title: Clinical features of pulmonary cryptococcosis in non-HIV patients in Japan.
abstract: OBJECTIVE
  To clarify the clinical features of pulmonary cryptococcosis in Japanese non-HIV population.
  
  
  METHODS
  Retrospective investigation of 151 pulmonary cryptococcosis cases between 1977 and 2012 was executed. The underlying disease (UDs), aggravating factors, radiological characteristics, and treatment were examined.
  
  
  RESULTS
  Sixty-seven patients (44.4%) had no UDs. The common UDs were diabetes (32.1%) followed by hematologic disease (22.6%), and collagen disease (22.6%). Peripherally distributed pulmonary nodules/masses were most commonly seen. Lesions in the right middle lobe (p = 0.01) and air bronchogram (P = 0.05) were significantly more frequent, respectively, in patients with UDs than patients without them. Azoles were mainly selected for the patients without meningoencephalitis. Mean treatment duration for patients with and without UDs was 6.64 and 2.87 months, respectively. Patients whose pulmonary nodules improved after treatment continued to experience gradual reduction of cryptococcosis antigen titers, even if antigen titers were positive at the time of treatment cessation. The average time for antigen titers to become negative after treatment cessation was 13.1 and 10.7 months for patients with and without UDs, respectively. When groups were compared according to the presence of meningoencephalitis complications, deaths, and survivals, factors contributing to cryptococcosis prognosis included higher age, hypoproteinemia, hypoalbuminemia, steroid use, high C-reactive protein levels, and meningoencephalitis complications.
  
  
  CONCLUSIONS
  It is crucial to consider the presence of UDs and meningoencephalitis for the choice of antifungals and treatment duration for cryptococcosis in non-HIV patients. Three- and six months-administration of azoles for pulmonary cryptococcosis with or without UDs, respectively is reasonable.
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. Electronic address: s-kohno@nagasaki-u.ac.jp.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
authors.affiliation: Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kakeya
authors.affiliation: Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Izumikawa
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Taiga
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Yanagihara
authors.affiliation: Department of Infectious Diseases and Infection Control, Saitama International Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Mitsutake
authors.affiliation: Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Miyazaki
authors.affiliation: Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, Japan.
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Maesaki
authors.affiliation: Omura Municipal Hospital, Nagasaki, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Yasuoka
authors.affiliation: Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tashiro
authors.affiliation: Biostatistics Section, Division of Scientific Data Registry, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Mine
authors.affiliation: Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Uetani
authors.affiliation: Department of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Ashizawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003453:Cryptococcosis / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006801:Humans; D007564:Japan; D008172:Lung Diseases, Fungal / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D008297:Male; D008590:Meningoencephalitis / Q000097:blood / Q000175:diagnosis / Q000382:microbiology; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Computed tomography; Cryptococcal antigen; Immune status; Meningoencephalitis; Non-HIV patient; Pulmonary cryptococcosis