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Tan X, Deng M, Fang Z, Yang Q, Zhang M, Wu J, Chen W. A nomogram to predict cryptococcal meningitis in patients with pulmonary cryptococcosis. Heliyon 2024; 10:e30281. [PMID: 38726150 PMCID: PMC11079104 DOI: 10.1016/j.heliyon.2024.e30281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
Background The most serious manifestation of pulmonary cryptococcosis is complicated with cryptococcal meningitis, while its clinical manifestations lack specificity with delayed diagnosis and high mortality. The early prediction of this complication can assist doctors to carry out clinical interventions in time, thus improving the cure rate. This study aimed to construct a nomogram to predict the risk of cryptococcal meningitis in patients with pulmonary cryptococcosis through a scoring system. Methods The clinical data of 525 patients with pulmonary cryptococcosis were retrospectively analyzed, including 317 cases (60.38 %) with cryptococcal meningitis and 208 cases (39.62 %) without cryptococcal meningitis. The risk factors of cryptococcal meningitis were screened by univariate analysis, LASSO regression analysis and multivariate logistic regression analysis. Then the risk factors were incorporated into the nomogram scoring system to establish a prediction model. The model was validated by receiver operating characteristic (ROC) curve, decision curve analysis (DCA) and clinical impact curve. Results Fourteen risk factors for cryptococcal meningitis in patients with pulmonary cryptococcosis were screened out by statistical method, including 6 clinical manifestations (fever, headache, nausea, psychiatric symptoms, tuberculosis, hematologic malignancy) and 8 clinical indicators (neutrophils, lymphocytes, glutamic oxaloacetic transaminase, T cells, helper T cells, killer T cells, NK cells and B cells). The AUC value was 0.978 (CI 96.2 %∼98.9 %), indicating the nomogram was well verified. Conclusion The nomogram scoring system constructed in this study can accurately predict the risk of cryptococcal meningitis in patients with pulmonary cryptococcosis, which may provide a reference for clinical diagnosis and treatment of patients with cryptococcal meningitis.
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Affiliation(s)
- Xiaoli Tan
- Department of Respiration, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Min Deng
- Department of Infectious Diseases, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Zhixian Fang
- Department of Respiration, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Qi Yang
- Department of Respiration, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ming Zhang
- Department of Respiration, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jiasheng Wu
- Department of Respiratory and Critical Care Medicine, Jiaxing Second Hospital, Jiaxing, China
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wenyu Chen
- Department of Respiration, The Affiliated Hospital of Jiaxing University, Jiaxing, China
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Howard-Jones AR, Sparks R, Pham D, Halliday C, Beardsley J, Chen SCA. Pulmonary Cryptococcosis. J Fungi (Basel) 2022; 8:1156. [PMID: 36354923 PMCID: PMC9696922 DOI: 10.3390/jof8111156] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 07/25/2023] Open
Abstract
Pulmonary cryptococcosis describes an invasive lung mycosis caused by Cryptococcus neoformans or Cryptococcus gattii complex. It is often a high-consequence disease in both immunocompromised and immunocompetent populations, and may be misdiagnosed as pulmonary malignancy, leading to a delay in therapy. Epidemiology follows that of cryptococcal meningoencephalitis, with C. gattii infection more common in certain geographic regions. Diagnostic tools include histopathology, microscopy and culture, and the detection of cryptococcal polysaccharide antigen or Cryptococcus-derived nucleic acids. All patients with lung cryptococcosis should have a lumbar puncture and cerebral imaging to exclude central nervous system disease. Radiology is key, both as an adjunct to laboratory testing and as the initial means of detection in asymptomatic patients or those with non-specific symptoms. Pulmonary cryptococcomas (single or multiple) may also be associated with disseminated disease and/or cryptococcal meningitis, requiring prolonged treatment regimens. Optimal management for severe disease requires extended induction (amphotericin B and flucytosine) and consolidation therapy (fluconazole) with close clinical monitoring. Susceptibility testing is of value for epidemiology and in regions where relatively high minimum inhibitory concentrations to azoles (particularly fluconazole) have been noted. Novel diagnostic tools and therapeutic agents promise to improve the detection and treatment of cryptococcosis, particularly in low-income settings where the disease burden is high.
