QJM : monthly journal of the Association of Physicians · 2013
Cryptococcosis in sarcoidosis: cryptOsarc, a comparative study of 18 cases.
СтатьяМногоцентровое исследованиеОбзорНазвание и аннотация: Перевод пока не подготовлен
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Bernard C, Maucort-Boulch D, Varron L, Charlier C, Sitbon K, Freymond N, Bouhour D, Hot A, Masquelet A C, Valeyre D, Costedoat-Chalumeau N, Etienne M, Gueit I, Jouneau S, Delaval P, Mouthon L, Pouget J, Serratrice J, Brion J-P, Vaylet F, Bremont C, Chennebault J M, Jaffuel S, Broussolle C, Lortholary O, Sève P, French Cryptococcosis Study Group
Аннотация
AIM: To describe the main characteristics and the treatment of cryptococcosis in patients with sarcoidosis.
DESIGN: Multicenter study including all patients notified at the French National Reference Center for Invasive Mycoses and Antifungals.
METHODS: Retrospective chart review. Each case was compared with two controls without opportunistic infections.
RESULTS: Eighteen cases of cryptococcosis complicating sarcoidosis were analyzed (13 men and 5 women). With 2749 cases of cryptococcosis registered in France during the inclusion period of this study, sarcoidosis accounted for 0.6% of all the cryptococcosis patients and for 2.9% of the cryptococcosis HIV-seronegative patients. Cryptococcosis and sarcoidosis were diagnosed concomitantly in four cases; while sarcoidosis was previously known in 14/18 patients, including 12 patients (67%) treated with steroids. The median rate of CD4 T cells was 145 per mm(3) (range: 55-1300) and not related to steroid treatment. Thirteen patients had cryptococcal meningitis (72%), three osteoarticular (17%) and four disseminated infections (22%). Sixteen patients (89%) presented a complete response to antifungal therapy. After a mean follow-up of 6 years, no death was attributable to cryptococcosis. Extra-thoracic sarcoidosis and steroids were independent risk factors of cryptococcosis in a logistic regression model adjusted with the sex of the patients.
CONCLUSIONS: Cryptococcosis is a significant opportunistic infection during extra-thoracic sarcoidosis, which occurs in one-third of the cases in patients without any treatment; it is not associated to severe CD4 lymphocytopenia and has a good prognosis.
DESIGN: Multicenter study including all patients notified at the French National Reference Center for Invasive Mycoses and Antifungals.
METHODS: Retrospective chart review. Each case was compared with two controls without opportunistic infections.
RESULTS: Eighteen cases of cryptococcosis complicating sarcoidosis were analyzed (13 men and 5 women). With 2749 cases of cryptococcosis registered in France during the inclusion period of this study, sarcoidosis accounted for 0.6% of all the cryptococcosis patients and for 2.9% of the cryptococcosis HIV-seronegative patients. Cryptococcosis and sarcoidosis were diagnosed concomitantly in four cases; while sarcoidosis was previously known in 14/18 patients, including 12 patients (67%) treated with steroids. The median rate of CD4 T cells was 145 per mm(3) (range: 55-1300) and not related to steroid treatment. Thirteen patients had cryptococcal meningitis (72%), three osteoarticular (17%) and four disseminated infections (22%). Sixteen patients (89%) presented a complete response to antifungal therapy. After a mean follow-up of 6 years, no death was attributable to cryptococcosis. Extra-thoracic sarcoidosis and steroids were independent risk factors of cryptococcosis in a logistic regression model adjusted with the sex of the patients.
CONCLUSIONS: Cryptococcosis is a significant opportunistic infection during extra-thoracic sarcoidosis, which occurs in one-third of the cases in patients without any treatment; it is not associated to severe CD4 lymphocytopenia and has a good prognosis.