Microbiological and clinical characteristics of cryptococcemia: a retrospective analysis of 85 cases in a Chinese hospital
| Autor: | Min Xu, Zhijie Pan, Jianying Zhou, Hua Zhou, Yiqi Fu, Yake Yao |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male China medicine.medical_specialty Antifungal Agents Genotype Itraconazole Cryptococcus Microbial Sensitivity Tests Flucytosine 03 medical and health sciences 0302 clinical medicine Internal medicine Humans Medicine Blood culture 030212 general & internal medicine DNA Fungal Mycological Typing Techniques Aged Retrospective Studies Voriconazole 0303 health sciences medicine.diagnostic_test biology 030306 microbiology business.industry Lumbar puncture Cryptococcus gattii Cryptococcosis General Medicine Middle Aged biology.organism_classification medicine.disease Hospitals Infectious Diseases Cryptococcus neoformans Female business Fungemia Meningitis Multilocus Sequence Typing medicine.drug |
| Zdroj: | Medical Mycology. 58:478-484 |
| ISSN: | 1460-2709 1369-3786 |
| DOI: | 10.1093/mmy/myz089 |
| Popis: | Cryptococcemia is a life-threatening fungal infection. Sometimes, it is hard to diagnose. The studies to describe the characteristics of cryptococcemia specifically were limited. We performed this retrospective analysis in a Chinese hospital during 2002–2015, including 85 cryptococcemia cases and 52 Cryptococcus spp. isolates. The species, mating type, antifungal susceptibility and multilocus sequence typing of Cryptococcus spp. were determined. C. neoformans var. grubii MATα of sequence type (ST) 5 is the representative strain of cryptococcemia, accounting for 51 isolates. The MIC50/90 values were 0.5/0.5, 1.0/1.0, 2.0/4.0, ≤0.06/0.25, and ≤0.06/≤0.06 μg/ml for amphotericin B, flucytosine, fluconazole, itraconazole, and voriconazole, respectively. Cryptococcemia was the first diagnostic proof of cryptococcosis in 37 patients (43.5%, 37/85). Compared with the patients initially diagnosed of cryptococcosis in other sites (mainly cerebrospinal fluid), the patients firstly diagnosed by blood culture had prolonged time from admission to diagnosis of cryptococcosis (9 days vs. 2 days, P < .001) and higher 30-day mortality (54.1% vs. 20.8%, P = .003), while fewer symptoms of meningitis (45.9% vs. 100%, P < .001). For the patients receiving lumbar puncture, the occurrence of meningitis was similar between the patients firstly diagnosed by blood culture and those firstly diagnosed in other sites (94.1% vs. 100%, P = .26). However, the patients first diagnosed by blood culture had lower baseline intracranial pressure (250 mm H2O vs. 342.5 mm H2O, P = .001). In conclusion, patients with cryptococcemia as the first diagnostic proof of cryptococcosis usually had neglected subtle symptoms of meningitis, which may result in delayed diagnosis and catastrophic outcome. |
| Databáze: | OpenAIRE |
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