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Cryptococcosis in Patients with Nephrotic Syndrome: A Pooled Analysis of Cases

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Abstract

Cryptococcosis is an infection that may be lethal in patients with nephrotic syndrome (NS). However, there is relatively limited epidemiological and clinical data about cryptococcosis in NS patients. We performed a pooled analysis to systemically summarize the epidemiology, risk factors, clinical and laboratory characteristics, treatments and outcomes of cryptococcosis in NS patients. Using data pooled from our hospital and studies identified via searches of three literature databases, 17 cases were identified for inclusion in this analysis. The prevalence of cryptococcosis in NS was 0.3%, with a higher rate in more recent years. Most patients were Asian (94%) and from upper-middle to high-income countries (76%). The median time interval from NS diagnosis to cryptococcosis diagnosis among the cryptococcosis patients was 16 months, and 46% of the identified cryptococcal infections were diagnosed within the first year of NS diagnosis. Cutaneous cryptococcosis was frequently diagnosed among the included patients (35%), 58% received an erroneous diagnosis and inappropriate treatment, 90% of whom had a cryptococcal infection mistaken for a bacterial infection. The mortality rate was 35%. Standard therapeutic strategies should be emphasized for both antifungal treatment and renal disease control. Further studies conducted in various medical centers are warranted to confirm our conclusions.

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Acknowledgements

We are thankful for the funds provided by the 973 Program (2013CB531601 and 2013CB531606), Major National R&D Projects of the National Health Department (2014ZX09J14106-02A), National Natural Science Foundation of China (Grant Numbers 81201269, 31270180); and Shanghai Science and Technology Committee (Grant Numbers 14DZ2272900 and 14495800500).

Author Contributions

WL, MC and WP were involved in study concept and design. WF, NH, and YL collected the data. JL and YL checked the data. WF and MC were involved in analysis and interpretation of data. WF drafted the manuscript. All authors contributed to the writing of the final manuscript.

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    Authors and Affiliations

    1. Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China

      Wenjie Fang, Nan Hong, Yingfang Li, Jia Liu, Lei Zhang, Weiwei Jiang, Wanqing Liao, Min Chen & Weihua Pan

    2. Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China

      Wenjie Fang, Nan Hong, Yingfang Li, Jia Liu, Lei Zhang, Weiwei Jiang, Wanqing Liao, Min Chen & Weihua Pan

    3. Medical College of Jiaying University, Meizhou, China

      Bo Qiu

    4. Department of Biology, McMaster University, Hamilton, Canada

      Jianping Xu

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    Wenjie Fang, Nan Hong, Yingfang Li and Jia Liu have contributed equally to this work.

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    Fang, W., Hong, N., Li, Y. et al. Cryptococcosis in Patients with Nephrotic Syndrome: A Pooled Analysis of Cases. Mycopathologia 182, 517–525 (2017). https://doi.org/10.1007/s11046-016-0101-9

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