Comprehensive Analysis and Risk Identification of Pulmonary Cryptococcosis in Non-HIV Patients

Abstract

Pulmonary cryptococcosis in the non-human immunodeficiency virus-infected population is uncommon. We aimed to explore the relevance between clinical presentations, radiological findings, and comorbidities and identify the outcome predictors. A total of 321 patients at Taichung Veterans General Hospital between 2005 and 2019 were included; of them, 204 (63.6%) had at least one comorbidity, while 67 (20.9%) had two or more. The most common comorbidities were diabetes mellitus (27.4%), malignant solid tumor (19.6%), autoimmune disease (15.6%), and chronic kidney disease (8.4%). Patients experiencing comorbidity, particularly those with multiple comorbidities, had a higher multilobar and extrapulmonary involvement, which could explain these patients being more symptomatic. In the overall population, extrapulmonary involvement independently predicted disease recurrence and death. Amongst patients with isolated pulmonary cryptococcosis, age, cryptococcal antigen (CrAg) titer in blood, and comorbidities not only predicted the extent of disease, but also its outcome. Of note, patients simultaneously with age ≥ 65 years, CrAg test ≥ 1:128, and multiple comorbidities had the lowest disease control of antifungal treatment (76.9%) and the highest rate of disease recurrence or death from any cause (40.0%). In conclusion, approximately two-thirds of patients had at least one underlying comorbidity. In addition to extrapulmonary involvement, old age, high CrAg titer in blood, and multiple comorbidities could act as risk factors for predicting the extent of disease and outcome.

Lateral flow assay as radiological prognosis factor of pulmonary cryptococcosis: A single center retrospective study in China

“…studies. Consistent with the previous nding [19], we found that positive baseline LFA was a risk factor for poor image outcome of PC. After antifungal therapy, the baseline LFA-negative group showed partial or complete absorption of lesions and without newly developed lesions, while the baseline LFA-positive group had a higher proportion of imaging exacerbation compared to those with weak positive LFA.…”

Clinical, radiological, and laboratory features of HIV-negative pulmonary cryptococcosis with regard to serum lateral flow assay

“…Those PC patients with fever had higher hs-CRP levels and larger pulmonary involvement (p < 0.05), which may indicate a risk of extrapulmonary dissemination (10). Furthermore, patients with multilobar involvement were more likely to be symptomatic as reported by Li et al (26).…”

“…We also observed that patients with SN generally presented with negative or weak positive sLFA, which is consistent with previous findings of Zhu et al ( 19 ). The serum CrAg test has a higher sensitivity in immunocompromised hosts ( 13 ), whose cryptococcal lesions are generally more serious and disseminated ( 1 , 26 ). We could not draw this conclusion due to the inadequate data of cellular and humoral immune assessment on our participants.…”

Pulmonary Cryptococcosis

“…In HIV/AIDS, infection typically manifests with CD4 T-lymphocyte counts under 100 cells/µL [26]. Other risk factors for cryptococcal disease include solid organ transplant [27], calcineurin inhibitors and other immunomodulatory agents [28], auto-antibodies against granulocyte-macrophage-colony stimulating factor (anti-GM-CSF) [29], decompensated cirrhosis [28], type 2 diabetes mellitus, malignant solid tumours, autoimmune diseases and chronic kidney disease [30]. Pulmonary disease in all these contexts is common although dissemination has been reported to be associated with pre-existing renal impairment [31].…”