Association between neuroimaging and clinical outcomes in individuals with central nervous system cryptococcosis.

Autor: Teixeira JC; Division of Infectious and Parasitic Diseases, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., de Oliveira VF; Division of Infectious and Parasitic Diseases, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Gomes HR; Division of Neurology, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Ribeiro SM; Microbiology Section of Division Central Laboratory, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., de Araujo EDMPA; Microbiology Section of Division Central Laboratory, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., da Cruz ICLV; Division of Infectious and Parasitic Diseases, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Taborda M; Division of Infectious and Parasitic Diseases, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Magri ASGK; Division of Infectious and Parasitic Diseases, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Vidal JE; Division of Infectious and Parasitic Diseases, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.; Department of Neurology, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil., Nastri ACSS; Division of Infectious and Parasitic Diseases, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Silva GD; Division of Neurology, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Magri MMC; Division of Infectious and Parasitic Diseases, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Mycoses [Mycoses] 2024 Jul; Vol. 67 (7), pp. e13767.
DOI: 10.1111/myc.13767
Abstrakt: Background: The radiological manifestations of central nervous system (CNS) cryptococcosis are diverse and often subtle. There is heterogeneity on how different neuroimaging patterns impact prognosis. This study aims to assess the association between the neuroimaging and clinical outcomes of CNS cryptococcosis.
Methods: All patients with CNS cryptococcosis between July 2017 and April 2023 who underwent brain magnetic resonance imaging (MRI) were included. The primary outcome was mortality during hospitalisation. Secondary outcomes were readmission, ventricular shunting, duration of hospitalisation and time to the first negative cerebrospinal fluid culture. We compared the outcomes for each of the five main radiological findings on the brain MRI scan.
Results: We included 46 proven CNS cryptococcosis cases. The two main comorbidity groups were HIV infection (20, 43%) and solid organ transplantation (10, 22%), respectively. Thirty-nine patients exhibited at least one radiological abnormality (85%), with the most common being meningeal enhancement (34, 74%). The mortality rates occurred at 11% (5/46) during hospitalisation. We found no significant disparities in mortality related to distinct radiological patterns. The presence of pseudocysts was significantly associated with the need for readmission (p = .027). The ventricular shunting was significantly associated with the presence of pseudocysts (p = .005) and hydrocephalus (p = .044).
Conclusion: In this study, there is no association between brain MRI findings and mortality. Larger studies are needed to evaluate this important issue.
(© 2024 Wiley‐VCH GmbH. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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