Clinical Characteristics and Mortality Risk Factors of
Cryptococcal Infection among HIV-Negative Patients
Pattarin Pongmekin MD*, Piriyaporn Chongtrakool PhD**,
Pitak Santanirand PhD**, Sasisopin Kiertiburanakul MD, MHS*
Affiliation :
* Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
** Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Objective : Describe the clinical characteristics, treatment, outcomes, complications, and factors associated with mortality
of cryptococcosis in HIV-negative patients.
Material and Method: A retrospective cohort study was conducted among HIV-negative adult patients with positive culture
for Cryptococcus neoformans between 2005 and 2010.
Results : Forty-nine HIV-negative patients were identified with median (IQR) age of 62.5 (45.5-71.9) years of which 40.8%
were male. The common underlying medical conditions were cardiovascular diseases (36.7%). The common sites of positive
culture were cerebrospinal fluid/intracerebral abscess (46.9%), blood (36%), and sputum/bronchoalveolar larvage fluid
(28.6%). Twenty-nine (59.2%) patients had co-infections with another organism, such as Gram-negative bacteria (24.4%),
M. tuberculosis (17.8%), and Gram-positive bacteria (13.3%). The common clinical presentations were fever (67.3%),
alteration of consciousness (34.7%), and headache (26.5%). Complication was detected in 61.2% such as acute kidney
injury (47.0%), coma (38.8%), and shock (22.4%). The overall mortality was 51%. By multivariate logistic regression,
factors associated with mortality were alteration of consciousness (adjusted OR = 6.85; 95% CI: 1.41-33.28, p = 0.017)
and co-infections (adjusted OR = 5.32; 95% CI: 1.25-22.69, p = 0.024).
Conclusion : The mortality rate of HIV-negative patients with cryptococcosis is very high. Early recognition and treatment
of cryptococcosis in HIV-negative patients are crucial and may improve the outcome.
Keywords : AIDS, Cryptococcus neoformans, Cryptococcosis, Cryptococcal meningitis, HIV
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