RESUMO
Cryptococcosis is traditionally associated with immunocompromised patients but is increasingly being identified in those without the human immunodeficiency virus (HIV) or other immunocompetent individuals. We aim to describe the characteristics, mortality, and associated variables with death among hospitalized patients with cryptococcosis in Brazil. This is the first multicenter retrospective cohort study conducted in seven public tertiary Brazilian hospitals. A total of 384 patients were included; the median age was 39 years and 283 (73.7%) were men. In all, 304 HIV-positive were hosts (79.2%), 16 (4.2%) solid organ transplant (SOT), and 64 (16.7%) non-HIV-positive/non-transplant (NHNT). Central nervous system (CNS) cryptococcosis had a significantly higher number across disease categories, with 313 cases (81.5%). A total of 271 (70.6%) patients were discharged and 113 (29.4%) died during hospitalization. In-hospital mortality among HIV-positive, SOT, and NHNT was 30.3% (92/304), 12.5% (2/16), and 29.7% (19/64), respectively. Induction therapy with conventional amphotericin B (AMB) mainly in combination with fluconazole (234; 84.2%) was the most used. Only 80 (22.3%) patients received an AMB lipid formulation: liposomal (n = 35) and lipid complex (n = 45). Most patients who died belong to the CNS cryptococcosis category (83/113; 73.4%) when compared with the others (P = .017). Multivariate analysis showed that age and disseminated cryptococcosis had a higher risk of death (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.05; P = .008 and OR, 1.84; 95% CI, 1.01-3.53; P = .048, respectively). Understanding the epidemiology of cryptococcosis in our settings will help to recognize the burden and causes of mortality and identify strategies to improve this scenario.
This multicenter cohort study included 384 hospitalized individuals with cryptococcosis in Brazil. Most individuals were men (74%), HIV-positive (79%), had central nervous system involvement (82%), and received conventional amphotericin plus fluconazole (84%). In-hospital mortality was high (29%).
Assuntos
Criptococose , Transplante de Órgãos , Masculino , Animais , Humanos , Feminino , Brasil/epidemiologia , Estudos Retrospectivos , Criptococose/tratamento farmacológico , Criptococose/epidemiologia , Criptococose/complicações , Criptococose/veterinária , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/veterinária , Anfotericina B/uso terapêutico , Lipídeos/uso terapêutico , Antifúngicos/uso terapêuticoRESUMO
Nos últimos anos, um número crescente de artigos sobre xenotransplantes ovarianos e testiculares vem sendo publicado e demonstrando com isso o interesse gradual da comunidade científica sobre o tema. O presente artigo versará sobre a construção do conhecimento científico neste campo de pesquisa, os avanços mais recentes e as perspectivas de utilização da técnica associada a outras biotécnicas, além disso, tratará das expectativas nacionais acerca do assunto e atuação do Laboratório de Transplantes Gonadais da UFERSA, em Mossoró-RN, no país e as tendências mundiais no tema.
In recent years, a growing number of publications about ovarian and testicular xenografts has been published and increasing gradually the interest of the scientific community on this theme. This paper will focus on the construction of scientific knowledge in this field of research, the latest advances and perspectives of utilization associated with other biotechniques. Furthermore, deal with national expectations about the subject and performance of the Laboratory of Gonadal Transplantation of UFERSA, in Mossoro-RN-Brazil, as in Brazil and globaltrends in theme.