Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy.

Pappas PG, Perfect JR, Cloud GA, Larsen RA, Pankey GA, Lancaster DJ, Henderson H, Kauffman CA, Haas DW, Saccente M, Hamill RJ, Holloway MS, Warren RM, Dismukes WE
Clin Infect Dis. 2001 33 (5): 690-9

PMID: 11477526 · DOI:10.1086/322597

We conducted a case study of human immunodeficiency virus (HIV)-negative patients with cryptococcosis at 15 United States medical centers from 1990 through 1996 to understand the demographics, therapeutic approach, and factors associated with poor prognosis in this population. Of 306 patients with cryptococcosis, there were 109 with pulmonary involvement, 157 with central nervous system (CNS) involvement, and 40 with involvement at other sites. Seventy-nine percent had a significant underlying condition. Patients with pulmonary disease were usually treated initially with fluconazole (63%); patients with CNS disease generally received amphotericin B (92%). Fluconazole was administered to approximately two-thirds of patients with CNS disease for consolidation therapy. Therapy was successful for 74% of patients. Significant predictors of mortality in multivariate analysis included age > or =60 years, hematologic malignancy, and organ failure. Overall mortality was 30%, and mortality attributable to cryptococcosis was 12%. Cryptococcosis continues to be an important infection in HIV-negative patients and is associated with substantial overall and cause-specific mortality.

MeSH Terms (23)

Adolescent Adult Aged Aged, 80 and over Antifungal Agents Azoles Child Child, Preschool Cryptococcosis Cryptococcus neoformans Female Fluconazole HIV Seronegativity Humans Infant Male Middle Aged Multivariate Analysis Predictive Value of Tests Prognosis Risk Factors Treatment Outcome United States

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