Epidemiology, management and outcomes of Cryptococcus gattii infections: A 22-year cohort.

Autor: O'Hern JA; Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia., Koenen A; Department of General Surgery, Royal Darwin Hospital, Darwin, Australia., Janson S; Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia., Hajkowicz KM; Royal Brisbane and Women's Hospital, Brisbane, Australia., Robertson IK; College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia., Kidd SE; National Mycology Reference Centre, SA Pathology, Adelaide, Australia., Baird RW; Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia.; Territory Pathology, Department of Health, Darwin, Australia., Tong SY; Menzies School of Health Research, Charles Darwin University, Darwin, Australia., Davis JS; Menzies School of Health Research, Charles Darwin University, Darwin, Australia., Carson P; Department of General Surgery, Royal Darwin Hospital, Darwin, Australia., Currie BJ; Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia.; Menzies School of Health Research, Charles Darwin University, Darwin, Australia., Ralph AP; Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia.; Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
Jazyk: angličtina
Zdroj: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2023 Mar 06; Vol. 17 (3), pp. e0011162. Date of Electronic Publication: 2023 Mar 06 (Print Publication: 2023).
DOI: 10.1371/journal.pntd.0011162
Abstrakt: Background: Cryptococcus gattii is a globally endemic pathogen causing disease in apparently immune-competent hosts. We describe a 22-year cohort study from Australia's Northern Territory to evaluate trends in epidemiology and management, and outcome predictors.
Methods: A retrospective cohort study of all C. gattii infections at the northern Australian referral hospital 1996-2018 was conducted. Cases were defined as confirmed (culture-positive) or probable. Demographic, clinical and outcome data were extracted from medical records.
Results: 45 individuals with C. gattii infection were included: 44 Aboriginal Australians; 35 with confirmed infection; none HIV positive out of 38 tested. Multifocal disease (pulmonary and central nervous system) occurred in 20/45 (44%). Nine people (20%) died within 12 months of diagnosis, five attributed directly to C. gattii. Significant residual disability was evident in 4/36 (11%) survivors. Predictors of mortality included: treatment before the year 2002 (4/11 versus 1/34); interruption to induction therapy (2/8 versus 3/37) and end-stage kidney disease (2/5 versus 3/40). Prolonged antifungal therapy was the standard approach in this cohort, with median treatment duration being 425 days (IQR 166-715). Ten individuals had adjunctive lung resection surgery for large pulmonary cryptococcomas (median diameter 6cm [range 2.2-10cm], versus 2.8cm [1.2-9cm] in those managed non-operatively). One died post-operatively, and 7 had thoracic surgical complications, but ultimately 9/10 (90%) treated surgically were cured compared with 10/15 (67%) who did not have lung surgery. Four patients were diagnosed with immune reconstitution inflammatory syndrome which was associated with age <40 years, brain cryptococcomas, high cerebrospinal fluid pressure, and serum cryptococcal antigen titre >1:512.
Conclusion: C. gattii infection remains a challenging condition but treatment outcomes have significantly improved over 2 decades, with eradication of infection the norm. Adjunctive surgery for the management of bulky pulmonary C. gattii infection appears to increase the likelihood of durable cure and likely reduces the required duration of antifungal therapy.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests:Dr. KH has received advisory board fees and grant support from Gilead Sciences. The authors have no other conflicts to declare.
(Copyright: © 2023 O’Hern et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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