Comparison of clinical features and survival between cryptococcosis in human immunodeficiency virus (HIV)-positive and HIV-negative patients.
Cryptococcosis is a life-threatening fungal infection among human immunodeficiency virus (HIV)-positive patients and also occurs frequently in HIV-negative patients. A retrospective cohort study was conducted among patients with cryptococcosis. Clinical manifestations, laboratory findings, treatment, and outcomes for 149 HIV-positive and 29 HIV-negative patients were compared. Neurological involvement occurred more frequently in HIV-positive patients (91.9 versus 20.7%, P<0.001), whereas pulmonary involvement was more frequently observed in HIV-negative patients (34.5 versus 2.7%, P<0.001). Ninety percent of HIV-positive patients and 74% of HIV-negative patients had positive serum cryptococcal antigen (P=0.119). HIV-positive patients were more likely to have a cerebrospinal fluid (CSF) preparation that is positive for India ink staining (81 versus 50%, P<0.001) and a CSF cryptococcal antigen titer of > or =1:1,024 (61.1 versus 16.7%, P=0.038). Most of the patients in both groups received amphotericin B as the primary therapy. Cryptococcosis-related mortality was high and did not differ between the two groups (22.2 versus 34.5%, P=0.162). Kaplan-Meier analysis revealed that HIV-positive patients had a higher relapse rate (P=0.011), especially among those lacking antiretroviral therapy. In conclusion, clinical presentation of cryptococcosis among HIV-negative patients varies and differs from that of HIV-positive patients. Awareness and prompt management are crucial for establishing a diagnosis and initiating proper treatment.
Jongwutiwes
Ubonvan
U
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Sungkanuparph
Ssomnuek
S
Kiertiburanakul
Sasisopin
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000097:blood / Q000134:cerebrospinal fluid; D023241:Antiretroviral Therapy, Highly Active; D002493:Central Nervous System Diseases / Q000150:complications; D002555:Cerebrospinal Fluid / Q000382:microbiology; D015331:Cohort Studies; D003453:Cryptococcosis / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D003455:Cryptococcus neoformans / Q000276:immunology; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008172:Lung Diseases, Fungal / Q000150:complications; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013785:Thailand / Q000453:epidemiology
D000935:Antifungal Agents; D000946:Antigens, Fungal; D000666:Amphotericin B