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Zhao Z, Song W, Liu L, Qi T, Wang Z, Tang Y, Sun J, Xu S, Yang J, Wang J, Chen J, Zhang R, Shen Y. Trends in Clinico-Epidemiological Profile and Outcomes of Patients with HIV-Associated Cryptococcal Meningitis in Shanghai, China, 2013-2023. Viruses 2024; 16:1333. [PMID: 39205307 DOI: 10.3390/v16081333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/15/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
The study aimed to analyze changes in the clinical and epidemiological aspects of HIV-associated cryptococcal meningitis (CM) patients and to identify factors influencing their prognosis. Clinical data of patients with HIV-associated CM treated in Shanghai, China between 2013 and 2023 were collected. This study included 279 cases, 2.89% of AIDS patients, showing a yearly decrease in CM prevalence among AIDS patients (p < 0.001). Overall mortality was 10.39% with rates declining from a 2013 peak of 15.38% to 0% in 2023 despite no significant temporal pattern (p = 0.265). Diagnosis took an average of 18 ± 1 days post-symptoms, and admission CD4 counts averaged 29.2 ± 2.5 cells/μL, hinting at a non-significant decline. Frequent symptoms included fever (62.4%), headache (61.6%), fatigue (44.1%), and appetite loss (39.8%), with younger patients more likely to initially show signs of meningeal irritation. Logistic regression analysis underscored the prognostic importance of cerebrospinal fluid (CSF) white blood cell (WBC) count and procalcitonin levels. Over the decade spanning from 2013 to 2023, the incidence and mortality rates of CM among AIDS patients exhibited a downward trend. The average duration from the onset of CM to confirmation of diagnosis remained prolonged. CSF WBC count and procalcitonin levels were associated with unfavorable outcomes.
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Affiliation(s)
- Zihui Zhao
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032, China
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Wei Song
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Li Liu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Tangkai Qi
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Zhenyan Wang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Yang Tang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Jianjun Sun
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Shuibao Xu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Junyang Yang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Jiangrong Wang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Jun Chen
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Renfang Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Yinzhong Shen
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
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Lamrous A, Repetto E, Depp T, Jimenez C, Chua AC, Kanapathipillai R, Jensen TO. C-reactive protein and procalcitonin use in adults in low- and middle-income countries: a narrative review. JAC Antimicrob Resist 2023; 5:dlad057. [PMID: 37206308 PMCID: PMC10190046 DOI: 10.1093/jacamr/dlad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
Objectives C-reactive protein (CRP) and procalcitonin (PCT) are widely used biomarkers in high-income countries. However, evidence for their use in low- and middle-income countries (LMICs) is scant. Because many factors, including rates of endemic disease, comorbidities and genetics, may influence biomarkers' behaviour, we aimed to review available evidence generated in LMICs. Methods We searched the PubMed database for relevant studies within the last 20 years that originated in regions of interest (Africa, Latin America, Middle East, South Asia or South East Asia), and full-text articles involving diagnosis, prognostication and evaluation of therapeutic response with CRP and/or PCT in adults (n = 88) were reviewed and categorized in 12 predefined focus areas. Results Overall, results were highly heterogeneous, at times conflicting, and often lacking clinically useful cut-off values. However, most studies demonstrated higher levels of CRP/PCT in patients with bacterial versus other infections. HIV and TB patients had consistently higher levels of CRP/PCT versus controls. In addition, higher CRP/PCT levels at baseline and follow-up in HIV, TB, sepsis and respiratory tract infections were associated with poorer prognosis. Conclusions Evidence generated from LMIC cohorts suggests that CRP and PCT may have potential to become effective clinical guiding tools particularly in respiratory tract infections, sepsis and HIV/TB. However, more studies are needed to define potential scenarios for use and cost-effectiveness. Consensus across stakeholders regarding target conditions, laboratory standards and cut-off values would support the quality and applicability of future evidence.
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Affiliation(s)
- Amin Lamrous
- Médecins Sans Frontières, Operational Center Barcelona, Barcelona, Spain
| | - Ernestina Repetto
- Médecins Sans Frontières, Operational Center Geneva, Geneva, Switzerland
- Infectious Diseases Department, Université Libre de Bruxelles (ULB), CHU Saint-Pierre, Brussels, Belgium
| | - Tim Depp
- Emergency Medicine, University of South Carolina School of Medicine, Greenville, SC, USA
| | - Carolina Jimenez
- Médecins Sans Frontières, Operational Center Paris, Paris, France
| | - Arlene C Chua
- Medical Department, Médecins Sans Frontières—International, Geneva, Switzerland
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Kim JH. Clinical Utility of Procalcitonin on Antibiotic Stewardship: A Narrative Review. Infect Chemother 2022; 54:610-620. [PMID: 36596677 PMCID: PMC9840962 DOI: 10.3947/ic.2022.0162] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022] Open
Abstract
Procalcitonin (PCT) was discovered as a useful marker for bacterial infection. Following its discovery, there have been a substantial number of clinical studies conducted to evaluate the presence of bacterial infections, and to guide antibiotic treatment by the stratified levels of PCT. Clinical evidence suggests that antibiotic treatment by PCT-guided antibiotic stewardship has been associated with a reduction in antibiotic usage without an increase in adverse outcomes. The use of PCT was approved by the Food and Drug Administration in the United States of America in 2017 to guide antibiotic treatment in sepsis and lower respiratory tract infections (LRTIs). In Korea, the use of PCT for sepsis and for pneumonia was approved in 2015 and 2022, respectively. This review will discuss the clinical utility of PCT on antibiotic stewardship in the management of sepsis and LRTIs including pneumonia.
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Affiliation(s)
- Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Abstract
The prognostic factor for in-hospital mortality in tuberculosis (TB) patients requiring intensive care unit (ICU) care remains unclear. Therefore, a retrospective study was conducted aiming to estimate the in-hospital mortality rate and the risk factors for mortality in a high-burden setting. All patients with culture-confirmed TB that were admitted to the ICU of the hospital between March 2012 and April 2019 were identified retrospectively. Data, such as demographic characteristics, comorbidities, laboratory measures and mortality, were obtained from medical records. The Cox proportional hazards regression model was used to identify prognostic factors that influence in-hospital mortality. A total of 82 ICU patients with confirmed TB were included in the analysis, and 22 deaths were observed during the hospital stay, 21 patients died in the ICU. In the multivariable model adjusted for sex and age, the levels of serum albumin and white blood cell (WBC) count were significantly associated with mortality in TB patients requiring ICU care (all P < 0.01), the hazard ratios were 0.8 (95% confidence interval (CI): 0.7–0.9) per 1 g/l and 1.1 (95% CI: 1.0–1.2) per 1 × 109/l, respectively. In conclusion, in-hospital mortality remains high in TB patients requiring ICU care. Low serum albumin level and high WBC count significantly impact the risk of mortality in these TB patients in China.
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Predictors of Mortality Among Hospitalized Patients With Lower Respiratory Tract Infections in a High HIV Burden Setting. J Acquir Immune Defic Syndr 2019; 79:624-630. [PMID: 30222660 DOI: 10.1097/qai.0000000000001855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Lower respiratory tract infections (LRTIs) are a leading cause of mortality in sub-Saharan Africa. Triaging identifies patients at high risk of death, but laboratory tests proposed for use in severity-of-illness scores are not readily available, limiting their clinical use. Our objective was to determine whether baseline characteristics in hospitalized participants with LRTI predicted increased risk of death. METHODS This was a secondary analysis from the Mulago Inpatient Non-invasive Diagnosis-International HIV-associated Opportunistic Pneumonias (MIND-IHOP) cohort of adults hospitalized with LRTI who underwent standardized investigations and treatment. The primary outcome was all-cause mortality at 2 months. Predictors of mortality were determined using multiple logistic regression. RESULTS Of 1887 hospitalized participants with LRTI, 372 (19.7%) died. The median participant age was 34.3 years (interquartile range, 28.0-43.3 years), 978 (51.8%) were men, and 1192 (63.2%) were HIV-positive with median CD4 counts of 81 cells/µL (interquartile range, 21-226 cells/µL). Seven hundred eleven (37.7%) participants had a microbiologically confirmed diagnosis. Temperature <35.5°C [adjusted odds ratio (aOR) = 1.77, 95% confidence intervals (CI): 1.20 to 2.60; P = 0.004], heart rate >120/min (aOR = 1.82, 95% CI: 1.37 to 2.43; P < 0.0001), oxygen saturation <90% (aOR = 2.74, 95% CI: 1.97 to 3.81; P < 0.0001), being bed-bound (aOR = 1.88, 95% CI: 1.47 to 2.41; P < 0.0001), and being HIV-positive (aOR = 1.49, 95% CI: 1.14 to 1.94; P = 0.003) were independently associated with mortality at 2 months. CONCLUSIONS Having temperature <35.5°C, heart rate >120/min, hypoxia, being HIV-positive, and bed-bound independently predicts mortality in participants hospitalized with LRTI. These readily available characteristics could be used to triage patients with LRTI in low-income settings. Providing adequate oxygen, adequate intravenous fluids, and early antiretroviral therapy (in people living with HIV/AIDS) may be life-saving in hospitalized patients with LRTI.
