目的:我们的目的是在法国的一个大型隐球菌病监测网络中描述HIV血清阴性个体中隐球菌病的特征和结果。
方法:我们纳入了2005年至2020年HIV血清阴性个体的隐球菌病事件。我们比较了患者特征,疾病介绍,隐球菌抗原(CrAg)结果,并根据潜在疾病诱导抗真菌治疗。我们研究了与90天死亡率相关的因素。在传播感染的患者中,我们调查了氟胞嘧啶和多烯联合用药是否与较低的死亡率相关.
结果:在652个人中,209(32.1%)有恶性肿瘤,130例(19.9%)为实体器官移植(SOT)受者,204(31.3%)患有其他免疫受损疾病,109人(16.7%)没有报告的潜在因素。最常见的表现是播散性感染(63.3%,413/652)和孤立的肺部感染(25.3%,165/652)。SOT患者最有可能传播感染和血清CrAg阳性结果。恶性肿瘤患者年龄较大,接受含氟胞嘧啶方案治疗播散性感染的可能性较小(58.7%,78/133vs.73.2%,194/265,p=0.029)。粗略的90天病死率为27.2%(95CI:23.5%-31.1%)。年龄≥60岁(OR:2.75[1.78-4.26],p<0.001),脑膜炎/真菌血症(aOR:4.79[1.80-12.7],p=0.002),和恶性肿瘤(AOR:2.4[1.14-5.07],p=0.02)与更高的90天死亡率相关。接受氟胞嘧啶和多烯组合与90天死亡率较低相关(aOR:0.40[0.23-0.71],p=0.002)在多变量分析和治疗加权逆概率分析中(AOR:0.45[0.25-0.80],p=0.006)。
结论:HIV血清阴性的隐球菌病者包括各种潜在的疾病,具有不同的表现和结果,需要量身定制的诊断和管理方法。
OBJECTIVE: We aimed to describe features and outcomes of cryptococcosis among HIV-seronegative individuals in a large surveillance network for cryptococcosis in France.
METHODS: We included incident cases of cryptococcosis in HIV-seronegative individuals from 2005 to 2020. We compared patient characteristics, disease presentations, cryptococcal antigen results, and induction antifungal treatments according to underlying disease. We examined factors associated with 90-day mortality. Among patients with disseminated infections, we investigated whether receipt of
flucytosine and polyene combination was associated with lower mortality.
RESULTS: Among 652 individuals, 209 (32.1%) had malignancy, 130 (19.9%) were solid-organ transplant recipients, 204 (31.3%) had other immunocompromising conditions, and 109 (16.7%) had no reported underlying factor. The commonest presentations were disseminated infections (63.3%, 413/652) and isolated pulmonary infections (25.3%, 165/652). Solid-organ transplant patients were most likely to have disseminated infections and a positive serum cryptococcal antigen result. Patients with malignancy were older and less likely to receive a
flucytosine-containing regimen for disseminated infections than others (58.7%, 78/133 vs. 73.2%, 194/265; p 0.029). The crude 90-day case-fatality ratio was 27.2% (95% CI, 23.5%-31.1%). Age ≥60 years (aOR: 2.75 [1.78-4.26]; p < 0.001), meningitis/fungaemia (aOR: 4.79 [1.80-12.7]; p 0.002), and malignancy (aOR: 2.4 [1.14-5.07]; p 0.02) were associated with higher 90-day mortality. Receipt of
flucytosine and polyene combination was associated with lower 90-day mortality (aOR: 0.40 [0.23-0.71]; p 0.002) in multivariable analysis and inverse probability of treatment weighted analysis (aOR: 0.45 [0.25-0.80]; p 0.006).
CONCLUSIONS: HIV-seronegative individuals with cryptococcosis comprise a wide range of underlying conditions with different presentations and outcomes, requiring a tailored approach to diagnosis and management.