Clinical features and Outcomes of Cryptococcemia patients with and without HIV infection

Zhao, Handan; Zhou, Ming; Zheng, Qiang; Zhu, Mingjian; Yang, Zongxing; Hu, Caiqin; Xu, Lijun

doi:10.1111/myc.13261

Cited by 11 publications

(8 citation statements)

References 48 publications

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“…As revealed by previous studies (Zhu et al, 2010;Fang et al, 2020;Fu et al, 2020;Zhou et al, 2020;Zhao et al, 2021), there are many more non-HIV patients in China than in other countries. In our study, we observed the same phenomenon: the proportion of patients with HIV was 12.78%.…”

Section: Discussionmentioning

confidence: 80%

“…grubii ST5-VNI-α. Most patients (64.80–71.4%) with cryptococcosis were not infected with HIV, according to data from a general hospital in Zhejiang Province, which is also a designated HIV hospital ( Fang et al, 2020 ; Zhao et al, 2021 ). To collect more strains to further and more comprehensively explore the clinical characteristics, drug susceptibility and molecular characteristics of Cryptococcus spp.…”

Section: Introductionmentioning

confidence: 99%

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Antifungal susceptibility and molecular characteristics of Cryptococcus spp. based on whole-genome sequencing in Zhejiang Province, China

et al. 2022

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Cryptococcus spp. is a complex species that often causes cryptococcosis, which is one of the most common opportunistic infections in adults living with HIV and has very high morbidity and mortality rates. This study aimed to investigate the antifungal susceptibility profiles and epidemiological characteristics of the Cryptococcus neoformans species complex (CNSC) and the Cryptococcus gattii species complex (CGSC) in Zhejiang Province, China. A total of 177 CNSC and 3 CGSC isolates were collected, and antifungal susceptibility was tested by FUNGUS 3 and verified with an E-test. Moreover, multiple classification methods and genomic analyses were performed. The majority of the isolates (96.11%) were C. neoformans (formerly C. neoformans var. grubii) (ST5-VNI-A-α). Our study highlights that most of the patients with cryptococcosis were non-HIV patients in China, and nearly half of them did not have underlying diseases that led to immune insufficiency. Most of the Cryptococcus spp. isolates in this study were sensitive to common antifungal drugs. Two 5-flucytosine (5-FC)-resistant strains were identified, and FUR1 mutation was detected in the 5-FC-resistant isolates. Typing based on whole-genome sequencing (WGS) showed better discrimination than that achieved with multilocus sequence typing (MLST) and indicated a clear population structure. A phylogenetic analysis based on WGS included more genomic information than traditional classification methods.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Antifungal susceptibility and molecular characteristics of Cryptococcus spp. based on whole-genome sequencing in Zhejiang Province, China

et al. 2022

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“…One in three patients with CNS cryptococcosis in our cohort died within 12 months after diagnosis-a rate that is consistent with prior reports in immunocompromised populations. 1,3,4,20,21 Factors associated with mortality were fungaemia, extra-CNS involvement, requirement of ICU level of care and initial low CSF lymphocyte percentage-all measures that reflect the extent of involvement, clinical severity or degree of immunocompromise at presentation. One recent report found non-CNS extrapulmonary involvement to have a similarly high 90-day mortality rate as CNS cryptococcosis.…”

Section: Discussionmentioning

confidence: 99%

“…This group of opportunistic pathogens, primarily C. neoformans and C. gattii , affects the central nervous system (CNS) in up to 67% of patients 1,2 . Factors associated with poor outcomes with cryptococcosis include fungaemia, immunocompromised state, active malignancy, end‐stage liver disease, use of non‐amphotericin B‐based therapy and lack of intracranial pressure management 2–5 . Overall, the outcomes of cryptococcosis remain poor, with mortality rates as high as 80% depending on extent of infection and patient factors 1,4,6,7 …”

Section: Introductionmentioning

confidence: 99%

Clinical and microbiologic outcomes of central nervous system cryptococcosis: Re‐examining the need for a 2‐week cerebrospinal fluid analysis

