217-223. doi: 10.1007/s00381-017-3667-8. Epub 2017 Nov 29.
4
Corticosteroids for shunted previously healthy patients with non-HIV cryptococcal meningoencephalitis.
J Neurol Neurosurg Psychiatry. 2018 Feb;89(2):219-220. doi: 10.1136/jnnp-2017-315830. Epub 2017 May 26.
5
Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis.
Lancet Infect Dis. 2017 Aug;17(8):873-881. doi: 10.1016/S1473-3099(17)30243-8. Epub 2017 May 5.
7
Spinal Arachnoiditis as a Complication of Cryptococcal Meningoencephalitis in Non-HIV Previously Healthy Adults.
Clin Infect Dis. 2017 Feb 1;64(3):275-283. doi: 10.1093/cid/ciw739. Epub 2016 Nov 10.
10
Paradoxical Immune Responses in Non-HIV Cryptococcal Meningitis.
PLoS Pathog. 2015 May 28;11(5):e1004884. doi: 10.1371/journal.ppat.1004884. eCollection 2015 May.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验