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Cryptococcosis in apparently immunocompetent patients
- Source :
- QJM. 99:143-151
- Publication Year :
- 2006
- Publisher :
- Oxford University Press (OUP), 2006.
-
Abstract
- Summary Background: Few reports have described the clinical and microbiological features of cryptococcosis in immunocompetent patients. Aim: To compare clinical presentations and outcomes of cryptococcosis in immunocompetent vs. immunocompromised patients. Design: Retrospective case series. Methods: All culture- or histology-confirmed cases (n ¼ 46) of cryptococcosis in two acute hospitals in Hong Kong (1995–2005) were included. Clinical presentations, rates of fungaemia, cerebrospinal fluid (CSF) parameters and clinical outcomes were recorded. Results: Twenty patients (43.5%) were apparently immunocompetent, 17 (37.0%) had predisposing factors other than HIV infection, and 9 (19.6%) were HIV-positive. Thirty-one (67.4%) presented with meningitis, four (8.7%) with pulmonary cryptococcosis, and 11 (23.9%) with extraneural, extrapulmonary cryptococcosis. Of the immunocompetent patients with retrievable isolates (n ¼ 8), three (37.5%) were Cryptococcus gattii; all isolates (n ¼ 6) from immunocompromised patients were Cryptococcus neoformans var. grubii. Immunocompetent patients more commonly presented with meningitis (80.0% vs. 47.1%, p ¼ 0.03), and tended toward lower rates of fungaemia (10.0% vs. 35.3%, p ¼ 0.06) and mortality (25.0% vs. 52.9%, p ¼ 0.06). Death was associated with fungaemia (p ¼ 0.01) and underlying malignancy (p < 0.01). In cryptococcal meningitis, immunocompetent patients had longer mean time from illness onset to presentation (34.4 vs. 12.6 days, p ¼ 0.02), more intense inflammatory responses (CSF: white blood cells 108 vs. 35� 10 9 / l, p ¼ 0.03; protein 1.61 g/l vs. 0.79 g/l, p ¼ 0.07), less fungaemia (0% vs. 26.7%, p ¼ 0.04) and more satisfactory clinical outcomes (81.3% vs. 46.7%, p ¼ 0.04). Discussion: A substantial proportion of patients with cryptococcosis are apparently immunocompetent. C. neoformans var. grubii and C. gattii are the common causes. Immunocompetent patients tend to present with localized, indolent neurological disease, with more intense inflammatory responses but better clinical outcomes.
- Subjects :
- Adult
Male
medicine.medical_specialty
Disease
Malignancy
Gastroenterology
Immunocompromised Host
Cerebrospinal fluid
Risk Factors
Internal medicine
Humans
Medicine
Cryptococcus gattii
Mycosis
Aged
Retrospective Studies
Cryptococcus neoformans
biology
business.industry
Cryptococcosis
General Medicine
Middle Aged
biology.organism_classification
medicine.disease
Cryptococcus
Immunology
Hong Kong
Female
business
Immunocompetence
Meningitis
Polymorphism, Restriction Fragment Length
Subjects
Details
- ISSN :
- 14602393 and 14602725
- Volume :
- 99
- Database :
- OpenAIRE
- Journal :
- QJM
- Accession number :
- edsair.doi.dedup.....6e7c0a75827125351433a04fe0953c9e