隐球菌性脑膜脑炎：巴西东北部一家医院与死亡相关的危险因素。

Cryptococcal meningoencephalitis: Risk factors associated to death in a hospital in Northeastern Brazil.

机构信息

Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil; Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil.

Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.

出版信息

J Mycol Med. 2023 Aug;33(3):101407. doi: 10.1016/j.mycmed.2023.101407. Epub 2023 May 30.

DOI:10.1016/j.mycmed.2023.101407

PMID:37295283

Abstract

INTRODUCTION

Cryptococcosis is an opportunistic systemic mycosis caused by pathogenic encapsulated yeasts of the genus Cryptococcus. The objective of the present study was to evaluate the risk factors associated with death of patients diagnosed with meningitis due to Cryptococcus spp.

METHODS

This retrospective cohort study included patients admitted to the São José Hospital (SJH) with Cryptococcal Meningoencephalitis (CM) who were diagnosed between 2010 and 2018. Data collection was carried out by reviewing the patients' medical records. Death during hospitalization was considered the primary outcome.

RESULTS

From 2010 to 2018, 21,519 patients were admitted to the HSJ, 124 of whom were hospitalized due to CM. The CM incidence rate was 5.8 cases/10 hospitalizations. We included 112 patients in the study. Male patients were the most affected (82.1%), and the median age was 37 years [IQR: 29-45]. HIV coinfection occurred in 79.4% of the patients. Fever (65.2%) and headache (88.4%) were the most frequent symptoms. Greater cellularity in the CSF was the most related factor to CM in non-HIV individuals (p < 0.05). Death during hospitalization occurred in 28.6% (n = 32) of the patients. The independent risk factors associated with death during the hospitalization were women (p = 0.009), age > 35 years (p = 0.046), focal neurological deficits (p = 0.013), altered mental status (p = 0.018) and HIV infection (p = 0.040). The twelve-month survival was lower in HIV-positive patients (p < 0.05).

CONCLUSION

Early diagnosis, optimal treatment, and clinical follow-up strategies, especially in HIV patients, should be prioritized.

摘要

引言

cryptococcosis 是一种由致病性包裹酵母 cryptococcus 引起的机会性系统性真菌病。本研究的目的是评估与诊断为 cryptococcus spp 引起的脑膜炎的患者死亡相关的危险因素。

方法

本回顾性队列研究纳入了 2010 年至 2018 年期间在圣若泽医院（sjh）因 cryptococcal 脑膜脑炎（cm）住院的患者。通过回顾患者的病历进行数据收集。住院期间死亡被认为是主要结局。

结果

2010 年至 2018 年，共有 21519 名患者入住 hsj，其中 124 名因 cm 住院。cm 的发病率为每 10 次住院 5.8 例。我们纳入了 112 名患者进行研究。男性患者受影响最严重（82.1%），中位年龄为 37 岁[IQR：29-45]。79.4%的患者合并 hiv 感染。发热（65.2%）和头痛（88.4%）是最常见的症状。非 hiv 个体中 csf 中更多的细胞与 cm 最相关（p<0.05）。住院期间死亡发生在 28.6%（n=32）的患者中。与住院期间死亡相关的独立危险因素包括女性（p=0.009）、年龄>35 岁（p=0.046）、局灶性神经功能缺损（p=0.013）、精神状态改变（p=0.018）和 hiv 感染（p=0.040）。hiv 阳性患者的 12 个月生存率较低（p<0.05）。