Pulmonary cryptococcosis characteristics in immunocompetent patients—A 20‐year clinical retrospective analysis in China

Abstract

SummaryBackgroundPulmonary cryptococcosis (PC) is not considered an rare, opportunistic infection anymore. The immunocompetent population accounts for an increasing proportion of the morbidity.ObjectiveThis study investigated the clinical characteristics of PC patients spanning 20 years, in a referral centre of China.Patients/MethodsWe retrospectively investigated the clinical data of 99 patients with PC who were diagnosed at Peking Union Medical College Hospital (PUMCH) from January 1998 to December 2017.ResultsPulmonary cryptococcosis incidence in PUMCH has seen sharp increase in two decades. There were 40.4% (40/99), 17.2% (17/99) and 42.4% (42/99) immunocompetent, mildly immunocompromised and severe immunocompromised patients, respectively. Significantly higher (P = .035) male predominance in immunocompetent and mildly immunocompromised groups (68.4%, 39/57) compared with severe immunocompromised group (45.2%, 19/42) was found. Overall, 27.5% (11/40) immunocompetent patients reported a significant difference (P = .02) in history of more than weekly drinking, higher than mildly or severe immunocompromised. No significant difference occurred in symptoms and radiographic characteristics among the groups. In pulmonary computerised tomography findings, the non‐air pathway feature was the dominant distribution characteristics in all patients with PC (P = .002). The gap in body dissemination frequency between immunocompetent combined with mildly immunocompromised (5.26%, 3/57) and severe immunocompromised (19.0%, 8/42) was marginally significant (P = .05).ConclusionsGender and alcohol drinking could be PC risk factors of concern in patients without severe immunodeficiency. No significant difference occurred in symptoms or radiographic characteristics between patients with different levels of immune status. The unique radiographic non‐air pathway distribution in the lung may be the feature of Cryptococcus invasion that may enhance accurate diagnosis.

Comparison of clinical features of pulmonary cryptococcosis with and without central nervous system involvement in China

“…3,12 When immunocompromised hosts are infected with Cryptococcus, the CNS is easily infected once symptoms occur in the lungs. 13 The most common symptoms of PC found in our study sample were cough (51.6%) and expectoration (38.2%), which is similar to previous reports. [13][14][15] Common clinical symptoms of CNS involvement are headache, fever, and chills, and the risk of CNS involvement is significantly increased when symptoms of fever and headache are present.…”

“… 3 , 12 When immunocompromised hosts are infected with Cryptococcus , the CNS is easily infected once symptoms occur in the lungs. 13 …”

“…The most common symptoms of PC found in our study sample were cough (51.6%) and expectoration (38.2%), which is similar to previous reports. 13 – 15 Common clinical symptoms of CNS involvement are headache, fever, and chills, and the risk of CNS involvement is significantly increased when symptoms of fever and headache are present. 16 According to reports, immunocompetent patients infected with Cryptococcus pneumonia have mild or no symptoms.…”

Clinical analysis in immunocompetent and immunocompromised patients with pulmonary cryptococcosis in western China

“…However, many previous studies have reported that cryptococcosis was more common in immunocompetent patients in China [17][18][19] . Another recent report showed 40.4% PC patients had normal immune function 12 . Although some patients with cryptococcosis seemed to be immunocompetent, some immune gene characteristics such as mannose-binding www.nature.com/scientificreports www.nature.com/scientificreports/ how to correctly evaluate immune function of patients is a problem that needs to be solved.…”

Disseminated Cryptococcosis in an Immunocompetent Child

“…This is the reason why disseminated cryptococcosis is more common in patients with an impaired immune function such as HIV. In HIV-uninfected patients, other underlying condition that have been identified include liver cirrhosis, diabetes mellitus, and autoimmune diseases [ 5 , 6 ]. However, no immunosuppressive condition, diabetes mellitus, chronic kidney disease, steroid use, or close contact with pigeon or bird droppings was identified in our patient.…”