Pulmonary cryptococcosis in nonimmunocompromised patients.
BACKGROUND
Cryptococcus neoformans can cause serious systemic infections requiring systemic antifungal therapy in immunocompromised hosts. However, isolated pulmonary cryptococcosis in nonimmunocompromised hosts has been reported to resolve spontaneously without treatment.


OBJECTIVE
s: To determine the role of antifungal therapy in the management of isolated pulmonary cryptococcosis in nonimmunocompromised hosts.


METHODS
Retrospective study.


METHODS
Tertiary care, referral medical center


METHODS
Thirty-six nonimmunocompromised subjects with isolated pulmonary cryptococcosis who received diagnoses at the Mayo Clinic (Rochester, MN) from 1976 to 2001.


METHODS
None.


RESULTS
Of 42 nonimmunocompromised subjects with cryptococcal infections, 36 (86%) had isolated pulmonary cryptococcosis. The mean (+/- SD) age of these 36 patients was 61 +/- 15 years (range, 14 to 88 years), and the groups included 17 men (47%) and 19 women (53%). Twenty-four patients (67%) were symptomatic, and 12 patients (33%) were asymptomatic. The most common presenting symptoms were cough, dyspnea, and fever. Cultures of sputum and bronchial washings most commonly yielded the diagnosis. Cerebrospinal fluid examination was performed in 11 patients (31%) and was negative in all of them. Follow-up information was available on 25 patients (69%) with a median duration of 19 months (range, 1 to 330 months). Twenty-three of these patients (92%) had resolution of their disease (no treatment, 8 patients; surgical resection only, 6 patients; and antifungal therapy, 9 patients). The condition of the two remaining patients had improved. There was no documented treatment failure, relapse, dissemination, or death in any of these 25 patients.


CONCLUSIONS
Our findings suggest that an initial period of observation without the administration of antifungal therapy is a reasonable option for nonimmunocompromised subjects with pulmonary cryptococcosis in the absence of systemic symptoms or evidence of dissemination, as well as after surgical resection for focal cryptococcal pneumonia.
Nadrous
Hassan F
HF
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Antonios
Vera S
VS
Terrell
Christine L
CL
Ryu
Jay H
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003453:Cryptococcosis / Q000188:drug therapy / Q000276:immunology* / Q000503:physiopathology; D003455:Cryptococcus neoformans / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000276:immunology* / Q000503:physiopathology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012189:Retrospective Studies
D000935:Antifungal Agents