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Zifodya JS, Crothers K. Treating bacterial pneumonia in people living with HIV. Expert Rev Respir Med 2019; 13:771-786. [PMID: 31241378 DOI: 10.1080/17476348.2019.1634546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Bacterial pneumonia remains an important cause of morbidity and mortality in people living with HIV (PLWH) in the antiretroviral therapy (ART) era. In addition to being immunocompromised, as reflected by low CD4 cell counts and elevated HIV viral loads, PLWH often have other behaviors associated with an increased risk of pneumonia including smoking and injected drug use. As PLWH are aging, comorbid conditions such as chronic obstructive pulmonary disease (COPD), cancers, and cardiovascular, renal and liver diseases are emerging as additional risk factors for pneumonia. Pathogens are often similar to those in HIV-uninfected individuals; however, PLWH are at risk for unusual and/or multi-drug resistant organisms causing bacterial pneumonia based, in part, on their CD4 cell counts and other exposures. Areas covered: In this review, we focus on the recognition and management of bacterial community-acquired pneumonia (CAP) in PLWH. Along with antimicrobial treatment, we discuss prevention strategies such as vaccination and smoking cessation. Expert opinion: Early initiation of ART after HIV infection can decrease the risk of pneumonia. Improved efforts at vaccination, smoking cessation, and reduction of other substance use are urgently needed in PLWH to decrease the risk for bacterial pneumonia. As PLWH are aging, comorbidities are additional risk factors for bacterial CAP.
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Affiliation(s)
- Jerry S Zifodya
- a Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle , Washington , USA
| | - Kristina Crothers
- a Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle , Washington , USA
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Shaddock EJ. How and when to use common biomarkers in community-acquired pneumonia. Pneumonia (Nathan) 2016; 8:17. [PMID: 28702296 PMCID: PMC5471704 DOI: 10.1186/s41479-016-0017-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 10/18/2016] [Indexed: 12/13/2022] Open
Abstract
Community-acquired pneumonia (CAP) is a leading cause of death in both the developed and developing world. The very young and elderly are especially vulnerable. Even with appropriate early antibiotics we still have not improved the outcomes in these patients since the 1950s, with 30-day case fatality rates of between 10-12%. Interventions to improve outcomes include immunomodulatory agents such as macrolides and corticosteroids. Treating doctors identify CAP patients who are likely to have poor outcomes by using severity scores such as the pneumonia severity index and CURB-65, which allows these patients to be placed in ICU settings from the start of the admission. Another novel way to identify these patients is with the use of biomarkers. This review illustrates how various biomarkers have been shown to predict mortality, complications and response to treatment in CAP patients. The evidence using either procalcitonin or C-reactive protein to demonstrate response to treatment and hence that the antibiotics chosen are appropriate can play an important role in antibiotic stewardship.
