非结核分枝杆菌中枢神经系统感染的流行病学、临床表现和预后预测因素:一项系统综述。

IF 3.6 Q1 TROPICAL MEDICINE Tropical Medicine and Health Pub Date : 2023-09-25 DOI:10.1186/s41182-023-00546-4
Durga Shankar Meena, Deepak Kumar, Vasudha Meena, Gopal Krishana Bohra, Vibhor Tak, Mahendra Kumar Garg
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引用次数: 0

摘要

背景:中枢神经系统表现是NTM感染的一个新方面,具有显著的死亡率。由于变形杆菌的表现和低怀疑指数,许多病例经常被错误地视为结核性脑膜炎或真菌感染。目的:关于NTM中枢神经系统疾病的文献很少,肺部疾病的可用数据最多。本系统综述旨在评估中枢神经系统NTM感染的流行病学、临床表现、诊断模式和预后预测因素。方法:在主要的电子数据库(PubMed、Google Scholar和Scopus)中使用关键词“CNS”、“中枢神经系统”、“脑脓肿”、“脑膜炎”、“脊柱”、“非结核分枝杆菌”和“NTM”进行文献检索。纳入1980年1月至2022年12月期间报告的所有中枢神经系统NTM感染病例。结果:共有77项研究(112例)纳入最终分析。所有患者的平均年龄为38岁,大多数患者为男性(62.5%)。偶然性和M。脓肿(分别为34.8%、21.4%和15.2%)。在33%的病例中发现了传播性疾病。HIV(33.9%)和神经外科硬件(22.3%)是常见的危险因素。颅内脓肿(36.6%)和软脑膜强化(28%)是神经影像学中最常见的表现。总病死率为37.5%。在多变量分析中,男性(校正OR 2.4,95%CI 1.2-7.9)和HIV(校正OR 3.7,95%CI 1.8-6.1)是死亡率的独立预测因素。M。偶然感染与生存率增加显著相关(校正OR 0.18,95%CI(0.08-0.45),p值0.012)。结论:目前的证据表明快速生长的NTM在中枢神经系统疾病中的作用正在显现。男性和HIV阳性与显著的死亡率相关,而M偶然性具有有利的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Epidemiology, clinical presentation, and predictors of outcome in nontuberculous mycobacterial central nervous system infection: a systematic review.

Background: CNS manifestations represent an emerging facet of NTM infection with significant mortality. Due to protean presentation and low index of suspicion, many cases are often treated erroneously as tubercular meningitis or fungal infections.

Objectives: Literature on NTM CNS disease is scarce, with most available data on pulmonary disease. This systematic review aimed to evaluate the epidemiology, clinical presentation, diagnostic modalities, and predictors of outcome in CNS NTM infection.

Methods: The literature search was performed in major electronic databases (PubMed, Google Scholar, and Scopus) using keywords "CNS," "Central nervous system," "brain abscess," "meningitis," "spinal," "Nontuberculous mycobacteria," "NTM". All cases of CNS NTM infection reported between January 1980 and December 2022 were included.

Results: A total of 77 studies (112 cases) were included in the final analysis. The mean age of all patients was 38 years, with most patients male (62.5%). Mycobacterium avium complex (MAC) was the most common aetiology, followed by M. fortuitum and M. abscessus (34.8%, 21.4% and 15.2%, respectively). The disseminated disease was found in 33% of cases. HIV (33.9%) and neurosurgical hardware (22.3%) were the common risk factors. Intracranial abscess (36.6%) and leptomeningeal enhancement (28%) were the most prevalent findings in neuroimaging. The overall case fatality rate was 37.5%. On multivariate analysis, male gender (adjusted OR 2.4, 95% CI 1.2-7.9) and HIV (adjusted OR 3.7, 95% CI 1.8-6.1) were the independent predictors of mortality). M. fortuitum infection was significantly associated with increased survival (adjusted OR 0.18, 95% CI (0.08-0.45), p value 0.012).

Conclusions: Current evidence shows the emerging role of rapid-grower NTM in CNS disease. Male gender and HIV positivity were associated with significant mortality, while M fortuitum carries favourable outcomes.

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来源期刊
Tropical Medicine and Health
Tropical Medicine and Health TROPICAL MEDICINE-
CiteScore
7.00
自引率
2.20%
发文量
90
审稿时长
11 weeks
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