Camous Laurent, Surel Arthur, Kallel Hatem, Nicolas Muriel, Martino Frederic, Valette Marc, Demoule Alexandre, Pommier Jean-David
Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles-Guyane University, Chemin de Chauvel, Les Abymes, France.
Réanimation médicale et chirurgicale-CHU de Guadeloupe, 97139, Les Abyme, France.
Ann Intensive Care. 2023 Apr 21;13(1):30. doi: 10.1186/s13613-023-01128-7.
To describe clinical and biological features and the outcomes of patients admitted for histoplasmosis in two intensive care units (ICU) in French Guyana and in the French West Indies (Guadeloupe).
All patients admitted to these two ICUs for culture-proven histoplasmosis between January 2014 to August 2022 were included in the study. Using univariate and multivariate analysis, we assessed risk factors at ICU admission that were associated with death.
Forty patients were included (65% men). Median age was 56 years and simplified acute physiologic score (SAPS) II was 65. HIV was found in 58%, another immunodeficiency was identified in 28%, and no underlying immunodeficiency could be identified in 14% of patients. Within the first 24 h of ICU admission, 85% of patients had acute respiratory failure, 78% had shock, 30% had coma, and 48% had hemophagocytic lymphohistiocytosis. Mechanical ventilation was instituted in 78% of patients and renal replacement therapy in 55%. The 30-day mortality was 53%. By multivariate analysis, factors independently associated with 30-day mortality were SOFA score (odds ratio [OR] 1.5, 95% confidence interval [CI] [1.1-2.1]), time between symptom onset and treatment per day (OR 1.1, 95% CI 1.0-1.1), and hemophagocytic lymphohistiocytosis (OR 6.4, 95% CI 1.1-47.5).
Histoplasmosis requiring ICU admission is a protean disease with multiple and severe organ involvement. Immunodeficiency is found in most patients. The prognosis remains severe despite appropriate treatment and is worsened by late treatment initiation.
描述法属圭亚那和法属西印度群岛（瓜德罗普岛）两个重症监护病房（ICU）收治的组织胞浆菌病患者的临床和生物学特征及预后。
纳入2014年1月至2022年8月期间因培养确诊的组织胞浆菌病入住这两个ICU的所有患者。采用单因素和多因素分析，评估入住ICU时与死亡相关的危险因素。
共纳入40例患者（65%为男性）。中位年龄为56岁，简化急性生理评分（SAPS）II为65分。58%的患者检测出HIV，28%的患者存在其他免疫缺陷，14%的患者未发现潜在免疫缺陷。在入住ICU的最初24小时内，85%的患者出现急性呼吸衰竭，78%的患者出现休克，30%的患者出现昏迷，48%的患者出现噬血细胞性淋巴组织细胞增生症。78%的患者接受了机械通气，55%的患者接受了肾脏替代治疗。30天死亡率为53%。多因素分析显示，与30天死亡率独立相关的因素为序贯器官衰竭评估（SOFA）评分（比值比[OR]1.5，95%置信区间[CI][1.1 - 2.1]）、症状出现至每日治疗的时间（OR 1.1，95%CI 1.0 - 1.1）以及噬血细胞性淋巴组织细胞增生症（OR 6.4，95%CI 1.1 - 47.5）。
需要入住ICU的组织胞浆菌病是一种具有多种严重器官受累的多变疾病。大多数患者存在免疫缺陷。尽管进行了适当治疗，预后仍然严重，且治疗开始延迟会使预后恶化。