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Affiliation(s)
- Erica J Shaddock
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Area 552 Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Parktown, Johannesburg, 2193 South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Auld E, Lin J, Chang E, Byanyima P, Ayakaka I, Musisi E, Worodria W, Davis JL, Segal M, Blackburn E, Huang L. HIV Infection Is Associated with Shortened Telomere Length in Ugandans with Suspected Tuberculosis. PLoS One 2016; 11:e0163153. [PMID: 27655116 PMCID: PMC5031464 DOI: 10.1371/journal.pone.0163153] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 09/02/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction HIV infection is a risk factor for opportunistic pneumonias such as tuberculosis (TB) and for age-associated health complications. Short telomeres, markers of biological aging, are also associated with an increased risk of age-associated diseases and mortality. Our goals were to use a single cohort of HIV-infected and HIV-uninfected individuals hospitalized with pneumonia to assess whether shortened telomere length was associated with HIV infection, TB diagnosis, and 2-month mortality. Methods This was a sub-study of the IHOP Study, a prospective observational study. Participants consisted of 184 adults admitted to Mulago Hospital in Kampala, Uganda who underwent evaluation for suspected TB and were followed for 2 months. Standardized questionnaires were administered to collect demographic and clinical data. PBMCs were isolated and analyzed using quantitative PCR to determine telomere length. The association between HIV infection, demographic and clinical characteristics, and telomere length was assessed, as were the associations between telomere length, TB diagnosis and 2-month mortality. Variables with a P≤0.2 in bivariate analysis were included in multivariate models. Results No significant demographic or clinical differences were observed between the HIV-infected and HIV-uninfected subjects. Older age (P<0.0001), male gender (P = 0.04), total pack-years smoked (P<0.001), alcohol consumption in the past year (P = 0.12), and asthma (P = 0.08) were all associated (P≤0.2) with shorter telomere length in bivariate analysis. In multivariate analysis adjusting for these five variables, HIV-positive participants had significantly shorter telomeres than HIV-negative participants (β = -0.0621, 95% CI -0.113 to -0.011, P = 0.02). Shortened telomeres were not associated with TB or short-term mortality. Conclusions The association between HIV infection and shorter telomeres suggests that HIV may play a role in cellular senescence and biological aging and that shorter telomeres may be involved in age-associated health complications seen in this population. The findings indicate a need to further research the impact of HIV on aging.
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Affiliation(s)
- Elizabeth Auld
- Division of HIV/AIDS, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Jue Lin
- Department of Biophysics and Biochemistry, University of California San Francisco, San Francisco, California, United States of America
| | - Emily Chang
- Division of HIV/AIDS, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
| | - Patrick Byanyima
- Makerere University – University of California, San Francisco (MU-UCSF) Research Collaboration, Kampala, Uganda
| | - Irene Ayakaka
- Makerere University – University of California, San Francisco (MU-UCSF) Research Collaboration, Kampala, Uganda
| | - Emmanuel Musisi
- Makerere University – University of California, San Francisco (MU-UCSF) Research Collaboration, Kampala, Uganda
| | - William Worodria
- Makerere University – University of California, San Francisco (MU-UCSF) Research Collaboration, Kampala, Uganda
- Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda
| | - J. Lucian Davis
- Department of Pulmonary, Critical Care & Sleep Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Mark Segal
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Elizabeth Blackburn
- Department of Biophysics and Biochemistry, University of California San Francisco, San Francisco, California, United States of America
| | - Laurence Huang
- Division of HIV/AIDS, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America
- Makerere University – University of California, San Francisco (MU-UCSF) Research Collaboration, Kampala, Uganda
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Takahashi K, Porcel JM, Lee P, Leung CC. Year in review 2014: Lung cancer, pleural diseases, respiratory infections and tuberculosis, bronchoscopic intervention and imaging. Respirology 2015; 20:674-83. [DOI: 10.1111/resp.12502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/01/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Kazuhisa Takahashi
- Department of Respiratory Medicine; Graduate School of Medicine; Juntendo University; Tokyo Japan
| | - José M Porcel
- Pleural Medicine Unit; Department of Internal Medicine; Biomedical Research Institute of Lleida; Arnau de Vilanova University Hospital; Lleida Spain
| | - Pyng Lee
- Department of Medicine; National University Hospital; Singapore
| | - Chi Chiu Leung
- Tuberculosis and Chest Service; Department of Health; Hong Kong China
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