To determine the role of antifungal therapy in the management of isolated pulmonary cryptococcosis in non-immunocompromised hosts.
Cases of cryptococcal infections diagnosed at Mayo Clinic Rochester, MN from 1976 to 2001 were identified. Non-immunocompromised patients with isolated pulmonary cryptococcosis were included in the study. Pulmonary cryptococcosis was defined by either: 1) histopathologic presence of the organism on a lung biopsy, or 2) a positive culture of a respiratory specimen or positive serum cryptococcal antigen test with clinical or radiographic evidence of active pulmonary infection. The following data were abstracted from the medical records: age, sex, clinical features, radiologic and laboratory studies, diagnostic tests, antifungal and surgical therapy, and follow up information. Final outcome was classified into resolution, improvement, relapse, or failure according to preset criteria.
Thirty-six patients had isolated pulmonary cryptococcosis. Their mean age was 61± 15 years and included 17 males and 19 females. Twenty-four patients were symptomatic and 12 were asymptomatic. Most common presenting symptoms were cough, dyspnea, and fever. Cerebrospinal fluid examination was performed in 11 patients (31%) and was negative in all of them. Follow-up information was available on 25 patients (69%) with a median duration of 19 months (range, 1 to 330 months). Twenty-three of these patients (92%) had resolution of their disease; eight had received no treatment, six had undergone surgical resection only, and nine received antifungal therapy. Two remaining patients had improved. There was no documented treatment failure, relapse, dissemination or death in any of these 25 patients.CONCLUSIONS: The majority of non-immunocompromised patients with isolated pulmonary cryptococcosis had resolution of their disease without antifungal therapy.
An initial period of observation without antifungal therapy is a reasonable option for non-immunocompromised subjects with pulmonary cryptococcosis in the absence of severe symptoms or evidence of dissemination.
H.F. Nadrous, None.