Antifungal Therapy and Management of Complications of Cryptococcosis due to Cryptococcus gattii

作者：Chen Sharon C A^*; Korman Tony M; Slavin Monica A; Marriott Deborah; Byth Karen; Bak Narin; Currie Bart J; Hajkowicz Krispin; Heath Christopher H; Kidd Sarah; McBride William J H; Meyer Wieland; Murray Ronan; Playford E Geoffrey; Sorrell Tania C

来源：Clinical Infectious Diseases, 2013, 57(4): 543-551.

DOI：10.1093/cid/cit341

• Cryptococcus gattii
• antifungal therapy
• neurologic complications
• IRIS

Background. We describe antifungal therapy and management of complications due to Cryptococcus gattii infection in 86 Australian patients followed for at least 12 months. %26lt;br%26gt;Methods. Patient data from culture-confirmed cases (2000-2007) were recorded at diagnosis, 6 weeks, 6 months, and 12 months. Clinical, laboratory, and treatment variables associated with raised intracranial pressure (ICP) and immune reconstitution inflammatory syndrome (IRIS) were determined. %26lt;br%26gt;Results. Seven of 10 patients with lung infection received amphotericin B (AMB) induction therapy (6 with 5-flucytosine [5-FC] for a median of 2 weeks); median duration of therapy including azole eradication therapy was 41 weeks, with a complete/partial clinical response in 78%. For neurologic disease, 88% of patients received AMB, 78% with 5-FC, for a median of 6 weeks. The median total course was 18 months. Nine patients receiving fluconazole induction therapy were reinduced with AMB plus 5-FC for clinical failure. Raised ICP (31 patients) was associated with initial abnormal neurology, and neurologic sequelae and/or death at 12 months (both P = .02); cerebrospinal fluid drains/shunts were placed in 58% of patients and in 64% of 22 patients with hydrocephalus. IRIS developed 2-12 months after starting antifungals in 8 patients, who presented with new/enlarging brain lesions. Risk factors included female sex, brain involvement at presentation, and higher median CD4 counts (all P %26lt; .05); corticosteroids reduced cryptococcoma-associated edema. %26lt;br%26gt;Conclusions. Induction AMB plus 5-FC is indicated for C. gattii neurologic cryptococcosis (6 weeks) and when localized to lung (2 weeks). Shunting was often required to control raised ICP. IRIS presents with cerebral manifestations.

• 出版日期2013-8-15