Abstract
Background
Cryptococcal epidemiology is changing in the modern antiretroviral era, and immune
status informs outcomes. We describe the differences in clinical presentation and
mortality of cryptococcosis by immune status in the antiretroviral therapy era.
Methods
We conducted a single-center retrospective cohort study of patients diagnosed with
cryptococcosis from 2002 through 2017. Data included demographics, clinical features,
diagnostics, and mortality.
Results
We identified 304 patients with Cryptococcus neoformans infections: 105 (35%) were people living with human immunodeficiency virus (HIV),
41 (13%) had a history of transplantation, and 158 (52%) were non-HIV nontransplant
(NHNT). Age analysis showed that people living with HIV were younger (40 years) than
transplant (53 years) and NHNT (61 years) (P < .001). Fevers and headache were more common in people living with HIV (70% and
57%) than in transplant (49% and 29%) and NHNT (49% and 38%) (P = .003 and P = .001), respectively. Meningitis was more common in people living with HIV (68%)
than in transplant recipients (32%) or NHNT (39%, P < .001). Disseminated cryptococcosis was more common in people living with HIV (97%)
as compared with transplant (66%) or NHNT (73%) (P < .001). Time to diagnosis from hospitalization was longer for transplant (median
2 days, interquartile range [IQR] ± 9 days) and NHNT patients (median 2 days, IQR
± 7 days) as compared with people living with HIV (median 1 day, IQR ± 2 days) (P = .003). NHNT patients had a higher risk of 90-day mortality (hazard ratio 3.3; 95%
confidence interval, 1.9-5.8) as compared with people living with HIV.
Conclusions
The majority of cryptococcosis occurs in NHNT patients. NHNT patients had more localized
pulmonary cryptococcosis and significantly higher 90-day mortality. Cryptococcosis
in NHNT patients appears to be a distinct entity that needs further study and requires
a higher level of clinical suspicion than it currently receives.
Keywords
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Article Info
Publication History
Published online: May 08, 2019
Footnotes
Funding: Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.
Conflict of Interest: WGP reports grant support from Merck Labs and consulting work with Merck Labs and Gilead. AS reports grant support and consulting work with Astellas, consulting work with Viamet, and consulting work with Minnetronix.
Authorship: All authors have had access to the data and a role in writing this manuscript.
Identification
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© 2019 Elsevier Inc. All rights reserved.
