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Comparison and temporal trends of three groups with cryptococcosis: HIV-infected, solid organ transplant, and HIV-negative/non-transplant.

AbstractBACKGROUND:
The Infectious Disease Society of America (IDSA) 2010 Clinical Practice Guidelines for the management of cryptococcosis outlined three key populations at risk of disease: (1) HIV-infected, (2) transplant recipient, and (3) HIV-negative/non-transplant. However, direct comparisons of management, severity and outcomes of these groups have not been conducted.
METHODOLOGY/PRINCIPAL FINDINGS:
Annual changes in frequency of cryptococcosis diagnoses, cryptococcosis-attributable mortality and mortality were captured. Differences examined between severe and non-severe disease within the context of the three groups included: demographics, symptoms, microbiology, clinical management and treatment. An average of nearly 15 patients per year presented at Duke University Medical Center (DUMC) with cryptococcosis. Out of 207 study patients, 86 (42%) were HIV-positive, 42 (20%) were transplant recipients, and 79 (38%) were HIV-negative/non-transplant. HIV-infected individuals had profound CD4 lymphocytopenia and a majority had elevated intracranial pressure. Transplant recipients commonly (38%) had renal dysfunction. Nearly one-quarter (24%) had their immunosuppressive regimens stopped or changed. The HIV-negative/non-transplant population reported longer duration of symptoms than HIV-positive or transplant recipients and 28% (22/79) had liver insufficiency or underlying hematological malignancies. HIV-positive and HIV-negative/non-transplant patients accounted for 89% of severe disease cryptococcosis-attributable deaths and 86% of all-cause mortality.
CONCLUSIONS/SIGNIFICANCE:
In this single-center study, the frequency of cryptococcosis did not change in the last two decades, although the underlying case mix shifted (fewer HIV-positive cases, stable transplant cases, more cases with neither). Cryptococcosis had a relatively uniform and informed treatment strategy, but disease-attributable mortality was still common.
AuthorsEmily W Bratton, Nada El Husseini, Cody A Chastain, Michael S Lee, Charles Poole, Til Stürmer, Jonathan J Juliano, David J Weber, John R Perfect
JournalPloS one (PLoS One) Vol. 7 Issue 8 Pg. e43582 ( 2012) ISSN: 1932-6203 [Electronic] United States
PMID22937064 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
Chemical References
  • Immunosuppressive Agents
Topics
  • Adult
  • Aged
  • Cryptococcosis (epidemiology)
  • Female
  • HIV Infections (epidemiology)
  • Humans
  • Immunosuppressive Agents (therapeutic use)
  • Intracranial Hypertension (pathology)
  • Male
  • Middle Aged
  • Transplants

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