Diagnosis and management of cryptococcal meningitis in HIV-infected adults.

IF 19 1区 医学 Q1 MICROBIOLOGY
Clinical Microbiology Reviews Pub Date : 2023-12-20 Epub Date: 2023-11-28 DOI:10.1128/cmr.00156-22
Thomas C McHale, David R Boulware, John Kasibante, Kenneth Ssebambulidde, Caleb P Skipper, Mahsa Abassi
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引用次数: 0

Abstract

Cryptococcal meningitis is a leading cause of morbidity and mortality globally, especially in people with advanced HIV disease. Cryptococcal meningitis is responsible for nearly 20% of all deaths related to advanced HIV disease, with the burden of disease predominantly experienced by people in resource-limited countries. Major advancements in diagnostics have introduced low-cost, easy-to-use antigen tests with remarkably high sensitivity and specificity. These tests have led to improved diagnostic accuracy and are essential for screening campaigns to reduce the burden of cryptococcosis. In the last 5 years, several high-quality, multisite clinical trials have led to innovations in therapeutics that have allowed for simplified regimens, which are better tolerated and result in less intensive monitoring and management of medication adverse effects. One trial found that a shorter, 7-day course of deoxycholate amphotericin B is as effective as the longer 14-day course and that flucytosine is an essential partner drug for reducing mortality in the acute phase of disease. Single-dose liposomal amphotericin B has also been found to be as effective as a 7-day course of deoxycholate amphotericin B. These findings have allowed for simpler and safer treatment regimens that also reduce the burden on the healthcare system. This review provides a detailed discussion of the latest evidence guiding the clinical management and special circumstances that make cryptococcal meningitis uniquely difficult to treat.

成人hiv感染者隐球菌性脑膜炎的诊断和治疗。
隐球菌性脑膜炎是全球发病率和死亡率的主要原因,特别是在晚期艾滋病患者中。在与晚期艾滋病毒疾病相关的所有死亡中,有近20%是由隐球菌性脑膜炎造成的,疾病负担主要由资源有限国家的人们承担。诊断方面的重大进展带来了低成本、易于使用的抗原检测,具有非常高的灵敏度和特异性。这些检测提高了诊断的准确性,对于减少隐球菌病负担的筛查运动至关重要。在过去的5年里,一些高质量的、多地点的临床试验已经导致了治疗方法的创新,从而简化了方案,使其具有更好的耐受性,并且减少了对药物不良反应的密集监测和管理。一项试验发现,较短的7天脱氧胆酸两性霉素B疗程与较长的14天疗程一样有效,氟胞嘧啶是降低疾病急性期死亡率的重要配套药物。单剂量脂质体两性霉素B也被发现与7天脱氧胆酸两性霉素B疗程一样有效。这些发现使得更简单、更安全的治疗方案成为可能,也减轻了医疗保健系统的负担。这篇综述提供了一个详细的讨论最新的证据指导临床管理和特殊情况下,使隐球菌脑膜炎独特的难以治疗。
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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来源期刊
Clinical Microbiology Reviews
Clinical Microbiology Reviews 医学-微生物学
CiteScore
54.20
自引率
0.50%
发文量
38
期刊介绍: Clinical Microbiology Reviews (CMR) is a journal that primarily focuses on clinical microbiology and immunology.It aims to provide readers with up-to-date information on the latest developments in these fields.CMR also presents the current state of knowledge in clinical microbiology and immunology.Additionally, the journal offers balanced and thought-provoking perspectives on controversial issues in these areas.
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