title: Cryptococcus neoformans infection in malignancy.
abstract: Cryptococcosis is an opportunistic invasive fungal infection that is well described and easily recognised when it occurs as meningitis in HIV-infected persons. Malignancy and its treatment may also confer a higher risk of infection with Cryptococcus neoformans, but this association has not been as well described. A case of cryptococcosis in a cancer patient is presented, and all cases of coincident C. neoformans infection and malignancy in adults published in the literature in English between 1970 and 2014 are reviewed. Data from these cases were aggregated in order to describe the demographics, type of malignancy, site of infection, clinical manifestations, treatment and outcomes of cryptococcosis in patients with cancer. Haematologic malignancies accounted for 82% of cases, with lymphomas over-represented compared to US population data (66% vs. 53% respectively). Cryptococcosis was reported rarely in patients with solid tumours. Haematologic malignancy patients were more likely to have central nervous system (P < 0.001) or disseminated disease (P < 0.001), receive Amphotericin B as part of initial therapy (P = 0.023), and had higher reported mortality rates than those with solid tumours (P = 0.222). Providers should have heightened awareness of the possibility of cryptococcosis in patients with haematologic malignancy presenting with infection.
authors.affiliation: University of Maryland School of Medicine Division of Infectious Diseases, Institute of Human Virology, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Schmalzle
authors.affiliation: University of Maryland School of Medicine Division of Infectious Diseases, Institute of Human Virology, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA.
authors.forename: Ulrike K
authors.initials: UK
authors.lastname: Buchwald
authors.affiliation: University of Maryland School of Medicine Division of Infectious Diseases, Institute of Human Virology, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Gilliam
authors.affiliation: University of Maryland School of Medicine Division of Infectious Diseases, Institute of Human Virology, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Riedel
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000382:microbiology; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D003455:Cryptococcus neoformans; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D008223:Lymphoma / Q000150:complications; D016919:Meningitis, Cryptococcal / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology; D009894:Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B
keywords: Cryptococcus; cancer; cryptococcosis; leukaemia; lymphoma; malignancy