Triple therapy combined with ventriculoperitoneal shunts can improve neurological function and shorten hospitalization time in non-HIV cryptococcal meningitis patients with increased intracranial pressure.
Background: Raised intracranial pressure (ICP) and insufficient antifungal regimens are the two main factors result to unsatisfactory outcomes in non-HIV cryptococcal meningitis (CM) patients. In this study, we try to discuss that whether triple therapy of amphotericin B (AmB), fluconazole, 5-flucyt...
| Publicado en: | BMC Infectious Diseases Vol. 20; no. 1 |
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| Autores principales: | , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
BioMed Central
11/16/2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=147016480&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 147016480 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14712334 1CHU jtl: BMC Infectious Diseases issn: 14712334 maglogo: N pubinfo: dt: 11/16/2020 vid: 20 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 147016480 147016480 NLM33198666 147016480 10.1186/s12879-020-05510-9 NLM33198666 147016480 ppct: 1 formats: tig: atl: Triple therapy combined with ventriculoperitoneal shunts can improve neurological function and shorten hospitalization time in non-HIV cryptococcal meningitis patients with increased intracranial pressure. aug: au: Li, Min Liu, Jia Deng, Xuhui Gan, Qingzhou Wang, Yijie Xu, Xiaofeng Jiang, Ying Peng, Fuhua affil: Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 510630, Guangzhou, Guangdong, China sug: subj: Intracranial Hypertension Drug Therapy Length of Stay Trends Antifungal Agents Therapeutic Use Meningitis, Cryptococcal Surgery Heterocyclic Compounds Therapeutic Use Intracranial Hypertension Surgery Ventriculoperitoneal Shunt Methods Cryptococcus Drug Effects Fluconazole Therapeutic Use Meningitis, Cryptococcal Drug Therapy Amphotericin B Therapeutic Use Treatment Outcomes Retrospective Design Prospective Studies Cryptococcus Adult Middle Age Female Spinal Puncture Drug Therapy, Combination Meningitis, Cryptococcal Complications Intracranial Hypertension Complications Human Male Validation Studies Comparative Studies Evaluation Research Multicenter Studies Scales Funding Source Adult: 19-44 years Middle Aged: 45-64 years Female Male ab: Background: Raised intracranial pressure (ICP) and insufficient antifungal regimens are the two main factors result to unsatisfactory outcomes in non-HIV cryptococcal meningitis (CM) patients. In this study, we try to discuss that whether triple therapy of amphotericin B (AmB), fluconazole, 5-flucytosine (5-FC) plus ventriculoperitoneal shunts (VPS) is superior to AmB, 5-FC, fluconazole plus intermittent lumbar puncture in induction therapy in non-HIV CM patients with increased ICP.Methods: We reviewed 66 clinical records from non-HIV CM patients with increased ICP. The demographic and clinical characteristics, BMRC staging, cerebrospinal fluid profiles (CSF), brain magnetic resonance imaging, treatment, and outcomes of these individuals were retrospectively analyzed. All non-HIV CM patients with increased ICP (≥ 25 cmH2O) were divided into two groups, including 27 patients treated with triple antifungal agents and 39 patients treated with the same triple therapy plus VPS.Results: Triple therapy plus VPS group had more satisfactory outcomes, more CSF sterilization at 10 weeks follow-up, lower CSF opening pressure, lower BMRC staging scores one week after VPS, less CSF C. neoformans counts and CSF culture positive. Besides, these patients had shorter hospital stay than triple therapy group.Conclusions: Triple antifungal agents combined with VPS could effectively reduce ICP, had faster rate of clearance of C. neoformans counts, more improved neurological function, shorten hospitalization time and better outcomes in non-HIV CM patients with increased ICP. Our study indicated that triple therapy plus early VPS may be an optimal treatment for non-HIV CM patients with increased ICP. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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