Cryptococcosis in pregnancy and the postpartum period: Case series and systematic review with recommendations for management.
Adolescent
Adult
Amphotericin B
/ therapeutic use
Antifungal Agents
/ therapeutic use
Clinical Trials as Topic
Cryptococcus neoformans
/ drug effects
Deoxycholic Acid
/ therapeutic use
Disease Management
Drug Combinations
Female
Fluconazole
/ therapeutic use
HIV Infections
/ complications
Humans
Meningitis, Cryptococcal
/ drug therapy
Postpartum Period
Pregnancy
Pregnancy Complications, Infectious
/ epidemiology
Prospective Studies
Uganda
/ epidemiology
Young Adult
Cryptococcus
HIV/AIDS
antifungal agents
pregnancy
systematic review
Journal
Medical mycology
ISSN: 1460-2709
Titre abrégé: Med Mycol
Pays: England
ID NLM: 9815835
Informations de publication
Date de publication:
01 Apr 2020
01 Apr 2020
Historique:
received:
23
05
2019
revised:
03
07
2019
accepted:
18
07
2019
pubmed:
7
11
2019
medline:
21
10
2020
entrez:
6
11
2019
Statut:
ppublish
Résumé
Cryptococcal meningitis causes 15% of AIDS-related deaths. Optimal management and clinical outcomes of pregnant women with cryptococcosis are limited to case reports, as pregnant women are often excluded from research. Amongst pregnant women with asymptomatic cryptococcosis, no treatment guidelines exist. We prospectively identified HIV-infected women who were pregnant or recently pregnant with cryptococcosis, screened during a series of meningitis research studies in Uganda from 2012 to 2018. Among 571 women screened for cryptococcosis, 13 were pregnant, one was breastfeeding, three were within 14 days postpartum, and two had recently miscarried. Of these 19 women (3.3%), 12 had cryptococcal meningitis, six had cryptococcal antigenemia, and one had a history of cryptococcal meningitis and was receiving secondary prophylaxis. All women with meningitis received amphotericin B deoxycholate (0.7-1.0 mg/kg). Five were exposed to 200-800 mg fluconazole during pregnancy. Of these five, three delivered healthy babies with no gross physical abnormalities at birth, one succumbed to meningitis, and one outcome was unknown. Maternal meningitis survival rate at hospital discharge was 75% (9/12), and neonatal/fetal survival rate was 44% (4/9) for those mothers who survived. Miscarriages and stillbirths were common (n = 4). Of six women with cryptococcal antigenemia, two received fluconazole, one received weekly amphotericin B, and three had unknown treatment courses. All women with antigenemia survived, and none developed clinical meningitis. We report good maternal outcomes but poor fetal outcomes for cryptococcal meningitis using amphotericin B, without fluconazole in the first trimester, and weekly amphotericin B in place of fluconazole for cryptococcal antigenemia.
Identifiants
pubmed: 31689712
pii: 5549534
doi: 10.1093/mmy/myz084
pmc: PMC7179752
doi:
Substances chimiques
Antifungal Agents
0
Drug Combinations
0
Deoxycholic Acid
005990WHZZ
Amphotericin B
7XU7A7DROE
amphotericin B, deoxycholate drug combination
87687-70-5
Fluconazole
8VZV102JFY
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
282-292Subventions
Organisme : NINDS NIH HHS
ID : R01 NS086312
Pays : United States
Organisme : NIAID NIH HHS
ID : K23 AI138851
Pays : United States
Organisme : NIAID NIH HHS
ID : T32 AI055433
Pays : United States
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : NIAID NIH HHS
ID : T35 AI118620
Pays : United States
Organisme : FIC NIH HHS
ID : K01 TW010268
Pays : United States
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.
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