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Clinical Investigations in Critical Care |

Acute Respiratory Failure Associated With Pulmonary Cryptococcosis in Non-AIDS Patients*

Regis A. Vilchez, MD; Peter Linden, MD; Joan Lacomis, MD; Philip Costello, MD; John Fung, MD; Shimon Kusne, MD
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*From the Departments of Medicine (Drs. Vilchez and Kusne), Surgery (Dr. Fung), Critical Care and Anesthesiology (Dr. Linden), and Radiology (Drs. Costello and Lacomis), University of Pittsburgh Medical Center, Pittsburgh, PA.

Correspondence to: Shimon Kusne, MD, University of Pittsburgh Medical Center, Division of Infectious Diseases, 501 Kaufmann Bldg, 3471 Fifth Ave, Pittsburgh, PA 15213; e-mail: kusnes2@msx.upmc.edu



Chest. 2001;119(6):1865-1869. doi:10.1378/chest.119.6.1865
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Purpose: To determine the incidence of acute respiratory failure (ARF) in non-AIDS patients with pulmonary cryptococcosis (PC).

Design: Retrospective cohort study.

Setting: University of Pittsburgh Medical Center, Pittsburgh, PA.

Subjects: All patients in whom PC without HIV infection was diagnosed between February 1989 and March 1999.

Results: Thirty-three patients with PC were identified, and 11 of those patients (33%) developed ARF and comprised the study group. Underlying diseases included solid-organ transplant recipients (seven patients; 64%) and other underlying medical conditions (four patients; 36%). The most common symptoms were cough, shortness of breath, and temperature elevation. Extrapulmonary involvement was seen in six patients (meningitis, four patients; peritonitis, one patient; laryngeal mass, one patient). Six of the 11 patients (55%) died.

Conclusion: ARF may develop in one third of non-AIDS patients with PC. This clinical syndrome is associated with the dissemination to extrapulmonary sites and high mortality rates. PC should be recognized as a possible cause of respiratory failure in non-AIDS patients.

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