中国南方地区 HIV 阴性隐球菌性脑膜炎与新型隐球菌性脑膜炎患者的特征和结局比较。
Comparison of features and outcomes between HIV-negative patients with Cryptococcus gattii meningitis and Cryptococcus neoformans meningitis in South China.
机构信息
Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Neurology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China.
出版信息
Mycoses. 2022 Sep;65(9):887-896. doi: 10.1111/myc.13491. Epub 2022 Jul 25.
OBJECTIVES
The objective of this study is to compare the epidemiologic, clinical, laboratory, and imaging features, and outcomes in patients with Cryptococcus gattii meningitis (CGM) and Cryptococcus neoformans meningitis (CNM).
METHODS
We performed a retrospective study of HIV-negative patients with CGM and CNM (2015-2021) distinguished by metagenomic next-generation sequencing in cerebrospinal fluid in South China.
RESULTS
A total of 81 patients (17 CGM, 64 CNM) were enrolled (72.8% male, median age 49 years, range 21-77 years), and CGM patients were younger (median, 43 vs 53 years, p = .005). Of 17 CGM, VGI and VGII accounted for 70.6% and 29.4%, respectively. CGM patients had less underlying diseases (7/17 [41.2%] vs 48/64 [75%], p = .018) and focal neurologic deficit (3/17 [17.6%] vs 35/64 [54.7%], p = .022), had higher intracranial pressure (15/17 [88.2%] vs 25/64 [39.1%], p = .002), more meningeal enhancement (14/17 [82.4%] vs 32/64 [50%], p = .034), less parenchymal involvement (median, 1 vs 3, p = .018), more lung cryptococcomas (6/12 [50%] vs 6/47 [12.8%], p = .014), faster CSF fungal clearance (p = .004), less complications (median, 1 vs 3, p < .001), and more favourable outcomes (16/17 [94.1%] vs 41/64 [64.1%], p = .035).
CONCLUSIONS
This study demonstrated that species identification helps to guide therapy and predict outcomes.
目的
本研究旨在比较新型隐球菌性脑膜炎（CGM）和新型隐球菌性脑膜炎（CNM）患者的流行病学、临床、实验室和影像学特征及结局。
方法
我们对 2015 年至 2021 年间在华南地区通过脑脊液宏基因组下一代测序区分的 HIV 阴性 CGM 和 CNM 患者进行了回顾性研究。
结果
共纳入 81 例患者（17 例 CGM，64 例 CNM；72.8%为男性，中位年龄 49 岁，范围 21-77 岁），CGM 患者更年轻（中位年龄 43 岁 vs 53 岁，p=0.005）。17 例 CGM 中，VGⅠ和 VGⅡ分别占 70.6%和 29.4%。CGM 患者基础疾病较少（7/17 [41.2%] vs 48/64 [75%]，p=0.018）和局灶性神经功能缺损（3/17 [17.6%] vs 35/64 [54.7%]，p=0.022），颅内压更高（15/17 [88.2%] vs 25/64 [39.1%]，p=0.002），脑膜强化更多（14/17 [82.4%] vs 32/64 [50%]，p=0.034），实质受累更少（中位数 1 对 3，p=0.018），肺部更多 cryptococcomas（6/12 [50%] vs 6/47 [12.8%]，p=0.014），更快清除 CSF 真菌（p=0.004），并发症更少（中位数 1 对 3，p<0.001），结局更好（16/17 [94.1%] vs 41/64 [64.1%]，p=0.035）。
结论
本研究表明，种属鉴定有助于指导治疗和预测结局。
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