Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.
William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.
Mycoses. 2022 Jul;65(7):733-740. doi: 10.1111/myc.13467. Epub 2022 May 25.
Cryptococcus spp. infection involving the central nervous system (CNS) is associated with poor outcomes. Current guidelines recommend repeating a cerebrospinal fluid (CSF) fungal culture after 2 weeks of treatment to evaluate for clearance. However, this practice has not clearly been associated with outcomes.
We sought to assess the relationship between CSF fungal clearance at 2 weeks and 12-month mortality in patients with CNS cryptococcosis.
This is a retrospective cohort study from 2011 to 2020 of patients with CNS cryptococcosis. Factors associated with 12-month mortality were assessed with Fisher's exact test for categorical variables and Mann-Whitney test for continuous variables.
Among 51 patients with CNS cryptococcosis, 42 (82.4%) were initially CSF culture positive. Among 27 patients with follow-up CSF culture at 2 weeks, 6 (22.2%) had a positive result. Factors associated with a positive CSF culture at 2 weeks were an initial CSF cryptococcal antigen titre ≥1:2560, fungaemia, and an elevated intracranial pressure requiring therapeutic lumbar punctures. The 12-month mortality rate was 33.3%, and this was significantly associated with baseline fungaemia, extra-CNS cryptococcal involvement and requirement of intensive care unit level of care. Lack of CSF culture clearance by 2 weeks was not associated with 12-month mortality.
CNS cryptococcosis has a high mortality rate. A markedly elevated CSF cryptococcal antigen, and opening CSF pressure was associated with lack of CSF culture clearance at 2 weeks of treatment. Severe disseminated disease and cryptococcemia were associated with 12-month mortality.
中枢神经系统（CNS）的隐球菌属感染与不良预后相关。目前的指南建议在治疗 2 周后重复进行脑脊液（CSF）真菌培养，以评估清除情况。然而，这种做法与结局之间的关系尚未明确。
我们旨在评估 CNS 隐球菌病患者在治疗 2 周时 CSF 真菌清除情况与 12 个月死亡率之间的关系。
这是一项回顾性队列研究，纳入了 2011 年至 2020 年期间患有 CNS 隐球菌病的患者。使用 Fisher 确切检验评估分类变量，Mann-Whitney 检验评估连续变量，以评估与 12 个月死亡率相关的因素。
在 51 例 CNS 隐球菌病患者中，42 例（82.4%）初始 CSF 培养阳性。在 27 例接受 2 周时随访 CSF 培养的患者中，有 6 例（22.2%）培养阳性。2 周时 CSF 培养阳性与初始 CSF 隐球菌抗原滴度≥1:2560、菌血症和需要治疗性腰椎穿刺以升高颅内压相关。12 个月的死亡率为 33.3%，与基线菌血症、CNS 外隐球菌累及和需要重症监护病房治疗水平显著相关。治疗 2 周时 CSF 培养未清除与 12 个月死亡率无关。
CNS 隐球菌病死亡率高。CSF 隐球菌抗原明显升高，以及打开 CSF 压力与治疗 2 周时 CSF 培养未清除有关。严重播散性疾病和隐球菌血症与 12 个月死亡率相关。
