Differentiating disseminated cryptococcosis from pulmonary cryptococcosis: Roles of clinical characteristics and cryptococcal antigen.

AbstractDistinguishing disseminated cryptococcosis (DC) from localized pulmonary cryptococcosis (PC) is crucial due to divergent management and disparate prognoses. This study aimed to recognize associated factors for DC from PC in non-human immunodeficiency virus (HIV) patients. Accordingly, 475 pathologically confirmed cryptococcosis cases (391 PC and 84 DC) were retrospectively reviewed over a 20-year period at a tertiary hospital in China. Clinical, radiographic, dynamic serum cryptococcal antigen (CrAg) titer profiles, treatment and prognosis were analyzed. Patients with DC were significantly associated with a history of glucocorticoid therapy (16.7% vs. 5.6%; P = 0.001) and autoimmune diseases (16.7% vs. 6.1%; P = 0.001) compared with PC, aggressive thoracic computed tomography findings, including patchy exudation (P = 0.001) and cavitation (P = 0.009), and markedly higher baseline median serum CrAg titers (1:1280 vs. 1:80, P < 0.001). By multivariable analysis, CNS symptoms (adjusted OR [aOR] 131.12, 95% CI 10.21-1683.9, P = 0.001), chronic liver disease (aOR 15.21, 95% CI 1.06-217.69, P = 0.045), and baseline serum CrAg ≥1:80 (aOR 13.51, 95% CI 1.39-131.07, P = 0.025) remained independently associated with DC. An initial CrAg titer ≥ 1:80 should prompt careful CNS evaluation and consideration of lumbar puncture. Patients with DC had significantly longer median CrAg clearance (P = 0.001) and antifungal duration (18 vs. 6 months), with higher mortality (9.5% vs. 1.0%; P < 0.001) compared to PC. Early risk-stratification is imperative to optimize interventions and improve survival.