Clinical features of cryptococcaemia: 65 critical cases

Abstract

Background: Cryptococcemia is associated with poor prognosis among patients with cryptococcal diseases; however, limited data are available on the clinical features of cryptocoaemia.Methods: A retrospective cohort study was conducted to describe the clinical features of cryptococcaemia. Demographic and clinical data of patients with positive blood culture of cryptococcus were obtained from the Xiangya hospital (2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). Demographic and clinical information was obtained from medical records.Results: Sixty-five patients were diagnosed and treated for cryptococcaemia out of which 53 (82%, 53/65) immunosuppressed patients were afflicted with HIV (12%, 8/65), tuberculosis (8%, 5/26), liver cirrhosis (6%, 3/65), chronic renal failure (6%, 3/65), nephrotic syndrome (13%, 7/65), systemic lupus erythematosus (8%, 5/65, chronic glomerulonephritis (11%, 6/65), malignant diseases (19%, 10/65), and Diabetes (11%, 6/65). Most patients (85%, 55/65), presented with fever. Other symptoms such as cough, headache, enlarged lymph nodes, liver or spleen, and septic shock were also reported.Typically, the sites of infection included the central nervous system, lung, skin, bone, abdomen, endometrium, lymph node, and blood. Although an early systemic antifungal therapy was given to sixty-one patients within 48h of hospitalization, the 60-day mortality was higher in immunosuppressed group (53%) than the immunocompetent group (8%).Conclusions: Our study indicated that fever, sepsis, and meningeal involvement were the most common clinical features of cryptococcaemia. Receiving treatment with immunosuppressive drugs, malignant diseases and HIV infection were the three major predisposing conditions. The immunosuppressed patients with cryptococcaemia presented a higher risk of mortality with poor prognosis.