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Clinical Investigations: INFECTION |

Pulmonary Cryptococcosis in Patients Without HIV Infection*

Judith A. Aberg, MD; Linda M. Mundy, MD; William G. Powderly, MD
Author and Funding Information

*From the Division of Infectious Diseases, Department of Medicine (Drs. Mundy and Powderly), Washington University School of Medicine, St. Louis, MO; and the AIDS Clinical Trials Unit, San Francisco General Hospital AIDS Program (Dr. Aberg), University of California, San Francisco, CA.



Chest. 1999;115(3):734-740. doi:10.1378/chest.115.3.734
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Purpose: To further elucidate the diagnostic and therapeutic approaches to patients with pulmonary cryptococcosis who are not HIV-infected.

Subjects: All of the patients without HIV infection who received care at two Midwest hospitals between January 1986 and February 1996 and had a respiratory isolate of Cryptococcus neoformans.

Methods: The medical records of the study patients were reviewed for demographic data, host immune status, respiratory symptoms, diagnostic studies, treatment, and follow-up.

Results: Forty-two patient presentations comprised the overall study group. Thirty-six patients (85.7%) had no evidence of dissemination, and six patients (14.3%) had disseminated disease. Seven of the 36 patient presentations were definitive pulmonary cryptococcosis, 15 were presumptive disease, and 14 were colonization with C neoformans. Neither the baseline demographic parameters nor the immune status appeared to discriminate the patients with disease from the patients with colonization. A serum cryptococcal antigen (sCRAG) was positive for 7 of 18 patients, 3 of whom were proven by culture to have a disseminated infection. A negative sCRAG was observed in 11 patients, one of whom had proven dissemination. Fifteen patients underwent a lumbar puncture as part of their evaluation, and cryptococcal meningitis was diagnosed in three of these patients, all of whom had positive blood cultures for C neoformans. The majority of the patients did not receive antifungal therapy.

Conclusion: In the majority of the patients, the lung appeared to be the sole organ involved, and a workup for systemic infection was rarely helpful. A positive sCRAG was not specific for dissemination. Antifungal therapy should be reserved for symptomatic patients, for patients with a positive sCRAG, and for patients with underlying immunosuppression.

Abbreviations: CSF = cerebrospinal fluid; sCRAG = serum cryptococcal antigen


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