Clinical Manifestations of Cryptococcus gattii Infection: Determinants of Neurological Sequelae and Death
| العنوان: | Clinical Manifestations of Cryptococcus gattii Infection: Determinants of Neurological Sequelae and Death |
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| المؤلفون: | Tania C. Sorrell, Monica A. Slavin, Sarah E. Kidd, Krispin Hajkowicz, Ronan J. Murray, Deborah Marriott, Sharon C.-A. Chen, Wieland Meyer, Christopher H. Heath, Narin Bak, Tony M. Korman, Karen Byth, William J. H. McBride, Bart J. Currie, Geoffrey Playford |
| المصدر: | Clinical Infectious Diseases. 55:789-798 |
| بيانات النشر: | Oxford University Press (OUP), 2012. |
| سنة النشر: | 2012 |
| مصطلحات موضوعية: | Adult, Male, Microbiology (medical), medicine.medical_specialty, Adolescent, Population, Disease, Meningitis, Cryptococcal, Spinal Puncture, Young Adult, Risk Factors, Internal medicine, Epidemiology, medicine, Humans, education, Cerebrum, Cryptococcus gattii, Aged, Cerebrospinal Fluid, Retrospective Studies, Aged, 80 and over, education.field_of_study, biology, medicine.diagnostic_test, business.industry, Lumbar puncture, Incidence (epidemiology), Australia, Middle Aged, Prognosis, medicine.disease, biology.organism_classification, Hydrocephalus, Radiography, Treatment Outcome, Infectious Diseases, Immunology, business, Meningitis |
| الوصف: | Background: Longer-term morbidity and outcomes of Cryptococcus gattii infection are not described. We analyzed clinical, microbiological, and outcome data in Australian patients followed for 12 months, to identify prognostic determinants. Methods: Culture-confirmed C. gattii cases from 2000 to 2007 were retrospectively evaluated. Clinical, microbiological, radiological, and outcome data were recorded at diagnosis and at 6 weeks, 6 months, and 12 months. Clinical and laboratory variables associated with mortality and with death and/or neurological sequelae were determined. Results: Annual C. gattii infection incidence was 0.61 per 10⁶ population. Sixty-two of 86 (72%) patients had no immunocompromise; 6 of 24 immunocompromised hosts had idiopathic CD4 lymphopenia, and 1 had human immunodeficiency virus/AIDS. Clinical and microbiological characteristics of infection were similar in immunocompromised and healthy hosts. Isolated lung, combined lung and central nervous system (CNS), and CNS only disease was reported in 12%, 51% and 34% of the cases, respectively. Complications in CNS disease included raised intracranial pressure (42%), hydrocephalus (30%), neurological deficits (27%; 6% developed during therapy) and immune reconstitutionlike syndrome (11%). Geometric mean serum cryptococcal antigen (CRAG) titers in CNS disease were 563.9 (vs 149.3 in isolated lung infection). Patient immunocompromise was associated with increased mortality risk. An initial cerebrospinal fluid CRAG titer of >= 256 predicted death and/or neurological sequelae (P = .05). Conclusions: Neurological C. gattii disease predominates in the Australian endemic setting. Lumbar puncture and cerebral imaging, especially if serum CRAG titers are >= 512, are essential. Long-term follow up is required to detect late neurological complications. Immune system evaluation is important because host immunocompromise is associated with reduced survival. |
| تدمد: | 1537-6591 1058-4838 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d5a69ccbda96b6cc70805687ced32c60Test https://doi.org/10.1093/cid/cis529Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....d5a69ccbda96b6cc70805687ced32c60 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15376591 10584838 |
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