Treatment and mortality outcomes in patients with other extrapulmonary cryptococcal disease compared with central nervous system disease

BACKGROUND: Determining the extent of Cryptococcal disease (CD) is key to therapeutic management. Treatment with fluconazole is only recommended for localized pulmonary disease. Induction therapy with amphotericin B (AmB) and flucytosine is recommended for disease at other sites, irrespective of central nervous system (CNS) involvement, but this is not often followed in patients without meningitis. In this study, we compared treatment and mortality between patients with CD of the CNS and other extrapulmonary (OE) sites. METHODS: This is a retrospective, single-center study of all hospitalized patients with non-pulmonary Cryptococcal infection from 2002 to 2015 who underwent lumbar puncture. Demographics, predisposing factors, comorbidities, clinical presentation, laboratory values, antifungal treatment, and mortality data were collected to evaluate 90-day mortality and treatment differences between patients with OE and CNS CD. Survival analysis was performed using multivariable Cox Regression analysis. RESULTS: Of 193 patients analyzed, 143 (74%) had CNS CD and 50 (26%) had OE CD. Ninety-day mortality was 23% and similar between the OE and CNS CD groups (22% vs 23%, P=0.9). In the comorbidity adjusted multivariable Cox Regression model, mortality risk was similar in the OE and CNS groups. Fewer patients with OE CD received induction therapy with AmB and flucytosine compared to those with CNS disease (28% vs 71.3%, P