隐球菌性脑膜炎。

IF 76.9 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL Nature Reviews Disease Primers Pub Date : 2023-11-09 DOI:10.1038/s41572-023-00472-z
Lillian Tugume, Kenneth Ssebambulidde, John Kasibante, Jayne Ellis, Rachel M Wake, Jane Gakuru, David S Lawrence, Mahsa Abassi, Radha Rajasingham, David B Meya, David R Boulware
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引用次数: 0

摘要

新型隐球菌和gattii隐球菌复合物引起脑膜脑炎,病死率高,发病率高,特别是在T细胞介导的免疫力缺乏的人中,最常见的是影响艾滋病毒感染者。尽管在过去十年中,全球与艾滋病毒相关的隐球菌性脑膜炎(HIV-CM)的发病率有所下降,但由于晚期艾滋病毒疾病的持续负担,隐球菌病仍占全球艾滋病相关死亡人数的五分之一。此外,在资源匮乏的环境中,死亡率仍然很高(约50%)。降低隐球菌病相关死亡率的药物正在扩大:血清中的隐球菌抗原筛查和针对隐球菌抗原血症的预防性唑治疗已经建立,而提高隐球菌抗原贫血患者生存率的强化预防性联合治疗方案正在进行临床试验。目前,以两性霉素为基础的短期(≤7天)治疗结合氟胞嘧啶是隐球菌性脑膜炎诱导治疗的首选方案。短期诱导方案是否能改善幸存者的长期发病率,如抑郁、神经认知能力下降和身体残疾,还有待进一步研究。在这里,我们讨论了潜在的免疫学、不断变化的流行病学以及隐球菌性脑膜炎管理的最新进展,重点是HIV相关疾病。
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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Cryptococcal meningitis.

Cryptococcus neoformans and Cryptococcus gattii species complexes cause meningoencephalitis with high fatality rates and considerable morbidity, particularly in persons with deficient T cell-mediated immunity, most commonly affecting people living with HIV. Whereas the global incidence of HIV-associated cryptococcal meningitis (HIV-CM) has decreased over the past decade, cryptococcosis still accounts for one in five AIDS-related deaths globally due to the persistent burden of advanced HIV disease. Moreover, mortality remains high (~50%) in low-resource settings. The armamentarium to decrease cryptococcosis-associated mortality is expanding: cryptococcal antigen screening in the serum and pre-emptive azole therapy for cryptococcal antigenaemia are well established, whereas enhanced pre-emptive combination treatment regimens to improve survival of persons with cryptococcal antigenaemia are in clinical trials. Short courses (≤7 days) of amphotericin-based therapy combined with flucytosine are currently the preferred options for induction therapy of cryptococcal meningitis. Whether short-course induction regimens improve long-term morbidity such as depression, reduced neurocognitive performance and physical disability among survivors is the subject of further study. Here, we discuss underlying immunology, changing epidemiology, and updates on the management of cryptococcal meningitis with emphasis on HIV-associated disease.

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来源期刊
Nature Reviews Disease Primers
Nature Reviews Disease Primers Medicine-General Medicine
CiteScore
76.70
自引率
0.20%
发文量
75
期刊介绍: Nature Reviews Disease Primers, a part of the Nature Reviews journal portfolio, features sections on epidemiology, mechanisms, diagnosis, management, and patient quality of life. The editorial team commissions top researchers — comprising basic scientists and clinical researchers — to write the Primers, which are designed for use by early career researchers, medical students and principal investigators. Each Primer concludes with an Outlook section, highlighting future research directions. Covered medical specialties include Cardiology, Dermatology, Ear, Nose and Throat, Emergency Medicine, Endocrinology, Gastroenterology, Genetic Conditions, Gynaecology and Obstetrics, Hepatology, Haematology, Infectious Diseases, Maxillofacial and Oral Medicine, Nephrology, Neurology, Nutrition, Oncology, Ophthalmology, Orthopaedics, Psychiatry, Respiratory Medicine, Rheumatology, Sleep Medicine, and Urology.
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