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Infective patterns of cryptococcosis in patients with connective tissue disease: a retrospective study

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Abstract

Objectives

To explore the clinical features and associated factors of cryptococcosis in patients with connective tissue disease (CTD) from Southern China.

Methods

Demographic and clinical data were collected between 2007 and 2018. Associated factors were analyzed by logistic regression analysis.

Results

A total of 6809 inpatients with CTD were included. Cryptococcosis was diagnosed in 30 patients (prevalence, 0.4%). Cryptococcosis was predominant in patients with ANCA-associated vasculitis (AAV) (prevalence, 6/530, 1.1%). Lung was commonly involved (18/30, 60.0%), followed by meninges (6/30, 20.0%), blood stream (5/30, 16.7%), and disseminated cryptococcosis (involved blood stream and meninges) (1/30, 3.3%). Infiltrates (10/18, 55.6%) and small nodules (8/18, 44.4%) were the main radiographic manifestation of pulmonary cryptococcosis (PC). The positive rate of serum cryptococcal antigen (CrAg) in patients with PC was 88.2%. Cryptococcus spp. were found in 75% (3/4) patients who underwent lung biopsy. Most of the patients with cryptococcal meningitis (CM) had elevated cerebrospinal fluid (CSF) opening pressure (6/7, 85.7%) and decreased CSF glucose level (5/7, 71.4%). Positive blood culture confirmed the diagnosis of cryptococcal sepsis (CS). Three patients died (10.0%), including one with CM and two with PC. Multivariate logistic regression analysis showed that accumulated dose of glucocorticoid (GC) [odds ratio (OR) = 1.42, 95% confidence interval (CI) 1.04–1.93, P = 0.03] was associated with cryptococcosis in patients with CTD.

Conclusions

Cryptococcosis develops in various organs. Typical radiological manifestation accompanied with positive serum CrAg provides helpful clues for the diagnosis. Lumbar puncture is a critical diagnostic method to distinguish CM. The accumulated dose of GC is associated with cryptococcosis in patients with CTD.

Key Points

• Pulmonary cryptococcosis is suspected if pulmonary nodules adjacent to the pleura are present, with serum CrAg positive.

• Cryptococcal meningitis has insidious onset and the diagnosis mainly depends on lumber puncture.

• Cryptococcal sepsis is not rare and needs timely blood culture in suspected patients.

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Acknowledgments

The authors would like to thank Dr. Meng Zhang for her technical assistance.

Funding

This project was supported by grants from the National Natural Science Foundation of China (81601403, 81603435), grants from the Natural Science Foundation of Guangdong Province (2018A0303130294), and grants from Guangdong Technology Project (2017A020215148).

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Author notes

  1. Minxi Lao, Yingying Gong and Chuyu Shen contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China

    Minxi Lao, Chuyu Shen, Cuicui Wang, Liuqin Liang, Zhongping Zhan & Dongying Chen

  2. Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Minxi Lao & Yingying Gong

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  1. Minxi Lao
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Correspondence to Zhongping Zhan or Dongying Chen.

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This study was approved by Institutional Review Board of the First Affiliated Hospital of Sun Yat-sen University (approval number 2019422). Written informed consent was deemed unnecessary by the Institutional Review Boards for human studies due to the retrospective nature of the data. Patients’ data were anonymized and kept confidential throughout this study. This work was conducted in compliance with the Declaration of Helsinki principles.

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Appendix 1. ICD-10 coding for CTD and cryptococcosis

Appendix 1. ICD-10 coding for CTD and cryptococcosis

Table 6 The ICD-10 coding of CTD and cryptococcosis
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Lao, M., Gong, Y., Shen, C. et al. Infective patterns of cryptococcosis in patients with connective tissue disease: a retrospective study. Clin Rheumatol 39, 3071–3081 (2020). https://doi.org/10.1007/s10067-020-05068-6

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