Cryptococcosis in human immunodeficiency virus-negative patients.
OBJECTIVE
To describe the clinical characteristics, treatment, and outcomes of cryptococcosis in HIV-negative patients.


METHODS
HIV-negative adult patients with positive culture for Cryptococcus neoformans who attended Ramathibodi Hospital between 1987 and 2003 were retrospectively reviewed.


RESULTS
During the 17 year review period, 40 HIV-negative patients with cryptococcosis were identified. Of these, 37 patients had medical records available for study. The mean age was 49+/-18 (range 16-83) years and 73% were female. Twenty-four patients (65%) had associated underlying conditions. The most common associated conditions included immunosuppressive drug treatment (41%), presence of systemic lupus erythematosus (16%), malignancies (16%), and diabetes mellitus (14%). C. neoformans was mainly recovered from cerebrospinal fluid (32%), blood (28%), and sputum/bronchoalveolar lavage/lung tissue (28%). Twenty-three patients (62%) had disseminated cryptococcosis. Six of 14 patients with cryptococcal meningitis were asymptomatic. About half of the patients were treated with amphotericin B and subsequent fluconazole. Five patients (14%) were initially misdiagnosed and treated for tuberculosis or bacterial infection. The overall mortality rate was 27%.


CONCLUSIONS
Cryptococcosis is not rare in HIV-negative patients. The mortality rate is high. Early recognition of cryptococcosis and use of appropriate antifungal therapy in these patients may improve clinical outcomes.
Kiertiburanakul
Sasisopin
S
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Rd, Bangkok 10400, Thailand. rasal@mahidol.ac.th
Wirojtananugoon
Sirirat
S
Pracharktam
Roongnapa
R
Sungkanuparph
Somnuek
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D003455:Cryptococcus neoformans / Q000302:isolation & purification; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D015658:HIV Infections / Q000276:immunology*; D018023:HIV Seronegativity; D006306:Health Surveys; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D012189:Retrospective Studies; D013785:Thailand; D016896:Treatment Outcome
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole