Nacher Mathieu, Valdes Audrey, Adenis Antoine, Blaizot Romain, Abboud Philippe, Demar Magalie, Djossou Félix, Epelboin Loïc, Misslin Caroline, Ntab Balthazar, Drak Alsibai Kinan, Couppié Pierre
CIC INSERM 1424, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana, France.
Département Formation Recherche Santé, Université de Guyane, Cayenne, 97300 Cayenne, French Guiana, France.
J Fungi (Basel). 2020 Sep 7;6(3):164. doi: 10.3390/jof6030164.
Disseminated histoplasmosis is the main AIDS-defining infection of French Guiana. We aim to describe our therapeutic experience for 349 patients with disseminated histoplasmosis between 1 January 1981 and 10 January 2014 in French Guiana. Survival, delays for treatment initiation, duration of induction therapy, and associated initial treatments are described. The death rate was 14.9 per 100 person-years, with an early drop in survival. Among those who died, >1/3 died within a year of HIV diagnosis, and ¾ of all patients with histoplasmosis had been diagnosed for HIV within a year. As induction treatment, 29% received liposomal amphotericin B, 12.9% received deoxycholate amphotericin B, 54% received itraconazole alone, and 21.8% received liposomal amphotericin B and itraconazole. The median delay between symptoms-onset and hospitalization was 19.5 days (IQR = 5-105). Liposomal amphotericin B or itraconazole was initiated shortly after admission. Treatment initiation was often presumptive for liposomal amphotericin B (27%) and itraconazole (20%). The median duration of liposomal amphotericin B treatment was 7 days (IQR = 5-11 days). The present study shows that ¾ of the patients were profoundly immunocompromised and had been diagnosed for HIV within the past year. Antifungal treatment was often initiated presumptively on admission. Over time there was a significant gradual decline in early death.
播散性组织胞浆菌病是法属圭亚那主要的艾滋病界定感染疾病。我们旨在描述1981年1月1日至2014年1月10日期间法属圭亚那349例播散性组织胞浆菌病患者的治疗经验。描述了生存率、开始治疗的延迟时间、诱导治疗的持续时间以及相关的初始治疗方法。死亡率为每100人年14.9例，生存率早期下降。在死亡患者中，超过三分之一在HIV诊断后一年内死亡，所有组织胞浆菌病患者中有四分之三在一年内被诊断出感染HIV。作为诱导治疗，29%的患者接受脂质体两性霉素B，12.9%的患者接受脱氧胆酸盐两性霉素B，54%的患者仅接受伊曲康唑，21.8%的患者接受脂质体两性霉素B和伊曲康唑。症状出现与住院之间的中位延迟时间为19.5天（四分位间距=5-105天）。入院后不久即开始使用脂质体两性霉素B或伊曲康唑。脂质体两性霉素B（27%）和伊曲康唑（20%）的治疗开始通常是基于推测。脂质体两性霉素B治疗的中位持续时间为7天（四分位间距=5-11天）。本研究表明，四分之三的患者免疫功能严重受损，且在过去一年内被诊断出感染HIV。抗真菌治疗通常在入院时基于推测开始。随着时间的推移，早期死亡率有显著的逐渐下降。
