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

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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.

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Acknowledgements

The original surveillance study, from which this study was derived, was sponsored in part by a grant from Pfizer, Inc.

Conflict of interest statement

JWB has received active research support from Astellas and Merck, is associated with the speakers’ bureau for Merck and Enzon, and provides consulting services for Pfizer and Enron. JRP has consulted for and received research grants and honoraria from Enzon, Astellas, Pfizer, Schering-Plough, and Merck. RAO has no conflicts of interest. RAL has received active clinical research grants from Gilead Sciences and Merck. GAP has no conflicts of interest. HH has no conflicts of interest. DWH has received research grants from Bavarian Nordic, Boehringer-Ingelheim, Bristol Meyers Squibb, Gilead Sciences, Merck, Tanox, and Tibotec. He is on Scientific Advisory Boards for Glaxo Smith Kline and Tibotec. CAK has received research grants from Merck, Astellas, Schering-Plough and is associated with the speakers’ bureau for Pfizer, Merck, Astellas, and Schering-Plough. RP has received grant support from Pfizer, Inc. AKZ has received grant support from Enzon Pharmaceuticals, is associated with the speakers’ bureau for Pfizer, Inc., and provides consulting services for Astellas Pharma and Merck and Co. PGP has received grant support and is associated with the speakers’ bureau for Pfizer Inc., Merck and Co., Schering-Plough, Astellas Pharma, and Enzon Pharmaceuticals. He also serves as an ad hoc advisor for Merck and Schering-Plough.

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Authors and Affiliations

  1. Division of Infectious Diseases and International Health, Department of Medicine, University of Alabama at Birmingham, 1900 University Boulevard, 229 Tinsley Harrison Tower, Birmingham, AL, 35294-0006, USA

    J. W. Baddley & P. G. Pappas

  2. Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, 0544 Hospital South, Box 3353 DUMV, Durham, NC, 27710, USA

    J. R. Perfect & A. K. Zaas

  3. Biostatistics and Bioinformatics Unit, Department of Medicine, University of Alabama at Birmingham, 1530 3rd Avenue South, WTI 153, Birmingham, AL, 35294-3300, USA

    R. A. Oster

  4. Division of Infectious Diseases, Department of Medicine, University of Southern California Keck School of Medicine, 2020 Zonal Avenue, IRD 632, Los Angeles, CA, 90089-9153, USA

    R. A. Larsen

  5. Division of Infectious Diseases, Department of Medicine, Ochsner Clinic, LT 73, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA

    G. A. Pankey

  6. Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216-4505, USA

    H. Henderson

  7. Department of Medicine, Vanderbilt University Medical Center, 21st Avenue South, Nashville, TN, 37232, USA

    D. W. Haas

  8. Department of Medicine, University of Michigan and Veterans Affairs, Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA

    C. A. Kauffman

  9. Division of Infectious Diseases, Department of Medicine, Mayo Clinic, 200 First Street, Southwest, Rochester, MN, 55905, USA

    R. Patel

Authors
  1. J. W. Baddley
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  2. J. R. Perfect
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  3. R. A. Oster
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  4. R. A. Larsen
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  5. G. A. Pankey
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  6. H. Henderson
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  7. D. W. Haas
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  8. C. A. Kauffman
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  9. R. Patel
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  10. A. K. Zaas
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  11. P. G. Pappas
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Corresponding author

Correspondence to J. W. Baddley.

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Baddley, J.W., Perfect, J.R., Oster, R.A. et al. Pulmonary cryptococcosis in patients without HIV infection: factors associated with disseminated disease. Eur J Clin Microbiol Infect Dis 27, 937–943 (2008). https://doi.org/10.1007/s10096-008-0529-z

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  • DOI: https://doi.org/10.1007/s10096-008-0529-z

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