Cryptococcosis in patients with hematologic malignancies. A report from GIMEMA-infection.
OBJECTIVE
Cryptococcosis is an important cause of morbidity and death in immunocompromised patients. The aim of this study was to evaluate clinical and laboratory characteristics, and outcome of patients with cryptococcosis complicating hematologic diseases.


METHODS
This was a retrospective study, conducted over a ten-year period (1993-2002) in 21 hematology divisions, in tertiary care or university hospitals.


RESULTS
This study evaluated 17 patients with hematologic diseases who developed cryptococcosis. Possible risk factors recognized before the onset of the infection were: administration of steroids for the underlying malignancy (6 patients), diabetes mellitus (4 patients), cutaneous lesions (2 patients) and autoimmune disease, hepatic cirrhosis, chronic renal failure and exposure to pigeons (1 patient each). Five patients received prophylaxis, consisting of fluconazole in 2 cases. Fever, neurological and respiratory signs developed according to the primary sites of infection (5 blood, 5 central nervous system, 4 lung, and 1 each in gut, skin and mouth). Diagnosis was made by positive microbiological culture, antigen detection in serum or cerebrospinal fluid, or polymerase chain reaction. All patients started specific treatment (fluconazole, 7 patients; amphotericin-B deoxycolate or liposomal amphotericin-B, 10 patients). Two patients died from cryptococcosis within 30 days after diagnosis.


CONCLUSIONS
Cryptococcosis in patients with hematologic malignancies is a rare complication. In neutropenic patients, it is less fatal than other fungal infections (i.e. aspergillosis or candidemia). Specific treatment, started promptly, positively influences the outcome.
Pagano
Livio
L
Istituto di Ematologia, Università Cattolica S. Cuore, Roma, Italia. lpagano@rm.unicatt.it
Fianchi
Luana
L
Caramatti
Cecilia
C
D'Antonio
Domenico
D
Melillo
Lorella
L
Caira
Morena
M
Masini
Luciano
L
Todeschini
Giuseppe
G
Girmenia
Corrado
C
Martino
Bruno
B
Cinieri
Saverio
S
Martino
Pietro
P
Del Favero
Albano
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D019337:Hematologic Neoplasms / Q000276:immunology / Q000382:microbiology*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000009:adverse effects
D000935:Antifungal Agents; D013256:Steroids; D015725:Fluconazole