Current epidemiology and clinical features of Cryptococcus infection in patients without Human Immunodeficiency Virus: a multicentre study in 46 hospitals in Australia and New Zealand

Coussement, J; Heath, CH; Roberts, MB; Lane, RJ; Spelman, T; Smibert, OC; Longhitano, A; Morrissey, O; Nield, B; Tripathy, M; Davis, JS; Kennedy, KJ; Lynar, SA; Crawford, LC; Crawford, SJ; Smith, BJ; Gador-Whyte, AP; Haywood, R; Mahony, AA; Howard, JC; Walls, GB; O&#39;Kane, GM; Broom, MT; Keighley, CL; Bupha-Intr, O; Cooley, L; O&#39;Hern, JA; Jackson, JD; Morris, AJ; Bartolo, C; Tramontana, AR; Grimwade, KC; Au Yeung, V; Chean, R; Woolnough, E; Teh, BW; Chen, SC; Slavin, MA; Australian and New Zealand Study Group for Cryptococcosis in patients without HIV infection

Author(s): Coussement, J; Heath, CH; Roberts, MB; Lane, RJ; Spelman, T; Smibert, OC; Longhitano, A; Morrissey, O; Nield, B; Tripathy, M; Davis, JS; Kennedy, KJ; Lynar, SA; Crawford, LC; Crawford, SJ; Smith, BJ; Gador-Whyte, AP; Haywood, R; Mahony, AA; Howard, JC; Walls, GB; O'Kane, GM; Broom, MT; Keighley, CL; Bupha-Intr, O; Cooley, L; O'Hern, JA; Jackson, JD; Morris, AJ; Bartolo, C; Tramontana, AR; Grimwade, KC; Au Yeung, V; Chean, R; Woolnough, E; Teh, BW; Chen, SC; Slavin, MA; Australian and New Zealand Study Group for Cryptococcosis in patients without HIV infection;
Details: Publication Year 2023-05-26,Volume 77,Issue #7,Page 976-986
Journal Title: Clinical Infectious Diseases
Publication Type: Research article
Abstract: INTRODUCTION: Patients without HIV infection are increasingly recognised to be at risk for cryptococcosis. Knowledge of characteristics of cryptococcosis in these patients remains incomplete. METHODS: We conducted a retrospective study of cryptococcosis in 46 Australian and New Zealand hospitals to compare its frequency in patients with and without HIV, and describe its characteristics in patients without HIV. Patients with cryptococcosis between January 2015 and December 2019 were included. RESULTS: Of 475 patients with cryptococcosis, 90% were HIV-negative (426/475) with the marked predominance of HIV-negative cases evident in both Cryptococcus neoformans (88.7%) and C. gattii cases (94.3%). Most patients without HIV (60.8%) had a known immunocompromising condition: cancer (n=91), organ transplantation (n=81), other immunocompromising condition (n=97). Cryptococcosis presented as incidental imaging findings in 16.4% of patients (70/426). The serum cryptococcal antigen test was positive in 85.1 % of tested patients (319/375); high titres independently predicted risk of central nervous system involvement. Lumbar puncture was performed in 167 patients to screen for asymptomatic meningitis, with a positivity rate of 13.2% where meningitis could have been predicted by a high serum cryptococcal antigen titre and/or fungaemia in 95% of evaluable cases. One-year all-cause mortality was 20.9% in patients without HIV and 21.7% in patients with HIV (p=0.89). CONCLUSION: The present study revealed 90% of cryptococcosis cases occurred in patients without HIV (89% and 94% for C. neoformans and C. gattii cases, respectively). Emerging patient risk groups were evident. A high level of awareness is warranted to diagnose cryptococcosis in patients without HIV.
Publisher: Oxford University Press
Keywords: Cryptococcus gattii; Cryptococcus neoformans; cancer; cryptococcosis; transplantation
Department(s): Infectious Diseases; Health Services Research
PubMed ID: 37235212
Publisher's Version: https://doi.org/10.1093/cid/ciad321
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2023-10-17 03:11:17

Last Modified: 2024-07-09 04:34:19