Determinants of Disease Presentation and Outcome during Cryptococcosis: The CryptoA/D Study
Identifieur interne : 000177 ( Ncbi/Checkpoint ); précédent : 000176; suivant : 000178Determinants of Disease Presentation and Outcome during Cryptococcosis: The CryptoA/D Study
Auteurs : Françoise Dromer [France] ; Simone Mathoulin-Pélissier [France] ; Odile Launay [France] ; Olivier Lortholary [France]Source :
- PLoS Medicine [ 1549-1277 ] ; 2007.
Abstract
Cryptococcosis is a life-threatening opportunistic fungal infection in both HIV-positive and -negative patients. Information on clinical presentation and therapeutic guidelines, derived mostly from clinical trials performed before introduction of highly active antiretroviral therapy in patients with cryptococcal meningoencephalitis, is missing data on extrameningeal involvement and infections by serotype D as opposed to serotype A of
The prospective multicenter study CryptoA/D was designed in France (1997–2001) to analyse the factors influencing clinical presentation and outcome without the bias of inclusion into therapeutic trials. Of the 230 patients enrolled, 177 (77%) were HIV-positive, 50 (22%) were female, and 161 (72.5%) were infected with serotype A. Based on culture results at baseline, cryptococcosis was more severe in men, in HIV-positive patients, and in patients infected with serotype A. Factors independently associated with mycological failure at week 2 independent of HIV status were initial dissemination (OR, 2.4 [95% confidence interval (CI), 1.2–4.9]), high (>1:512) serum antigen titre (OR, 2.6 [1.3–5.4]), and lack of flucytosine during induction therapy (OR, 3.8 [1.9–7.8]). The three-month survival was shorter in patients with abnormal neurology or brain imaging at baseline, and in those with haematological malignancy.
Thus sex, HIV status, and infecting serotype are major determinants of presentation and outcome during cryptococcosis. We propose a modification of current guidelines for the initial management of cryptococcosis based on systematic fungal burden evaluation.
Url:
DOI: 10.1371/journal.pmed.0040021
PubMed: 17284154
PubMed Central: 1808080
Affiliations:
Links toward previous steps (curation, corpus...)
- to stream Pmc, to step Corpus: 000222
- to stream Pmc, to step Curation: 000220
- to stream Pmc, to step Checkpoint: 000125
- to stream Ncbi, to step Merge: 000177
- to stream Ncbi, to step Curation: 000177
Links to Exploration step
PMC:1808080Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Determinants of Disease Presentation and Outcome during Cryptococcosis: The CryptoA/D Study </title>
<author><name sortKey="Dromer, Francoise" sort="Dromer, Francoise" uniqKey="Dromer F" first="Françoise" last="Dromer">Françoise Dromer</name>
<affiliation wicri:level="1"><nlm:aff id="aff1"> Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, CNRS URA3042, Institut Pasteur, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea> Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, CNRS URA3042, Institut Pasteur, Paris</wicri:regionArea>
<placeName><settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Mathoulin Pelissier, Simone" sort="Mathoulin Pelissier, Simone" uniqKey="Mathoulin Pelissier S" first="Simone" last="Mathoulin-Pélissier">Simone Mathoulin-Pélissier</name>
<affiliation wicri:level="1"><nlm:aff id="aff2"> Institut Bergonié, Centre Régional de Lutte Contre le Cancer du Sud-Ouest, Bordeaux, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea> Institut Bergonié, Centre Régional de Lutte Contre le Cancer du Sud-Ouest, Bordeaux</wicri:regionArea>
<placeName><settlement type="city">Bordeaux</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Launay, Odile" sort="Launay, Odile" uniqKey="Launay O" first="Odile" last="Launay">Odile Launay</name>
<affiliation wicri:level="1"><nlm:aff id="aff3"> Université Paris V, Hôpital Cochin, Service de Médecine Interne, CIC Vaccinologie Cochin–Pasteur, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea> Université Paris V, Hôpital Cochin, Service de Médecine Interne, CIC Vaccinologie Cochin–Pasteur, Paris</wicri:regionArea>
