Nsenga Lauryn, Kajjimu Jonathan, Olum Ronald, Ninsiima Sandra, Kyazze Andrew Peter, Ssekamatte Phillip, Kibirige Davis, Baluku Joseph Baruch, Andia-Biraro Irene, Bongomin Felix
School of Medicine, Kabale University, Kabale, Uganda.
Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Ther Adv Infect Dis. 2021 May 5;8:20499361211014769. doi: 10.1177/20499361211014769. eCollection 2021 Jan-Dec.
A better understanding of the epidemiology of cryptococcal infection in HIV-negative individuals is an international research interest. Immune dysfunction in diabetes mellitus (DM) significantly increases the risk of acquiring and reactivation of infection due to . Risk factors and outcomes of cryptococcosis in DM are not well documented.
The objective of this study was to determine the clinical characteristics and outcomes of cryptococcal infections in persons living with DM.
MEDLINE (via PubMed), EMBASE, and the Cochrane Library databases were searched in November 2020. The searches covered the period between 1980 and 2020.We included studies that reported confirmed cryptococcosis in patients with DM. Reference lists of included articles were also searched, and additional studies were included if appropriate. No language restriction was applied. Single case reports, case series and original articles were included whereas review articles were excluded.
A total of 28 studies (24 single case reports, 4 retrospectives) were included involving 47 unique patients from Asia (17 cases), North America (six cases), South America (three cases) and Africa (two cases). Men constituted 75% ( = 18) of the cases. Median age was 60.5 (range: 27-79) years. The majority of the patients had cryptococcal meningitis (68.1%, = 32) followed by disseminated cryptococcosis (6.4%, = 7), and others (isolated cutaneous disease one, peritonitis one, pleural one, thyroid one, adrenal one). Diagnosis was achieved through either culture and microscopy (38/47), cryptococcal antigen tests (9/47) or histopathology (9/47) singly or in a combination. All-cause mortality was 38.3% ( = 18). Among those with meningitis mortality was 36.2%.
A wide spectrum of cryptococcal infections with varying severity occurs in DM. Mortality remains unacceptably high. There is a need for more studies to characterize better cryptococcal disease in DM.
更好地了解HIV阴性个体中隐球菌感染的流行病学是一项国际研究热点。糖尿病（DM）患者的免疫功能障碍会显著增加感染获得和再激活的风险。DM患者隐球菌病的危险因素和结局尚无充分记录。
本研究的目的是确定DM患者隐球菌感染的临床特征和结局。
于2020年11月检索MEDLINE（通过PubMed）、EMBASE和Cochrane图书馆数据库。检索涵盖1980年至2020年期间。我们纳入了报告DM患者确诊隐球菌病的研究。还检索了纳入文章的参考文献列表，如有合适的额外研究也纳入其中。不设语言限制。纳入单病例报告、病例系列和原创文章，排除综述文章。
共纳入28项研究（24项单病例报告，4项回顾性研究），涉及来自亚洲（17例）、北美（6例）、南美（3例）和非洲（2例）的47例独特患者。男性占病例的75%（n = 18）。中位年龄为60.5岁（范围：27 - 79岁）。大多数患者患有隐球菌性脑膜炎（68.1%，n = 32），其次是播散性隐球菌病（6.4%，n = 7），其他情况（孤立性皮肤疾病1例、腹膜炎1例、胸膜炎1例、甲状腺1例、肾上腺1例）。通过培养和显微镜检查（38/47）、隐球菌抗原检测（9/47）或组织病理学（9/47）单独或联合进行诊断。全因死亡率为38.3%（n = 18）。脑膜炎患者的死亡率为36.2%。
DM患者中发生了一系列严重程度不同的隐球菌感染。死亡率仍然高得令人无法接受。需要更多研究来更好地描述DM患者的隐球菌病特征。
