Clinical characteristics and mortality risk factors of cryptococcal infection among HIV-negative patients

Describe the clinical characteristics, treatment, outcomes, complications, and factors associated with mortality of cryptococcosis in HIV-negative patients.

A retrospective cohort study was conducted among HIV-negative adult patients with positive culture for Cryptococcus neoformans between 2005 and 2010.

Forty-nine HIV-negative patients were identified with median (IQR) age of 62.5 (45.5-71.9) years of which 40.8% were male. The common underlying medical conditions were cardiovascular diseases (36.7%). The common sites of positive culture were cerebrospinal fluid/intracerebral abscess (46.9%), blood (36%), and sputum/bronchoalveolar larvage fluid (28.6%). Twenty-nine (59.2%) patients had co-infections with another organism, such as Gram-negative bacteria (24.4%), M. tuberculosis (17.8%), and Gram-positive bacteria (13.3%). The common clinical presentations were fever (67.3%), alteration of consciousness (34.7%), and headache (26.5%). Complication was detected in 61.2% such as acute kidney injury (47.0%), coma (38.8%), and shock (22.4%). The overall mortality was 51%. By multivariate logistic regression, factors associated with mortality were alteration of consciousness (adjusted OR = 6.85; 95% CI: 1.41-33.28, p = 0.017) and co-infections (adjusted OR = 5.32; 95% CI: 1.25-22.69, p = 0.024).

The mortality rate of HIV-negative patients with cryptococcosis is very high. Early recognition and treatment of cryptococcosis in HIV-negative patients are crucial and may improve the outcome.