Unique characteristics of cryptococcosis identified after death in patients with liver cirrhosis: comparison with concurrent cohort diagnosed antemortem
| Autor: | W Cedric, Jeffrey M. Tessier, Rachel Miller, Christine E. Koval, Thomas V. Cacciarelli, Kevin S. Gregg, Jade Le, Marilyn M. Wagener, David B. Banach, Albert J. Eid, Andrea Zimmer, Erika D. Lease, Darin Ostrander, Hsin-Yun Sun, Ahlaam Alynbiawi, Raymund R. Razonable, Fernanda P. Silveira, Costi D. Sifri, George Alangaden, Shirish Huprikar, Michele I. Morris, Emily A. Blumberg, Robin K. Avery, Nina Singh, Jose Montero, J. Stephen Dummer, Henry B. Randall, Miloni Shroff |
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| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Liver Cirrhosis Male medicine.medical_specialty Cirrhosis Fulminant medicine.medical_treatment 030106 microbiology Severity of Illness Index 03 medical and health sciences Liver disease Internal medicine Severity of illness medicine Humans Fungemia Mechanical ventilation business.industry General Medicine Cryptococcosis Middle Aged medicine.disease Prognosis Infectious Diseases Cohort Female Radiology business |
| Zdroj: | Medical mycology. 55(3) |
| ISSN: | 1460-2709 |
| Popis: | Characteristics of cirrhosis-associated cryptococcosis first diagnosed after death are not fully known. In a multicenter study, data generated as standard of care was systematically collected in 113 consecutive patients with cirrhosis and cryptococcosis followed for 80 patient-years. The diagnosis of cryptococcosis was first established after death in 15.9% (18/113) of the patients. Compared to cases diagnosed while alive, these patients had higher MELD score (33 vs. 22, P = .029) and higher rate of cryptococcemia (75.0% vs. 41.9%, P = .027). Cases diagnosed after death, in comparison to those diagnosed during life were more likely to present with shock (OR 3.42, 95% CI 1.18-9.90, P = .023), require mechanical ventilation at admission (OR 8.5, 95% CI 2.74-26.38, P = .001), less likely to undergo testing for serum cryptococcal antigen (OR 0.07, 95% CI 0.02-0.21, P < .001) and have positive antigen when the test was performed (OR 0.07, 95% CI 0.01-0.60, P = .016). In a subset of cirrhotic patients with advanced liver disease cryptococcosis was first recognized after death. These patients had the characteristics of presenting with fulminant fungemia, were less likely to have positive serum cryptococcal antigen and posed a diagnostic challenge for care providers. |
| Databáze: | OpenAIRE |
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