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Cryptococcosis in patients with cancer
D P Kontoyiannis1, W K Peitsch, B T Reddy
1Department of Internal Medicine Specialties, Section of Infectious Diseases, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. dkontoyi@notes.mdacc.tmc.edu
Summary
Cryptococcosis is rare in cancer patients without HIV, but diagnosis can be challenging. However, invasive procedures offer good diagnostic yield, and fluconazole monotherapy shows high success rates.
Area of Science:
- Infectious Diseases
- Oncology
- Medical Mycology
Background:
- Cryptococcosis is an opportunistic fungal infection, typically associated with human immunodeficiency virus (HIV) infection.
- Its occurrence in non-HIV cancer patients is less common, making its presentation and management in this population a critical area of study.
Purpose of the Study:
- To retrospectively review cases of cryptococcosis in cancer patients without known HIV infection.
- To analyze the clinical presentations, diagnostic challenges, and treatment outcomes of this rare condition.
Main Methods:
- Retrospective review of 31 cancer patients with culture-proven cryptococcosis between 1989-1999.
- Analysis of patient demographics, underlying conditions (hematologic malignancy, lymphopenia, steroid use), clinical manifestations, diagnostic methods, and treatment responses.
Main Results:
- Hematologic malignancy (65%) was the most common underlying disease; lymphopenia (61%) and prior steroid use (51%) were frequent comorbidities.
- Pulmonary cryptococcosis was most common (19 patients), with initial misdiagnosis as malignancy occurring frequently.
- Invasive diagnostic procedures showed good yield for pulmonary and meningeal disease; fluconazole monotherapy achieved 92% success.
Conclusions:
- Cryptococcosis is a rare but significant complication in cancer patients lacking HIV infection.
- Despite diagnostic challenges, invasive procedures and targeted antifungal therapy, particularly fluconazole, lead to favorable outcomes.