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Affiliation(s)
- Annaleise R. Howard-Jones
- Centre for Infectious Diseases & Microbiology Laboratory Services, New South Wales Health Pathology—Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2145, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2145, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, NSW 2006, Australia
| | - Rebecca Sparks
- Centre for Infectious Diseases & Microbiology Laboratory Services, New South Wales Health Pathology—Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2145, Australia
| | - David Pham
- Centre for Infectious Diseases & Microbiology Laboratory Services, New South Wales Health Pathology—Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Catriona Halliday
- Centre for Infectious Diseases & Microbiology Laboratory Services, New South Wales Health Pathology—Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Justin Beardsley
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2145, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, NSW 2006, Australia
- Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases & Microbiology Laboratory Services, New South Wales Health Pathology—Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2145, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2145, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, NSW 2006, Australia
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Abstract
Cryptococcosis is a disease caused by the pathogenic fungi Cryptococcus neoformans and Cryptococcus gattii, both environmental fungi that cause severe pneumonia and may even lead to cryptococcal meningoencephalitis. Although C. neoformans affects more fragile individuals, such as immunocompromised hosts through opportunistic infections, C. gattii causes a serious indiscriminate primary infection in immunocompetent individuals. Typically seen in tropical and subtropical environments, C. gattii has increased its endemic area over recent years, largely due to climatic factors that favor contagion in warmer climates. It is important to point out that not only C. gattii, but the Cryptococcus species complex produces a polysaccharidic capsule with immunomodulatory properties, enabling the pathogenic species of Cryptococccus to subvert the host immune response during the establishment of cryptococcosis, facilitating its dissemination in the infected organism. C. gattii causes a more severe and difficult-to-treat infection, with few antifungals eliciting an effective response during chronic treatment. Much of the immunopathology of this cryptococcosis is still poorly understood, with most studies focusing on cryptococcosis caused by the species C. neoformans. C. gattii became more important in the epidemiological scenario with the outbreaks in the Pacific Northwest of the United States, which resulted in phylogenetic studies of the virulent variant responsible for the severe infection in the region. Since then, the study of cryptococcosis caused by C. gattii has helped researchers understand the immunopathological aspects of different variants of this pathogen.
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Taketa T, Nakamura T. Multiple cystic lesions after treatment for pulmonary cryptococcosis. Clin Case Rep 2021; 9:e05090. [PMID: 34824849 PMCID: PMC8603361 DOI: 10.1002/ccr3.5090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Abstract
Pulmonary cryptococcosis presents various radiological manifestations depending on the immunological status of the host. The most common chest radiographic findings include single or multiple nodules. Herein, we present a rare case of pulmonary cryptococcosis in a patient with rheumatoid arthritis presenting as multiple cystic lesions that enlarged after treatment.
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Affiliation(s)
- Tomoyo Taketa
- Departments of Respiratory MedicineHohigaoka Medical CenterOsakaJapan
| | - Takahito Nakamura
- Departments of Respiratory MedicineHohigaoka Medical CenterOsakaJapan
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Clinical analysis in immunocompetent and immunocompromised patients with pulmonary cryptococcosis in western China. Sci Rep 2020; 10:9387. [PMID: 32523003 PMCID: PMC7287058 DOI: 10.1038/s41598-020-66094-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/15/2020] [Indexed: 02/05/2023] Open
Abstract
Cryptococcosis is a systemic infection and it may occur in immunocompromised and immunocompetent hosts. In order to better understand the clinical characteristics of patients with PC in different immune status, we retrospectively investigated the clinical, radiological, and treatment profiles of immunocompetent and immunocompromised patients with PC during a 10-year period (2008–2017). As a result, out of 136 patients, 94 (69.1%) were immunocompromised hosts. For the PC patients without CNS involvement, higher percentage of immunocompetent patients (39.5%, 15/38) had asymptomatic presentation than immunocompromised patients (6.3%, 3/48) (P < 0.05). Multiple pulmonary nodules (72.7%, 56/77), ground-glass attenuation/interstitial changes (94.4%, 17/18) and cavitation (88.6%, 31/35) were significantly frequent in immunocompromised patients (P < 0.05). A total of 47 patients were misdiagnosed as tuberculosis or tumors based on CT signs. PC was likely to be misdiagnosed as tuberculosis in immunocompromised patients (88.2%, 15/17), and tumor was more likely to be considered in immunocompetent patients (43.3%, 13/30). Immunocompetent patients accounted for 80% (24/30) of patients with definite diagnosis on surgical lung biopsy. Fluconazole monotherapy can achieve good clinical outcome in most PC patients without central nervous system (CNS) involvement (91.5%, 54/59). After 3 months of treatment, 92.7% (38/41) patients have improved imaging findings. In conclusion, PC has diverse imaging manifestations and it is easily misdiagnosed. Lobectomy should be carefully selected in immunocompetent patients with a single lung lesion. Fluconazole monotherapy is preferred for PC patients without CNS involvement.
