Description of Cryptococcosis Following SARS-CoV-2 Infection: A Disease Survey Through the Mycosis Study Group Education and Research Consortium (MSG-19).

Background: Invasive fungal infections have been described throughout the COVID-19 pandemic. Cryptococcal disease after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported in several isolated case reports and 1 larger case series. We sought to describe cryptococcal infections following SARS-CoV-2 through establishing a database to investigate underlying risk factors, disease manifestations, and outcomes.
Methods: We created a crowdsourced call for cases solicited through the Mycoses Study Group Education and Research Consortium, the Centers for Disease Control and Prevention Emerging Infectious Diseases Network, and infectious diseases Twitter groups. Data were collected in a web-based and secure REDCap survey without personal identifiers.
Results: Sixty-nine cases were identified and submitted by 29 separate institutional sites. Cryptococcosis was diagnosed a median of 22 days (interquartile range, 9-42 days) after SARS-CoV-2 infection. Mortality among those with available follow-up was 72% (26/36) for the immunocompetent group and 48% (15/31) for the immunocompromised group (likelihood ratio, 4.01; P = .045). We observed a correlation between disease manifestation (central nervous system infection, proven/probable disseminated disease, and respiratory) and mortality (P = .002).
Conclusions: The mortality rate of 59% for patients with cryptococcosis following SARS-CoV-2 is higher than that of modern Cryptococcus cohorts. There was an association between immunocompromised status and cryptococcal disease manifestations as well as mortality. Moreover, our series emphasizes the need for clinical and laboratory assessment of opportunistic infections beyond 30 days when concerning symptoms develop.
Competing Interests: Potential conflicts of interest. J. M. reports royalties or licenses from UpToDate. L. O.-Z. reports grants or contracts to institution from Pfizer, Scynexis, and Pulmocide; consulting fees to author from Pfizer, Gilead, Cidara, and F2G; and roles as President of MSGERC and Vice-President of ICHS. P. G. P. reports grants or contracts from Astellas, Scynexis, Gilead, Cidara, Melinta, and F2G, and consulting fees from Melinta, Matinas, F2G, and Cidara. J. P. reports royalties or licenses from UpToDate and Pulmocide (data review). A. S. reports grants or contracts from Astellas and Mayne, and consulting fees from F2G and GSK. P. V. reports grants or contracts paid to Mayo Clinic from Cidara, Scynexis, and Ansun; payment or honoraria paid to author from Merck Manual (author of chapter on fungi); and participation on a data and safety monitoring board or advisory board for AbbVie and Scynexis (payments to Mayo Clinic). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
(© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)