Q J Med 2002; 95: 511-518
© 2002 Association of Physicians
Cryptococcaemia: clinical features and prognostic factors
From the Departments of 1 Internal Medicine and 2 Laboratory Medicine, National Taiwan University Hospital, Taipei, and 3 Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
Received 4 February 2002 and in revised form 1 April 2002
Background: Limited data are available on the clinical significance of cryptococcaemia, which occurs in 10–30% of patients with cryptococcal diseases.
Aim: To describe the clinical features of cryptococcaemia and identify its prognostic factors.
Study design: Retrospective cohort study.
Methods: All adult patients with Cryptococcus neoformans isolated from blood culture at the National Taiwan University Hospital, Taipei, 1981–2001, were included. Demographic and clinical information was obtained from medical records.
Results: Fifty-two patients were diagnosed and treated for cryptococcaemia. Acquired immunodeficiency syndrome (24/52, 46%), immunosuppressive therapy (12/52, 23%) and decompensated liver cirrhosis (11/52, 21%) were the three major predisposing conditions. Forty-two patients (81%, n=52) had sepsis, including four patients with septic shock, when blood cultures were obtained. Of the 38 patients in whom lumbar puncture was done, cerebrospinal fluid culture showed meningeal involvement in 32 (84%). The 30-day fatality rate was 37%. Liver cirrhosis, septic shock at presentation, an initial APACHE II score 
20, age 60 years and female gender were associated with mortality under univariate analysis. Starting antifungal therapy within 48 h after blood culture was associated with improved survival. Under multivariate analysis, liver cirrhosis remained a strong independent predictor of mortality at 30 days after blood culture (HR 16.3, 95%CI 2.6–101.7, p=0.003).
Discussion: Patients with cryptococcaemia have a high risk of mortality within 30 days. Sepsis and meningeal involvement are common. Those with liver cirrhosis have a particularly poor prognosis.
Dr Wen-Yi Shau and Dr Chi-Tai Fang contributed equally to this work.
Address correspondence to Dr C.-T. Fang, Section of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan. e-mail: fangct{at}ha.mc.ntu.edu.tw
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. Lau, T. C. Sorrell, S. Chen, K. Stanley, J. Iredell, and C. Halliday Multiplex Tandem PCR: a Novel Platform for Rapid Detection and Identification of Fungal Pathogens from Blood Culture Specimens J. Clin. Microbiol., September 1, 2008; 46(9): 3021 - 3027. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Fishman, R. G. Gonzalez, and J. A. Branda Case 11-2008 -- A 45-Year-Old Man with Changes in Mental Status after Liver Transplantation N. Engl. J. Med., April 10, 2008; 358(15): 1604 - 1613. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Kitkungvan, A. Apisarnthanarak, P. Plengpart, and L. M Mundy Fever of unknown origin in patients with HIV infection in Thailand: an observational study and review of the literature Int J STD AIDS, April 1, 2008; 19(4): 232 - 235. [Abstract] [Full Text] [PDF]
|
|