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Hou X, Kou L, Han X, Zhu R, Song L, Liu T. Pulmonary cryptococcosis characteristics in immunocompetent patients-A 20-year clinical retrospective analysis in China. Mycoses 2019; 62:937-944. [PMID: 31287920 PMCID: PMC6852394 DOI: 10.1111/myc.12966] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 12/28/2022]
Abstract
Background Pulmonary cryptococcosis (PC) is not considered an rare, opportunistic infection anymore. The immunocompetent population accounts for an increasing proportion of the morbidity. Objective This study investigated the clinical characteristics of PC patients spanning 20 years, in a referral centre of China. Patients/Methods We retrospectively investigated the clinical data of 99 patients with PC who were diagnosed at Peking Union Medical College Hospital (PUMCH) from January 1998 to December 2017. Results Pulmonary cryptococcosis incidence in PUMCH has seen sharp increase in two decades. There were 40.4% (40/99), 17.2% (17/99) and 42.4% (42/99) immunocompetent, mildly immunocompromised and severe immunocompromised patients, respectively. Significantly higher (P = .035) male predominance in immunocompetent and mildly immunocompromised groups (68.4%, 39/57) compared with severe immunocompromised group (45.2%, 19/42) was found. Overall, 27.5% (11/40) immunocompetent patients reported a significant difference (P = .02) in history of more than weekly drinking, higher than mildly or severe immunocompromised. No significant difference occurred in symptoms and radiographic characteristics among the groups. In pulmonary computerised tomography findings, the non‐air pathway feature was the dominant distribution characteristics in all patients with PC (P = .002). The gap in body dissemination frequency between immunocompetent combined with mildly immunocompromised (5.26%, 3/57) and severe immunocompromised (19.0%, 8/42) was marginally significant (P = .05). Conclusions Gender and alcohol drinking could be PC risk factors of concern in patients without severe immunodeficiency. No significant difference occurred in symptoms or radiographic characteristics between patients with different levels of immune status. The unique radiographic non‐air pathway distribution in the lung may be the feature of Cryptococcus invasion that may enhance accurate diagnosis.
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Affiliation(s)
- Xiaomeng Hou
- Department of Pulmonary Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Kou
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Xiaozhen Han
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Rui Zhu
- Department of Medical Record, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lan Song
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Tao Liu
- Department of Pulmonary Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Gao LW, Jiao AX, Wu XR, Zhao SY, Ma Y, Liu G, Yin J, Xu BP, Shen KL. Clinical characteristics of disseminated cryptococcosis in previously healthy children in China. BMC Infect Dis 2017; 17:359. [PMID: 28532447 PMCID: PMC5440943 DOI: 10.1186/s12879-017-2450-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/08/2017] [Indexed: 12/26/2022] Open
Abstract
Background Disseminated cryptococcosis is a rare and fatal disease, and limited data exist regarding it in children. This study aimed to investigate the clinical characteristics of disseminated cryptococcosis in previously healthy children in China. Methods Hospitalized patients with disseminated cryptococcosis were enrolled during January 1996 to December 2015 in Beijing Children’s Hospital, Capital Medical University, China. Data on clinical manifestations, laboratory tests, treatment, and prognosis were evaluated. Results A total of 52 pediatric patients with no underlying disease were enrolled, including 38 boys and 14 girls. Only 10 cases had a history of exposure to pigeon droppings. Fever, cough, and hepatomegaly were 3 main manifestations of disseminated cryptococcosis. However, headache was more common in patients with central nervous system (CNS) invasion than in patients with non-CNS invasion (P < 0.05). Lung (96.2%, 50/52) was the most commonly invaded organ, but only 9.6% (5/52) of patients had respiratory signs. The most common findings on chest imaging were hilar or mediastinal lymphadenopathy (46.8%, 22/47), and nodules (44.7%, 21/47), including small nodules in a scattered distribution (57.1%, 12/21) or miliary distribution (42.9%, 9/25), especially localized in subpleural area. Subsequent invasion occurred in the CNS, abdomen lymph nodes, liver, spleen, peripheral lymph nodes, and skin. In all patients, 42.3% (22/52) and 51.9% (27/52) had elevated eosinophils or IgE, respectively. The positive rate of serum cryptococcal antigen was higher, especially in patients with CNS invasion (approximately 83.3%), than with other primary methods used for pathogen detection, including cerebrospinal fluid (CSF) cryptococcal antigen, cultures of blood, bone marrow, or CSF, and CSF ink staining. The overall mortality rate of pediatric patients in our study was 11.5% (6/52). Some cases had long-term sequela, including hydrocephalus, cirrhosis, or blindness. Conclusions Disseminated cryptococcosis can occur in previously healthy or immunocompetent children in China. Lung and CNS were most commonly invaded by this disease. Furthermore, most cases usually showed no obvious or specific symptoms or signs, and therefore pediatricians should pay more careful attention to identify this disease.
