Features of cryptococcosis among 652 HIV-seronegative individuals in France: a cross-sectional observational study (2005-2020).
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Paccoud Olivier, Desnos-Ollivier Marie, Persat Florence, Demar Magalie, Boukris-Sitbon Karine, Bellanger Anne-Pauline, Bonhomme Julie, Bonnal Christine, Botterel Françoise, Bougnoux Marie-Elisabeth, Brun Sophie, Cassaing Sophie, Cateau Estelle, Chouaki Taieb, Cornet Muriel, Dannaoui Eric, Desbois-Nogard Nicole, Durieux Marie-Fleur, Favennec Loïc, Fekkar Arnaud, Gabriel Frederic, Gangneux Jean-Pierre, Guitard Juliette, Hasseine Lilia, Huguenin Antoine, Le Gal Solène, Letscher-Bru Valérie, Mahinc Caroline, Morio Florent, Nicolas Muriel, Poirier Philippe, Ranque Stéphane, Roosen Gabrielle, Rouges Célia, Roux Anne-Laure, Sasso Milène, Alanio Alexandre, Lortholary Olivier, Lanternier Fanny, French Mycoses Study Group
Аннотация
METHODS: We included incident cases of cryptococcosis in HIV-seronegative individuals from 2005 to 2020. We compared patient characteristics, disease presentations, cryptococcal antigen results, and induction antifungal treatments according to underlying disease. We examined factors associated with 90-day mortality. Among patients with disseminated infections, we investigated whether receipt of flucytosine and polyene combination was associated with lower mortality.
RESULTS: Among 652 individuals, 209 (32.1%) had malignancy, 130 (19.9%) were solid-organ transplant recipients, 204 (31.3%) had other immunocompromising conditions, and 109 (16.7%) had no reported underlying factor. The commonest presentations were disseminated infections (63.3%, 413/652) and isolated pulmonary infections (25.3%, 165/652). Solid-organ transplant patients were most likely to have disseminated infections and a positive serum cryptococcal antigen result. Patients with malignancy were older and less likely to receive a flucytosine-containing regimen for disseminated infections than others (58.7%, 78/133 vs. 73.2%, 194/265; p 0.029). The crude 90-day case-fatality ratio was 27.2% (95% CI, 23.5%-31.1%). Age ≥60 years (aOR: 2.75 [1.78-4.26]; p < 0.001), meningitis/fungaemia (aOR: 4.79 [1.80-12.7]; p 0.002), and malignancy (aOR: 2.4 [1.14-5.07]; p 0.02) were associated with higher 90-day mortality. Receipt of flucytosine and polyene combination was associated with lower 90-day mortality (aOR: 0.40 [0.23-0.71]; p 0.002) in multivariable analysis and inverse probability of treatment weighted analysis (aOR: 0.45 [0.25-0.80]; p 0.006).
DISCUSSION: HIV-seronegative individuals with cryptococcosis comprise a wide range of underlying conditions with different presentations and outcomes, requiring a tailored approach to diagnosis and management.