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Size Matters: Measurement of Capsule Diameter in Cryptococcus neoformans
Published on: February 27, 2018
Risk factors for invasive Cryptococcus neoformans diseases: a case-control study
Ying-Ying Lin1, Stephanie Shiau2, Chi-Tai Fang3
1Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Background:
Cryptococcus neoformans is a ubiquitous environmental fungus that can cause life-threatening meningitis and fungemia, often in the presence of acquired immunodeficiency syndrome (AIDS), liver cirrhosis, diabetes mellitus, or other medical conditions. To distinguish risk factors from comorbidities, we performed a hospital-based, density-sampled, matched case-control study.
Methods:
All new-onset cryptococcal meningitis cases and cryptococcemia cases at a university hospital in Taiwan from 2002-2010 were retrospectively identified from the computerized inpatient registry and were included in this study. Controls were selected from those hospitalized patients not experiencing cryptococcal meningitis or cryptococcemia. Controls and cases were matched by admission date, age, and gender. Conditional logistic regression was used to analyze the risk factors.
Results:
A total of 101 patients with cryptococcal meningitis (266 controls) and 47 patients with cryptococcemia (188 controls), of whom 32 patients had both cryptococcal meningitis and cryptococcemia, were included in this study. Multivariate regression analysis showed that AIDS (adjusted odds ratio [aOR] = 181.4; p < 0.001), decompensated liver cirrhosis (aOR = 8.5; p = 0.008), and cell-mediated immunity (CMI)-suppressive regimens without calcineurin inhibitors (CAs) (aOR = 15.9; p < 0.001) were independent risk factors for cryptococcal meningitis. Moreover, AIDS (aOR = 216.3, p < 0.001), decompensated liver cirrhosis (aOR = 23.8; p < 0.001), CMI-suppressive regimens without CAs (aOR = 7.3; p = 0.034), and autoimmune diseases (aOR = 9.3; p = 0.038) were independent risk factors for developing cryptococcemia. On the other hand, diabetes mellitus and other medical conditions were not found to be risk factors for cryptococcal meningitis or cryptococcemia.
Conclusions:
The findings confirm AIDS, decompensated liver cirrhosis, CMI-suppressive regimens without CAs, and autoimmune diseases are risk factors for invasive C. neoformans diseases.
Insights
Acquired immunodeficiency syndrome (AIDS), liver cirrhosis, and immunosuppressive treatments without calcineurin inhibitors are key risk factors for invasive Cryptococcus neoformans infections. Diabetes mellitus was not identified as a risk factor in this study.
Area of Science:
- Infectious Diseases
- Immunology
- Mycology
Background:
- Cryptococcus neoformans is an environmental fungus causing severe infections like meningitis and fungemia.
- These infections are prevalent in immunocompromised individuals, including those with AIDS, liver cirrhosis, or diabetes.
- Distinguishing risk factors from comorbidities is crucial for understanding disease pathogenesis.
Purpose of the Study:
- To identify independent risk factors for cryptococcal meningitis and cryptococcemia.
- To differentiate between risk factors and comorbidities in patients with invasive Cryptococcus neoformans disease.
Main Methods:
- A hospital-based, density-sampled, matched case-control study was conducted.
- Retrospective data from 2002-2010 on new-onset cryptococcal meningitis and cryptococcemia cases were analyzed.
- Conditional logistic regression was used to determine risk factors, matching cases with controls by admission date, age, and gender.
Main Results:
- Acquired immunodeficiency syndrome (AIDS) was a major risk factor for both conditions (aOR=181.4 for meningitis, aOR=216.3 for fungemia).
- Decompensated liver cirrhosis (aOR=8.5 for meningitis, aOR=23.8 for fungemia) and CMI-suppressive regimens without calcineurin inhibitors (aOR=15.9 for meningitis, aOR=7.3 for fungemia) were significant risk factors.
- Autoimmune diseases were also identified as a risk factor for cryptococcemia (aOR=9.3). Diabetes mellitus was not found to be a risk factor.
Conclusions:
- AIDS, decompensated liver cirrhosis, specific immunosuppressive regimens, and autoimmune diseases are confirmed risk factors for invasive Cryptococcus neoformans diseases.
- The study highlights the importance of immune status and specific comorbidities in susceptibility to cryptococcosis.
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