Yetmar

Ranganath

Mendoza

et al. 2022

Mycoses

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Background Cryptococcus spp. infection involving the central nervous system (CNS) is associated with poor outcomes. Current guidelines recommend repeating a cerebrospinal fluid (CSF) fungal culture after 2 weeks of treatment to evaluate for clearance. However, this practice has not clearly been associated with outcomes. Objectives We sought to assess the relationship between CSF fungal clearance at 2 weeks and 12‐month mortality in patients with CNS cryptococcosis. Methods This is a retrospective cohort study from 2011 to 2020 of patients with CNS cryptococcosis. Factors associated with 12‐month mortality were assessed with Fisher’s exact test for categorical variables and Mann–Whitney test for continuous variables. Results Among 51 patients with CNS cryptococcosis, 42 (82.4%) were initially CSF culture positive. Among 27 patients with follow‐up CSF culture at 2 weeks, 6 (22.2%) had a positive result. Factors associated with a positive CSF culture at 2 weeks were an initial CSF cryptococcal antigen titre ≥1:2560, fungaemia, and an elevated intracranial pressure requiring therapeutic lumbar punctures. The 12‐month mortality rate was 33.3%, and this was significantly associated with baseline fungaemia, extra‐CNS cryptococcal involvement and requirement of intensive care unit level of care. Lack of CSF culture clearance by 2 weeks was not associated with 12‐month mortality. Conclusions CNS cryptococcosis has a high mortality rate. A markedly elevated CSF cryptococcal antigen, and opening CSF pressure was associated with lack of CSF culture clearance at 2 weeks of treatment. Severe disseminated disease and cryptococcemia were associated with 12‐month mortality.

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“…isolations, 42 patients with 79 Candida spp. isolations and 10 patients with 21 other fungal infections in CSF culture (Zhao et al, 2021). Ultimately, the 42 patients from whom Candida spp.…”

Section: Study Cohort and Patient Enrollmentmentioning

confidence: 99%

Single and Repeated Episodes of Candida Species Isolated From Cerebrospinal Fluid for Diagnosing Probable Candida meningitis

Zhao

Zhou

et al. 2021

Front. Microbiol.

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Background: The clinical relevance of single or repeated episodes of Candida spp. in cerebrospinal fluid (CSF) in adult patients is debatable.Methods: Forty-two patients with positive Candida episodes in CSF were enrolled in this retrospective study.Results: A total of 42.9% (18/42) were determined to have probable Candida meningitis (PCM). Neurosurgery [odds ratio (OR) (95% confidence interval), OR: 14.4 (1.6–126.1), P = 0.004], lumbar drainage [OR: 5.8 (1.5–23.3), P = 0.009], VP shunt [(OR: 5.6 (1.2–25.8), P = 0.020)], external ventricular drainage [OR: 4.7 (1.3–17.7), P = 0.018], CRP ≥ 10.0 mg/L [OR: 4.9 (1.3–18.1), P = 0.034], and postsurgical broad-spectrum antibiotics [OR: 9.5 (1.8–50.5), P = 0.004] were risk factors associated with PCM. A single CSF Candida episode for the diagnosis of PCM had 7.7% (0.4–37.9%) sensitivity and 20.7% (8.7–40.3%) specificity, whereas repeated episodes of Candida had 66.7% (41.2–85.6%) sensitivity and 95.8% (76.9–99.8%) specificity. No significant difference was found in radiological imaging or CSF profiles between PCM and non-PCM patients. A total of 37.5% (9/24) of patients without PCM received empirical antifungal treatment, and 88.9% (16/18) of patients with PCM received preemptive antifungal treatment. PCM patients had hospitalized mortality rates of 50.0% (9/18). The odds ratio of mortality was 23.0 (2.5–208.6) for PCM patients compared with non-PCM patients (P = 0.001).Conclusion: Both single and repeated positive CSF samples have low validity for the diagnosis of PCM, suggesting that novel strategies for diagnosis algorithms of PCM are urgently needed. Empirical antifungal treatment should be started immediately for suspicious patients with risk factors.

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Clinical features and Outcomes of Cryptococcemia patients with and without HIV infection

Cited by 11 publications

References 48 publications

Antifungal susceptibility and molecular characteristics of Cryptococcus spp. based on whole-genome sequencing in Zhejiang Province, China

Antifungal susceptibility and molecular characteristics of Cryptococcus spp. based on whole-genome sequencing in Zhejiang Province, China

Clinical and microbiologic outcomes of central nervous system cryptococcosis: Re‐examining the need for a 2‐week cerebrospinal fluid analysis

Single and Repeated Episodes of Candida Species Isolated From Cerebrospinal Fluid for Diagnosing Probable Candida meningitis

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