European Journal of Clinical Microbiology & Infectious Diseases

, Volume 27, Issue 10, pp 937–943

Pulmonary cryptococcosis in patients without HIV infection: factors associated with disseminated disease

  • J. W. Baddley
  • J. R. Perfect
  • R. A. Oster
  • R. A. Larsen
  • G. A. Pankey
  • H. Henderson
  • D. W. Haas
  • C. A. Kauffman
  • R. Patel
  • A. K. Zaas
  • P. G. Pappas
Article

DOI: 10.1007/s10096-008-0529-z

Cite this article as:
Baddley, J.W., Perfect, J.R., Oster, R.A. et al. Eur J Clin Microbiol Infect Dis (2008) 27: 937. doi:10.1007/s10096-008-0529-z

Abstract

Cryptococcus neoformans is an uncommonly recognized cause of pneumonia in HIV-negative patients. Because of its propensity to disseminate to the meninges and other sites, a lumbar puncture is recommended for patients with pulmonary cryptococcosis, regardless of other risk factors. This study explored clinical and laboratory features to help predict which patients had pulmonary disease alone versus those who had pulmonary plus extrapulmonary disease. A retrospective chart review at 15 medical centers was performed from 1990 to 2000 of all HIV-negative patients who had pulmonary cryptococcosis. Demographic, clinical, radiographic, and laboratory features were evaluated to determine factors that differentiated those patients who had extrapulmonary disease. Among 166 patients who had pulmonary cryptococcosis, 122 had pulmonary infection only and 44 had pulmonary plus extrapulmonary (disseminated) disease. A negative serum cryptococcal antigen titer was more common in patients with pulmonary disease alone (p < 0.01). Multivariate analysis demonstrated that patients who had disseminated disease were more likely than those who only had pulmonary disease to have cirrhosis (p = 0.049), headache (p < 0.001), weight loss (p = 0.003), fever (p = 0.035), altered mental status (p < 0.001), and to be receiving high-dose corticosteroids (p = 0.008). In this large cohort of HIV-negative patients with pulmonary cryptococcosis, there were easily distinguished clinical and laboratory features among patients with pulmonary disease alone versus those with pulmonary plus extrapulmonary disease. These findings may be helpful in the evaluation of HIV-negative patients with pulmonary cryptococcosis with regard to the need for lumbar puncture or to search for disseminated disease.

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • J. W. Baddley
    • 1
  • J. R. Perfect
    • 2
  • R. A. Oster
    • 3
  • R. A. Larsen
    • 4
  • G. A. Pankey
    • 5
  • H. Henderson
    • 6
  • D. W. Haas
    • 7
  • C. A. Kauffman
    • 8
  • R. Patel
    • 9
  • A. K. Zaas
    • 2
  • P. G. Pappas
    • 1
  1. 1.Division of Infectious Diseases and International Health, Department of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Division of Infectious Diseases, Department of MedicineDuke University Medical CenterDurhamUSA
  3. 3.Biostatistics and Bioinformatics Unit, Department of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.Division of Infectious Diseases, Department of MedicineUniversity of Southern California Keck School of MedicineLos AngelesUSA
  5. 5.Division of Infectious Diseases, Department of MedicineOchsner ClinicNew OrleansUSA
  6. 6.Division of Infectious Diseases, Department of MedicineUniversity of Mississippi Medical CenterJacksonUSA
  7. 7.Department of MedicineVanderbilt University Medical CenterNashvilleUSA
  8. 8.Department of MedicineUniversity of Michigan and Veterans Affairs, Ann Arbor Healthcare SystemAnn ArborUSA
  9. 9.Division of Infectious Diseases, Department of MedicineMayo ClinicRochesterUSA