背景:颅内真菌感染(IcFI)的临床表现不同导致诊断和治疗困难。非洲人口不成比例地受到这种疾病的高负担的影响。整个非洲大陆采用的诊断和治疗方式缺乏明确性。在这次审查中,我们的目标是细节管理,以及非洲各地IcFI的结果。
方法:本范围审查使用Arksey和O\'Malley框架进行。MEDLINE,EMBASE,科克伦图书馆,非洲医学指数,从数据库开始到8月10日,对非洲在线期刊进行了相关文章的搜索,2021年。使用系统评价的首选报告项目和范围审查指南的Meta分析扩展来报告审查结果。
结果:在确定的5,779条记录中,共131篇文章。平均年龄为35.6岁,大多数(56.4%)为男性。大多数(n=8,433/8,693,97.0%)的IcFI表现为脑膜炎,IcFIs最常见的可传播诱发因素是HIV/AIDS(n=7,815/8,693,89.9%),最常见的非传染性危险因素是糖尿病(n=32/8,693,0.4%)。隐球菌是最常见的致病生物(n=8,428/8,693,97.0%)。最常用的诊断方式是弥漫性IcFI的脑脊液(CSF)培养(n=4,390/6,830,64.3%),和MRI成像(n=12/30,40%)的局灶性IcFI。最常见的治疗方式是仅使用抗真菌药物的医疗管理(n=4,481/8,693,51.6%)。儿科最常用的抗真菌剂,成年患者采用两性霉素B和氟康唑双重治疗(51.5%vs44.9%)。总死亡率高(n=3,475/7,493,46.3%),成人和儿科患者相似(47.8%vs42.1%)。
结论:大多数IcFI发生在免疫抑制个体中,尽管有了新的诊断技术,脑脊液培养主要用于非洲。儿童和成人之间使用的抗真菌药物方案相似。非洲儿童和成年患者的IcFI结果均较差。
BACKGROUND: Intracranial fungal infections\' (IcFIs) varying clinical manifestations lead to difficulties in diagnosis and treatment. African populations are disproportionately affected by the high burden of the disease. There is a lack of clarity as to the diagnostic and treatment modalities employed across the continent. In this
review, we aim to detail the management, and outcome of IcFIs across Africa.
METHODS: This scoping
review was conducted using the Arksey and O\'Malley framework. MEDLINE, EMBASE, Cochrane Library, African Index Medicus, and African Journals Online were searched for relevant articles from database inception to August 10th, 2021. The Preferred Reporting Items for Systematic
Review and Meta-Analysis extension for Scoping Reviews guidelines were used to report the findings of the
review.
RESULTS: Of the 5,779 records identified, 131 articles were included. The mean age was 35.6 years, and the majority (56.4%) were males. The majority (n = 8,433/8,693, 97.0%) of IcFIs presented as a meningitis, the most common communicable predisposing factor of IcFIs was HIV/AIDS (n = 7,815/8,693, 89.9%), and the most common non-communicable risk factor was diabetes mellitus (n = 32/8,693, 0.4%). Cryptococcus species was the most common (n = 8,428/8,693, 97.0%) causative organism. The most commonly used diagnostic modality was cerebrospinal (CSF) cultures (n = 4,390/6,830, 64.3%) for diffuse IcFIs, and MRI imaging (n = 12/30, 40%) for focal IcFIs. The most common treatment modality was medical management with antifungals only (n = 4,481/8,693, 51.6%). The most commonly used antifungal agent in paediatric, and adult patients was amphotericin B and fluconazole dual therapy (51.5% vs 44.9%). The overall mortality rate was high (n = 3,475/7,493, 46.3%), and similar for both adult and paediatric patients (47.8% vs 42.1%).
CONCLUSIONS: Most IcFIs occurred in immunosuppressed individuals, and despite the new diagnostic techniques, CSF culture was mostly used in Africa. Antifungals regimens used was similar between children and adults. The outcome of IcFIs in Africa was poor for both paediatric and adult patients.