title: Comparison and temporal trends of three groups with cryptococcosis: HIV-infected, solid organ transplant, and HIV-negative/non-transplant.
abstract: BACKGROUND
  The Infectious Disease Society of America (IDSA) 2010 Clinical Practice Guidelines for the management of cryptococcosis outlined three key populations at risk of disease: (1) HIV-infected, (2) transplant recipient, and (3) HIV-negative/non-transplant. However, direct comparisons of management, severity and outcomes of these groups have not been conducted.
  
  
  RESULTS
  Annual changes in frequency of cryptococcosis diagnoses, cryptococcosis-attributable mortality and mortality were captured. Differences examined between severe and non-severe disease within the context of the three groups included: demographics, symptoms, microbiology, clinical management and treatment. An average of nearly 15 patients per year presented at Duke University Medical Center (DUMC) with cryptococcosis. Out of 207 study patients, 86 (42%) were HIV-positive, 42 (20%) were transplant recipients, and 79 (38%) were HIV-negative/non-transplant. HIV-infected individuals had profound CD4 lymphocytopenia and a majority had elevated intracranial pressure. Transplant recipients commonly (38%) had renal dysfunction. Nearly one-quarter (24%) had their immunosuppressive regimens stopped or changed. The HIV-negative/non-transplant population reported longer duration of symptoms than HIV-positive or transplant recipients and 28% (22/79) had liver insufficiency or underlying hematological malignancies. HIV-positive and HIV-negative/non-transplant patients accounted for 89% of severe disease cryptococcosis-attributable deaths and 86% of all-cause mortality.
  
  
  CONCLUSIONS
  In this single-center study, the frequency of cryptococcosis did not change in the last two decades, although the underlying case mix shifted (fewer HIV-positive cases, stable transplant cases, more cases with neither). Cryptococcosis had a relatively uniform and informed treatment strategy, but disease-attributable mortality was still common.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Emily W
authors.initials: EW
authors.lastname: Bratton
authors.forename: Nada
authors.initials: N
authors.lastname: El Husseini
authors.forename: Cody A
authors.initials: CA
authors.lastname: Chastain
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.forename: Charles
authors.initials: C
authors.lastname: Poole
authors.forename: Til
authors.initials: T
authors.lastname: Stürmer
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Juliano
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
authors.forename: John R
authors.initials: JR
authors.lastname: Perfect
mesh_terms: D000328:Adult; D000368:Aged; D003453:Cryptococcosis / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D019586:Intracranial Hypertension / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019737:Transplants
chemical_list: D007166:Immunosuppressive Agents