Characteristics, mortality, associated variables with death, and therapeutic response among HIV-positive, solid organ transplant (SOT), and non-HIV-positive/non-transplant (NHNT) patients with cryptococcosis: First multicenter cohort study in Brazil.

Autor:	Bridi Cavassin F; Internal Medicine and Health Sciences Department, Universidade Federal do Paraná (UFPR), Curitiba, Brazil., Vidal JE; Infectious Diseases Department, Instituto de Infectologia Emílio Ribas (IIER), São Paulo, Brazil., Baú-Carneiro JL; Faculdades Pequeno Príncipe (FPP), Curitiba, Brazil., Silva de Miranda Godoy C; Medical Education and Research Department, Hospital de Doenças Tropicais Dr. Anuar Auad (HDT), Goiânia, Brazil., de Bastos Ascenço Soares R; Medical Education and Research Department, Hospital de Doenças Tropicais Dr. Anuar Auad (HDT), Goiânia, Brazil., Magri MMC; Infectious Diseases Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FAMUSP), São Paulo, Brazil., Falci DR; Infectious Diseases Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil., Sakuma De Oliveira C; Infectious Diseases Department, Hospital Universitário do Oeste do Paraná (HUOP), Cascavel, Brazil., Verena Almeida Mendes A; Infectious Diseases Department, Hospital São Rafael (HSR), Salvador, Brazil., Breda GL; Infectious Diseases Department, Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, Brazil., Rego CM; Infectious Diseases Department, Instituto de Infectologia Emílio Ribas (IIER), São Paulo, Brazil., Araujo Félix M; Infectious Diseases Department, Instituto de Infectologia Emílio Ribas (IIER), São Paulo, Brazil., Pacheco Katopodis P; Medical Education and Research Department, Pontifícia Universidade Católica de Goiás, Goiânia, Brazil., da Silva do Ó JR; Medical Education and Research Department, Pontifícia Universidade Católica de Goiás, Goiânia, Brazil., Pereira Lima Abrão M; Medical Education and Research Department, Universidade Federal de Goiás, Goiânia, Brazil., Taborda M; Infectious Diseases Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC/FAMUSP), São Paulo, Brazil., Teles Teixeira Pereira T; Pharmacy Department, Hospital São Rafael (HSR), Salvador, Brazil., Queiroz-Telles F; Public Health Department, Universidade Federal do Paraná (UFPR), Hospital de Clínicas da Universidade Federal do Paraná (HC/UFPR), Curitiba, Brazil.
Jazyk:	angličtina
Zdroj:	Medical mycology [Med Mycol] 2023 Feb 03; Vol. 61 (2).
DOI:	10.1093/mmy/myad011
Abstrakt:	Cryptococcosis is traditionally associated with immunocompromised patients but is increasingly being identified in those without the human immunodeficiency virus (HIV) or other immunocompetent individuals. We aim to describe the characteristics, mortality, and associated variables with death among hospitalized patients with cryptococcosis in Brazil. This is the first multicenter retrospective cohort study conducted in seven public tertiary Brazilian hospitals. A total of 384 patients were included; the median age was 39 years and 283 (73.7%) were men. In all, 304 HIV-positive were hosts (79.2%), 16 (4.2%) solid organ transplant (SOT), and 64 (16.7%) non-HIV-positive/non-transplant (NHNT). Central nervous system (CNS) cryptococcosis had a significantly higher number across disease categories, with 313 cases (81.5%). A total of 271 (70.6%) patients were discharged and 113 (29.4%) died during hospitalization. In-hospital mortality among HIV-positive, SOT, and NHNT was 30.3% (92/304), 12.5% (2/16), and 29.7% (19/64), respectively. Induction therapy with conventional amphotericin B (AMB) mainly in combination with fluconazole (234; 84.2%) was the most used. Only 80 (22.3%) patients received an AMB lipid formulation: liposomal (n = 35) and lipid complex (n = 45). Most patients who died belong to the CNS cryptococcosis category (83/113; 73.4%) when compared with the others (P = .017). Multivariate analysis showed that age and disseminated cryptococcosis had a higher risk of death (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.05; P = .008 and OR, 1.84; 95% CI, 1.01-3.53; P = .048, respectively). Understanding the epidemiology of cryptococcosis in our settings will help to recognize the burden and causes of mortality and identify strategies to improve this scenario. (© The Author(s) 2023. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)
Databáze:	MEDLINE
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