Pulmonary Cryptococcosis: Localized and Disseminated Infections in 27 Patients with AIDS

Abstract

We reviewed the records of 85 patients infected with both human immunodeficiency virus and Cryptococcus neoformans. Twenty-seven patients (32%) had pulmonary cryptococcosis. C. neoformans was cultured from bronchoalveolar lavage (BAL) or pleural fluid in 25 cases; the remaining two patients had cryptococcal antigen (CA) detected in BAL fluid and C. neoformans cultured from other sites. All but one of the 27 patients had detectable CA in serum. The CD4+ lymphocyte count was low in all cases (median, 24/mm3). Clinical manifestations of pulmonary cryptococcosis included fever (94%), cough (71%), dyspnea (7%), expectoration (4%), chest pain (2%), and hemoptysis (1%). Diffuse interstitial opacities (70.5%), focal interstitial abnormalities, alveolar opacities, adenopathies, cavitary lesions, and pleural effusions were evident. Outcome was poor (mean survival time, 23 weeks) despite treatment. Patients with localized pulmonary cryptococcosis appeared to have a higher CD4+ lymphocyte count, an earlier diagnosis, lower serum CA titers, fewer previous or concomitant infections, and a better prognosis than patients with disseminated cryptococcosis.

Pulmonary infections in HIV-infected patients: an update in the 21st century

“…The severity of symptoms and extent of dissemination are inversely proportional to the CD4 lymphocyte count; most symptomatic cases occur in patients with ,100 cells per mm 3 . Cryptococcal pneumonia in HIV patients most commonly presents with diffuse bilateral interstitial infiltrates that often mimics PCP [118]. In addition, unilateral interstitial infiltrate, focal consolidation, nodules, cavitation, pleural effusion and hilar adenopathy have been reported [118].…”

“…Cryptococcal pneumonia in HIV patients most commonly presents with diffuse bilateral interstitial infiltrates that often mimics PCP [118]. In addition, unilateral interstitial infiltrate, focal consolidation, nodules, cavitation, pleural effusion and hilar adenopathy have been reported [118]. Culture of expectorated sputum samples can be positive, but higher yields are obtained using bronchoscopic sampling.…”

Cryptococcal Pleural Effusion in a Patient with Chronic Renal Failure Receiving Long-term Corticosteroid Therapy for Rheumatoid Arthritis.

“…As for pulmonary manifestations of CN infection, parenchymal nodules are common in the case of healthy persons. Conversely, diffuse interstitial infiltrates, alveolar consolidation, ground glass shadow, and mediastinal or hilar lymphadenopathy are most commonly seen in cases of compromised persons with a disease such as AIDS (4,(6)(7)(8)(9)(10). In the present case, a localized interstitial infiltrate shadow was observed on the chest CT (Fig.…”

“…Cryptococcus neoformans (CN) infection associated with pleural effusion is uncommon, even in patients with acquired immunodeficiency syndrome (AIDS) (4,(6)(7)(8)(9)(10). Here, wereport a rare case ofpleural effusion due to CN that developed in a patient with chronic renal failure receiving long-term corticosteroid treatment for rheumatoid arthritis (RA).…”

“…Cryptococcal pulmonary infection rarely occurs in healthy or compromised persons (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”