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Affiliation(s)
- Li-Wei Gao
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - An-Xia Jiao
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Xi-Rong Wu
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Shun-Ying Zhao
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yun Ma
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Gang Liu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ju Yin
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Bao-Ping Xu
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Respiratory Diseases, Beijing, China.
| | - Kun-Ling Shen
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Respiratory Diseases, Beijing, China
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Choi HW, Chong S, Kim MK, Park IW. Pulmonary cryptococcosis manifesting as diffuse air-space consolidations in an immunocompetent patient. J Thorac Dis 2017; 9:E138-E141. [PMID: 28275498 DOI: 10.21037/jtd.2017.02.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary cryptococcosis is an opportunity infection commonly occurred in the immunocompromised patients. However pulmonary cryptococcosis in the immunocompetent was reported up to 35% and these cases tend to show confined and localized radiologic findings than in immunocompromised patients. To our knowledge, extensive air-space consolidations have not frequently occurred in the immunocompetent patient. Therefore, in this case, we report a rare case of a 73-year-old woman who was diagnosed with pulmonary cryptococcosis, manifesting as diffuse air-space consolidations even though normal immune status. Thus, the possibility of pulmonary cryptococcosis should be considered when a patient with a normal immune status presents without respiratory symptoms are accompanied by consolidation on imaging.
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Affiliation(s)
- Hye Won Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Semin Chong
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mi Kyung Kim
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Won Park
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Thambidurai L, Prabhuradhan R, Singhvi P, Ilanchezhian S, Ramachandran R, Shankar H. Cryptococcal pneumonia: the great mimicker. BJR Case Rep 2017; 3:20150358. [PMID: 30363287 PMCID: PMC6159249 DOI: 10.1259/bjrcr.20150358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 11/05/2022] Open
Abstract
Cryptococcal pneumonia is a fungal infection caused by Cryptococcus neoformans predominantly in immunosuppressed individuals and rarely in the immunocompetent population. In this study, we describe the varied radiological presentations in three patients, both immunosuppressed and immunocompetent individuals. The varied imaging presentations pose a great challenge for the radiologist and the clinician. The imaging findings mimic other diseases and it might make the diagnosis difficult purely on radiological features alone. Hence, image-guided biopsies and further evaluation are essential for confirmation of diagnosis.
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Affiliation(s)
- Lasya Thambidurai
- Radiology, Sri Ramachandra Medical College and Hospital, Porur, Chennai, Tamilnadu, India
| | - R Prabhuradhan
- Radiology, Sri Ramachandra Medical College and Hospital, Porur, Chennai, Tamilnadu, India
| | - Praveenkumar Singhvi
- Radiology, Sri Ramachandra Medical College and Hospital, Porur, Chennai, Tamilnadu, India
| | - S Ilanchezhian
- Radiology, Sri Ramachandra Medical College and Hospital, Porur, Chennai, Tamilnadu, India
| | - Rajoo Ramachandran
- Radiology, Sri Ramachandra Medical College and Hospital, Porur, Chennai, Tamilnadu, India
| | - Haree Shankar
- Radiology, Sri Ramachandra Medical College and Hospital, Porur, Chennai, Tamilnadu, India
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Fisher JF, Valencia-Rey PA, Davis WB. Pulmonary Cryptococcosis in the Immunocompetent Patient-Many Questions, Some Answers. Open Forum Infect Dis 2016; 3:ofw167. [PMID: 27704021 PMCID: PMC5047412 DOI: 10.1093/ofid/ofw167] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/29/2016] [Indexed: 12/21/2022] Open
Abstract
Background. There are no prospective data regarding the management of pulmonary cryptococcosis in the immunocompetent patient. Clinical guidelines recommend oral fluconazole for patients with mild to moderate symptoms and amphotericin B plus flucytosine followed by fluconazole for severe disease. It is unclear whether patients who have histological evidence of Cryptococcus neoformans but negative cultures will even respond to drug treatment. We evaluated and managed a patient whose presentation and course raised important questions regarding the significance of negative cultures, antifungal choices, duration of therapy, and resolution of clinical, serologic, and radiographic findings. Methods. In addition to our experience, to answer these questions we reviewed available case reports and case series regarding immunocompetent patients with pulmonary cryptococcosis for the last 55 years using the following definitions: Definite - Clinical and/or radiographic findings of pulmonary infection and respiratory tract isolation of C. neoformans without other suspected etiologies; Probable - Clinical and radiographic findings of pulmonary infection, histopathologic evidence of C. neoformans, and negative fungal cultures with or without a positive cryptococcal polysaccharide antigen. Results. Pulmonary cryptococcosis resolves in most patients with or without specific antifungal therapy. Clinical, radiographic, and serologic resolution is slow and may take years. Conclusions. Persistently positive antigen titers are most common in untreated patients and may remain strongly positive despite complete or partial resolution of disease. Respiratory fungal cultures are often negative and may indicate nonviable organisms.
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