Cryptococcosis in human immunodeficiency virus-negative patients

Int J Infect Dis. 2006 Jan;10(1):72-8. doi: 10.1016/j.ijid.2004.12.004. Epub 2005 Nov 9.

Abstract

Objective: To describe the clinical characteristics, treatment, and outcomes of cryptococcosis in HIV-negative patients.

Methods: HIV-negative adult patients with positive culture for Cryptococcus neoformans who attended Ramathibodi Hospital between 1987 and 2003 were retrospectively reviewed.

Results: During the 17 year review period, 40 HIV-negative patients with cryptococcosis were identified. Of these, 37 patients had medical records available for study. The mean age was 49+/-18 (range 16-83) years and 73% were female. Twenty-four patients (65%) had associated underlying conditions. The most common associated conditions included immunosuppressive drug treatment (41%), presence of systemic lupus erythematosus (16%), malignancies (16%), and diabetes mellitus (14%). C. neoformans was mainly recovered from cerebrospinal fluid (32%), blood (28%), and sputum/bronchoalveolar lavage/lung tissue (28%). Twenty-three patients (62%) had disseminated cryptococcosis. Six of 14 patients with cryptococcal meningitis were asymptomatic. About half of the patients were treated with amphotericin B and subsequent fluconazole. Five patients (14%) were initially misdiagnosed and treated for tuberculosis or bacterial infection. The overall mortality rate was 27%.

Conclusions: Cryptococcosis is not rare in HIV-negative patients. The mortality rate is high. Early recognition of cryptococcosis and use of appropriate antifungal therapy in these patients may improve clinical outcomes.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Amphotericin B / therapeutic use*
  • Antifungal Agents / therapeutic use*
  • Cryptococcosis / diagnosis*
  • Cryptococcosis / drug therapy*
  • Cryptococcosis / etiology
  • Cryptococcosis / prevention & control
  • Cryptococcus neoformans / isolation & purification
  • Diabetes Complications / complications
  • Female
  • Fluconazole / therapeutic use*
  • HIV Infections / immunology*
  • HIV Seronegativity*
  • Health Surveys
  • Hospitals, University / statistics & numerical data
  • Humans
  • Immunosuppression Therapy / adverse effects
  • Lupus Erythematosus, Systemic / complications
  • Male
  • Middle Aged
  • Neoplasms / complications
  • Retrospective Studies
  • Thailand
  • Treatment Outcome

Substances

  • Antifungal Agents
  • Amphotericin B
  • Fluconazole