<placeName><settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Lortholary, Olivier" sort="Lortholary, Olivier" uniqKey="Lortholary O" first="Olivier" last="Lortholary">Olivier Lortholary</name>
<affiliation wicri:level="1"><nlm:aff id="aff1"> Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, CNRS URA3042, Institut Pasteur, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea> Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, CNRS URA3042, Institut Pasteur, Paris</wicri:regionArea>
<placeName><settlement type="city">Paris</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff4"> Université Paris V–Hôpital Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea> Université Paris V–Hôpital Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Paris</wicri:regionArea>
<placeName><settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">17284154</idno>
<idno type="pmc">1808080</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808080</idno>
<idno type="RBID">PMC:1808080</idno>
<idno type="doi">10.1371/journal.pmed.0040021</idno>
<date when="2007">2007</date>
<idno type="wicri:Area/Pmc/Corpus">000222</idno>
<idno type="wicri:Area/Pmc/Curation">000220</idno>
<idno type="wicri:Area/Pmc/Checkpoint">000125</idno>
<idno type="wicri:Area/Ncbi/Merge">000177</idno>
<idno type="wicri:Area/Ncbi/Curation">000177</idno>
<idno type="wicri:Area/Ncbi/Checkpoint">000177</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Determinants of Disease Presentation and Outcome during Cryptococcosis: The CryptoA/D Study </title>
<author><name sortKey="Dromer, Francoise" sort="Dromer, Francoise" uniqKey="Dromer F" first="Françoise" last="Dromer">Françoise Dromer</name>
<affiliation wicri:level="1"><nlm:aff id="aff1"> Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, CNRS URA3042, Institut Pasteur, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea> Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, CNRS URA3042, Institut Pasteur, Paris</wicri:regionArea>
<placeName><settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Mathoulin Pelissier, Simone" sort="Mathoulin Pelissier, Simone" uniqKey="Mathoulin Pelissier S" first="Simone" last="Mathoulin-Pélissier">Simone Mathoulin-Pélissier</name>
<affiliation wicri:level="1"><nlm:aff id="aff2"> Institut Bergonié, Centre Régional de Lutte Contre le Cancer du Sud-Ouest, Bordeaux, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea> Institut Bergonié, Centre Régional de Lutte Contre le Cancer du Sud-Ouest, Bordeaux</wicri:regionArea>
<placeName><settlement type="city">Bordeaux</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Launay, Odile" sort="Launay, Odile" uniqKey="Launay O" first="Odile" last="Launay">Odile Launay</name>
<affiliation wicri:level="1"><nlm:aff id="aff3"> Université Paris V, Hôpital Cochin, Service de Médecine Interne, CIC Vaccinologie Cochin–Pasteur, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea> Université Paris V, Hôpital Cochin, Service de Médecine Interne, CIC Vaccinologie Cochin–Pasteur, Paris</wicri:regionArea>
<placeName><settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Lortholary, Olivier" sort="Lortholary, Olivier" uniqKey="Lortholary O" first="Olivier" last="Lortholary">Olivier Lortholary</name>
<affiliation wicri:level="1"><nlm:aff id="aff1"> Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, CNRS URA3042, Institut Pasteur, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea> Unité de Mycologie Moléculaire, Centre National de Référence Mycologie et Antifongiques, CNRS URA3042, Institut Pasteur, Paris</wicri:regionArea>
<placeName><settlement type="city">Paris</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="aff4"> Université Paris V–Hôpital Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Paris, France</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea> Université Paris V–Hôpital Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Paris</wicri:regionArea>
