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Pulmonary cryptococcosis in nonimmunocompromised patients
Hassan F Nadrous1, Vera S Antonios, Christine L Terrell
1Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Chest
|December 11, 2003
Summary
Observation without antifungal therapy is a reasonable option for nonimmunocompromised individuals with pulmonary cryptococcosis. Most patients experienced disease resolution, indicating spontaneous recovery is common in these cases.
Area of Science:
- Pulmonology
- Infectious Diseases
- Mycology
Background:
- Cryptococcus neoformans can cause severe systemic infections in immunocompromised individuals, necessitating antifungal treatment.
- Isolated pulmonary cryptococcosis in nonimmunocompromised hosts may resolve spontaneously without intervention.
Purpose of the Study:
- To investigate the role and efficacy of antifungal therapy in managing isolated pulmonary cryptococcosis among nonimmunocompromised patients.
Main Methods:
- A retrospective study was conducted at a tertiary care referral medical center.
- Data were analyzed for 36 nonimmunocompromised subjects diagnosed with isolated pulmonary cryptococcosis between 1976 and 2001.
- No specific antifungal interventions were mandated for the study cohort.
Main Results:
- Of 36 patients with isolated pulmonary cryptococcosis, 92% (23/25) achieved disease resolution or improvement during follow-up.
- Resolution occurred with no treatment (8 patients), surgical resection alone (6 patients), or antifungal therapy (9 patients).
- No treatment failures, relapses, dissemination, or deaths were documented in the observed patients.
Conclusions:
- Initial observation without antifungal therapy is a viable management strategy for nonimmunocompromised patients with pulmonary cryptococcosis.
- This approach is suitable when systemic symptoms or signs of dissemination are absent, and also post-surgical resection for focal pneumonia.