Clinical characteristics of pulmonary cryptococcosis patients with different immune statuses: A 10-year multicenter retrospective study in China.

Publisher: Elsevier Country of Publication: England NLM ID: 8908438 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-3064 (Electronic) Linking ISSN: 09546111 NLM ISO Abbreviation: Respir Med Subsets: MEDLINE

Publication: 2003- : Oxford : Elsevier
Original Publication: London : Baillière Tindall, in association with the British Thoracic Society, [c1989-

Cryptococcosis*/immunology ; Cryptococcosis*/epidemiology ; Cryptococcosis*/drug therapy ; Lung Diseases, Fungal*/immunology ; Lung Diseases, Fungal*/epidemiology ; Lung Diseases, Fungal*/drug therapy ; Lung Diseases, Fungal*/diagnosis; Humans ; Retrospective Studies ; China/epidemiology ; Male ; Female ; Middle Aged ; Adult ; Aged ; Immunocompetence ; Antifungal Agents/therapeutic use ; Immunologic Deficiency Syndromes/immunology ; Immunologic Deficiency Syndromes/complications ; Immunocompromised Host/immunology ; Treatment Outcome ; Young Adult ; Adolescent ; Incidence

Background and Objective: We aimed to evaluate clinical characteristics and therapeutic efficacy of pulmonary cryptococcosis (PC) in patients with different immune status in a large multicenter population to support appropriate clinical management of this public health threat.
Methods: We retrospectively investigated the medical records of 510 patients with PC from January 2014 to June 2023 in 10 representative regional tertiary teaching hospitals in Hubei province of China, and clinical data of these patients were then stratified by different immune statuses.
Results: Immunocompetent (IC) patients accounted for 68.8 % (351/510), mild-to-moderate immunodeficiency (MID) patients accounted for 16.7 % (85/510), and severe immunodeficiency (SID) patients accounted for 14.5 % (74/510). PC patients in the MID and SID groups had a higher incidence of central nervous system (CNS) involvement than that in the IC group [4.7 % (MID) vs. 8.1 % (SID) vs. 1.1 % (IC), p = 0.002]. Patients with fever in SID group (35.1 %, 26/74) was more common (p < 0.01). Solitary nodule/mass were more common in the IC group than the MID and SID groups (p < 0.05); in contrast, diffuse nodules in MID or SID groups was significantly greater than that in IC groups (p < 0.01). The follow-up showed that the overall treatment improvement rate for PC showed a significant difference between the 3 groups [90.3 % (IC) vs. 75.3 % (MID) vs. 54.1 % (SID), p = 0.00].
Conclusion: The incidence of PC is increasing in Central China, especially for the immunocompetent PC population. In addition, there are significant differences in age, systemic symptoms, certain radiographic characteristics and some laboratory results between immunosuppressed and immunocompetent PC hosts. And finally, limited nodules/masses and mild symptoms in patients with PC often lead to misdiagnosis and unnecessary pulmonary resection, but CrAg assay contributes to early noninvasive diagnosis.
Competing Interests: Declaration of competing interest We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled, “Clinical characteristics and therapeutic analysis of pulmonary cryptococcosis patients with different immune statuses: A 10-year multicenter retrospective study in China”.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)

Keywords: Cryptococcus capsular antigen (CrAg); Culture; Histopathology; Immunocompetent; Immunodeficiency; Pulmonary cryptococcosis

0 (Antifungal Agents)

Date Created: 20241117 Date Completed: 20241211 Latest Revision: 20241211

20241212

10.1016/j.rmed.2024.107866

39551250