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

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.