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Cryptococcaemia: clinical features and prognostic factors.

S-S Jean1, C-T Fang, W-Y Shau

  • 1Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

QJM : Monthly Journal of the Association of Physicians
|July 30, 2002
PubMed
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Cryptococcaemia, a serious bloodstream infection, carries a high 30-day mortality risk, especially in patients with liver cirrhosis. Early antifungal treatment improves survival outcomes for this severe fungal infection.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Clinical Medicine

Background:

  • Cryptococcaemia affects 10-30% of patients with cryptococcal diseases, yet clinical significance data remain limited.
  • Understanding risk factors is crucial for managing this opportunistic fungal infection.

Purpose of the Study:

  • To delineate the clinical characteristics of cryptococcaemia.
  • To identify key prognostic factors influencing patient outcomes.

Main Methods:

  • Retrospective cohort study design.
  • Analysis of adult patients with *Cryptococcus neoformans* bloodstream infections from 1981-2001.
  • Collection and review of demographic and clinical data from medical records.

Main Results:

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  • Fifty-two patients were identified with cryptococcaemia, frequently associated with acquired immunodeficiency syndrome (46%), immunosuppressive therapy (23%), and liver cirrhosis (21%).
  • Sepsis (81%) and meningeal involvement (84% of those with lumbar puncture) were common.
  • The 30-day mortality rate was 37%, with liver cirrhosis, septic shock, high APACHE II scores, older age, and female gender predicting mortality. Early antifungal therapy improved survival.

Conclusions:

  • Cryptococcaemia is associated with substantial 30-day mortality.
  • Sepsis and central nervous system involvement are frequent complications.
  • Liver cirrhosis emerges as a significant independent predictor of poor prognosis in cryptococcaemia.