PMID- 31077652
OWN - NLM
STAT- MEDLINE
DCOM- 20200129
LR  - 20200801
IS  - 1555-7162 (Electronic)
IS  - 0002-9343 (Print)
IS  - 0002-9343 (Linking)
VI  - 132
IP  - 8
DP  - 2019 Aug
TI  - Presentation and Mortality of Cryptococcal Infection Varies by Predisposing 
      Illness: A Retrospective Cohort Study.
PG  - 977-983.e1
LID - S0002-9343(19)30391-2 [pii]
LID - 10.1016/j.amjmed.2019.04.026 [doi]
AB  - BACKGROUND: Cryptococcal epidemiology is changing in the modern antiretroviral 
      era, and immune status informs outcomes. We describe the differences in clinical 
      presentation and mortality of cryptococcosis by immune status in the 
      antiretroviral therapy era. METHODS: We conducted a single-center retrospective 
      cohort study of patients diagnosed with cryptococcosis from 2002 through 2017. 
      Data included demographics, clinical features, diagnostics, and mortality. 
      RESULTS: We identified 304 patients with Cryptococcus neoformans infections: 105 
      (35%) were people living with human immunodeficiency virus (HIV), 41 (13%) had a 
      history of transplantation, and 158 (52%) were non-HIV nontransplant (NHNT). Age 
      analysis showed that people living with HIV were younger (40 years) than 
      transplant (53 years) and NHNT (61 years) (P < .001). Fevers and headache were 
      more common in people living with HIV (70% and 57%) than in transplant (49% and 
      29%) and NHNT (49% and 38%) (P = .003 and P = .001), respectively. Meningitis was 
      more common in people living with HIV (68%) than in transplant recipients (32%) 
      or NHNT (39%, P < .001). Disseminated cryptococcosis was more common in people 
      living with HIV (97%) as compared with transplant (66%) or NHNT (73%) (P < .001). 
      Time to diagnosis from hospitalization was longer for transplant (median 2 days, 
      interquartile range [IQR] +/- 9 days) and NHNT patients (median 2 days, IQR +/- 7 
      days) as compared with people living with HIV (median 1 day, IQR +/- 2 days) (P = 
      .003). NHNT patients had a higher risk of 90-day mortality (hazard ratio 3.3; 95% 
      confidence interval, 1.9-5.8) as compared with people living with HIV. 
      CONCLUSIONS: The majority of cryptococcosis occurs in NHNT patients. NHNT 
      patients had more localized pulmonary cryptococcosis and significantly higher 
      90-day mortality. Cryptococcosis in NHNT patients appears to be a distinct entity 
      that needs further study and requires a higher level of clinical suspicion than 
      it currently receives.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Hevey, Matthew A
AU  - Hevey MA
AD  - Division of Infectious Diseases, Department of Medicine, Washington University 
      School of Medicine, St. Louis, Mo. Electronic address: matthewhevey@gmail.com.
FAU - George, Ige A
AU  - George IA
AD  - Division of Infectious Diseases, Department of Medicine, Washington University 
      School of Medicine, St. Louis, Mo.
FAU - Raval, Krunal
AU  - Raval K
AD  - Division of Infectious Diseases, Department of Medicine, Washington University 
      School of Medicine, St. Louis, Mo.
FAU - Powderly, William G
AU  - Powderly WG
AD  - Division of Infectious Diseases, Department of Medicine, Washington University 
      School of Medicine, St. Louis, Mo.
FAU - Spec, Andrej
AU  - Spec A
AD  - Division of Infectious Diseases, Department of Medicine, Washington University 
      School of Medicine, St. Louis, Mo.
LA  - eng
GR  - UL1 TR002345/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20190508
PL  - United States
TA  - Am J Med
JT  - The American journal of medicine
JID - 0267200
SB  - IM
MH  - Adult
MH  - Cohort Studies
MH  - Cryptococcosis/etiology/*mortality
MH  - Cryptococcus neoformans/drug effects/pathogenicity
MH  - Female
MH  - HIV Infections/complications
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Organ Transplantation/adverse effects/methods
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Statistics, Nonparametric
PMC - PMC6744315
MID - NIHMS1529317
OTO - NOTNLM
OT  - Adult
OT  - Cryptococcus
OT  - HIV
OT  - Mortality
OT  - Presentation
OT  - Prognosis
OT  - Transplant
EDAT- 2019/05/12 06:00
MHDA- 2020/01/30 06:00
PMCR- 2020/08/01
CRDT- 2019/05/12 06:00
PHST- 2018/11/03 00:00 [received]
PHST- 2019/04/16 00:00 [revised]
PHST- 2019/04/20 00:00 [accepted]
PHST- 2019/05/12 06:00 [pubmed]
PHST- 2020/01/30 06:00 [medline]
PHST- 2019/05/12 06:00 [entrez]
PHST- 2020/08/01 00:00 [pmc-release]
AID - S0002-9343(19)30391-2 [pii]
AID - 10.1016/j.amjmed.2019.04.026 [doi]
PST - ppublish
SO  - Am J Med. 2019 Aug;132(8):977-983.e1. doi: 10.1016/j.amjmed.2019.04.026. Epub 
      2019 May 8.