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Manifestations of pulmonary cryptococcosis in patients with acquired immunodeficiency syndrome
M L Cameron1, J A Bartlett, H A Gallis
1Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Abstract:
Cryptococcosis is a common opportunistic infection in patients with AIDS. Meningitis is the most frequent manifestation of infection with Cryptococcus neoformans; pneumonia due to this organism, though less frequently recognized, is also a significant entity. A retrospective review was performed of all patients seen at Duke University Medical Center between January 1981 and July 1989 who were infected with both human immunodeficiency virus type 1 and C. neoformans. Of 31 patients with these concomitant infections, 12 had cryptococcal pneumonia (10 definite and two presumptive cases). Eleven of these 12 patients had evidence of extrapulmonary cryptococcal disease as well. Chest radiography showed interstitial infiltrates in 11 instances. For ten of the 12 patients, pulmonary cultures were positive for C. neoformans. Bronchoalveolar lavage fluid from all five patients who underwent bronchoscopy yielded the organism. Acute-phase mortality from cryptococcosis was 42% among patients with pneumonia. Cryptococcal pneumonia in patients with AIDS is probably more common than has previously been recognized and typically presents as interstitial disease that may mimic other opportunistic infections.
Insights
Cryptococcal pneumonia is an underrecognized opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). This condition often presents as interstitial lung disease and is associated with a high mortality rate.
Area of Science:
- Infectious Diseases
- Pulmonology
- Immunology
Background:
- Cryptococcosis is a significant opportunistic infection in individuals with acquired immunodeficiency syndrome (AIDS).
- While cryptococcal meningitis is the most common presentation, pulmonary involvement is also a critical, though less recognized, manifestation.
- Human immunodeficiency virus type 1 (HIV-1) and Cryptococcus neoformans coinfection necessitates understanding diverse clinical presentations.
Purpose of the Study:
- To investigate the incidence and characteristics of cryptococcal pneumonia in patients coinfected with HIV-1 and C. neoformans.
- To describe the clinical and radiographic features of this pulmonary manifestation.
- To assess the mortality associated with cryptococcal pneumonia in this patient population.
Main Methods:
- Retrospective review of patients coinfected with HIV-1 and C. neoformans at Duke University Medical Center (January 1981–July 1989).
- Analysis of clinical data, chest radiography, pulmonary cultures, and bronchoalveolar lavage findings.
- Evaluation of mortality rates within the acute phase of cryptococcal infection.
Main Results:
- Twelve of 31 (38.7%) patients with HIV-1 and C. neoformans coinfection had cryptococcal pneumonia.
- Eleven of these 12 patients also exhibited extrapulmonary cryptococcal disease.
- Chest radiography revealed interstitial infiltrates in 11 cases, and pulmonary cultures were positive in 10 patients.
Conclusions:
- Cryptococcal pneumonia in AIDS patients is likely more prevalent than previously thought.
- The condition typically manifests as interstitial lung disease, potentially mimicking other opportunistic infections.
- A significant acute-phase mortality rate of 42% was observed among patients with cryptococcal pneumonia.