<placeName><settlement type="city">Paris</settlement>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j">PLoS Medicine</title>
<idno type="ISSN">1549-1277</idno>
<idno type="eISSN">1549-1676</idno>
<imprint><date when="2007">2007</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background</title>
<p>Cryptococcosis is a life-threatening opportunistic fungal infection in both HIV-positive and -negative patients. Information on clinical presentation and therapeutic guidelines, derived mostly from clinical trials performed before introduction of highly active antiretroviral therapy in patients with cryptococcal meningoencephalitis, is missing data on extrameningeal involvement and infections by serotype D as opposed to serotype A of <named-content content-type="genus-species">Cryptococcus neoformans</named-content>
.</p>
</sec>
<sec id="st2"><title>Methods and Findings</title>
<p>The prospective multicenter study CryptoA/D was designed in France (1997–2001) to analyse the factors influencing clinical presentation and outcome without the bias of inclusion into therapeutic trials. Of the 230 patients enrolled, 177 (77%) were HIV-positive, 50 (22%) were female, and 161 (72.5%) were infected with serotype A. Based on culture results at baseline, cryptococcosis was more severe in men, in HIV-positive patients, and in patients infected with serotype A. Factors independently associated with mycological failure at week 2 independent of HIV status were initial dissemination (OR, 2.4 [95% confidence interval (CI), 1.2–4.9]), high (>1:512) serum antigen titre (OR, 2.6 [1.3–5.4]), and lack of flucytosine during induction therapy (OR, 3.8 [1.9–7.8]). The three-month survival was shorter in patients with abnormal neurology or brain imaging at baseline, and in those with haematological malignancy.</p>
</sec>
<sec id="st3"><title>Conclusions</title>
<p>Thus sex, HIV status, and infecting serotype are major determinants of presentation and outcome during cryptococcosis. We propose a modification of current guidelines for the initial management of cryptococcosis based on systematic fungal burden evaluation.</p>
</sec>
</div>
</front>
<back><div1 type="bibliography"><listBibl><biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
<biblStruct></biblStruct>
</listBibl>
</div1>
</back>
</TEI>
<affiliations><list><country><li>France</li>
</country>
<settlement><li>Bordeaux</li>
<li>Paris</li>
</settlement>
</list>
<tree><country name="France"><noRegion><name sortKey="Dromer, Francoise" sort="Dromer, Francoise" uniqKey="Dromer F" first="Françoise" last="Dromer">Françoise Dromer</name>
</noRegion>
<name sortKey="Launay, Odile" sort="Launay, Odile" uniqKey="Launay O" first="Odile" last="Launay">Odile Launay</name>
<name sortKey="Lortholary, Olivier" sort="Lortholary, Olivier" uniqKey="Lortholary O" first="Olivier" last="Lortholary">Olivier Lortholary</name>
<name sortKey="Lortholary, Olivier" sort="Lortholary, Olivier" uniqKey="Lortholary O" first="Olivier" last="Lortholary">Olivier Lortholary</name>
<name sortKey="Mathoulin Pelissier, Simone" sort="Mathoulin Pelissier, Simone" uniqKey="Mathoulin Pelissier S" first="Simone" last="Mathoulin-Pélissier">Simone Mathoulin-Pélissier</name>
</country>
</tree>
</affiliations>
</record>
Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/France/explor/LeHavreV1/Data/Ncbi/Checkpoint
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000177 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Ncbi/Checkpoint/biblio.hfd -nk 000177 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien |wiki= Wicri/France |area= LeHavreV1 |flux= Ncbi |étape= Checkpoint |type= RBID |clé= PMC:1808080 |texte= Determinants of Disease Presentation and Outcome during Cryptococcosis: The CryptoA/D Study }}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Ncbi/Checkpoint/RBID.i -Sk "pubmed:17284154" \ | HfdSelect -Kh $EXPLOR_AREA/Data/Ncbi/Checkpoint/biblio.hfd \ | NlmPubMed2Wicri -a LeHavreV1
![]() | This area was generated with Dilib version V0.6.25. | ![]() |