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Description of Cryptococcosis Following SARS-CoV-2 Infection: A Disease Survey Through the Mycosis Study Group
Jeremey Walker1, Todd McCarty1, Gerald McGwin1
1University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama, USA.
Background:
Invasive fungal infections have been described throughout the COVID-19 pandemic. Cryptococcal disease after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported in several isolated case reports and 1 larger case series. We sought to describe cryptococcal infections following SARS-CoV-2 through establishing a database to investigate underlying risk factors, disease manifestations, and outcomes.
Methods:
We created a crowdsourced call for cases solicited through the Mycoses Study Group Education and Research Consortium, the Centers for Disease Control and Prevention Emerging Infectious Diseases Network, and infectious diseases Twitter groups. Data were collected in a web-based and secure REDCap survey without personal identifiers.
Results:
Sixty-nine cases were identified and submitted by 29 separate institutional sites. Cryptococcosis was diagnosed a median of 22 days (interquartile range, 9-42 days) after SARS-CoV-2 infection. Mortality among those with available follow-up was 72% (26/36) for the immunocompetent group and 48% (15/31) for the immunocompromised group (likelihood ratio, 4.01; P = .045). We observed a correlation between disease manifestation (central nervous system infection, proven/probable disseminated disease, and respiratory) and mortality (P = .002).
Conclusions:
The mortality rate of 59% for patients with cryptococcosis following SARS-CoV-2 is higher than that of modern Cryptococcus cohorts. There was an association between immunocompromised status and cryptococcal disease manifestations as well as mortality. Moreover, our series emphasizes the need for clinical and laboratory assessment of opportunistic infections beyond 30 days when concerning symptoms develop.
Insights
Cryptococcal infections following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) show high mortality, especially in immunocompetent individuals. Early assessment for opportunistic infections is crucial after SARS-CoV-2 diagnosis.
Area of Science:
- Infectious Diseases
- Mycology
- Virology
Background:
- Invasive fungal infections, including cryptococcal disease, have been observed during the COVID-19 pandemic.
- Previous reports on cryptococcosis post-SARS-CoV-2 infection were limited to case reports and a small case series.
Purpose of the Study:
- To establish a database to investigate risk factors, disease manifestations, and outcomes of cryptococcal infections following SARS-CoV-2.
- To describe the clinical characteristics and mortality associated with cryptococcosis in patients with a history of SARS-CoV-2 infection.
Main Methods:
- A crowdsourced call for cases was distributed through professional networks and social media.
- Data were collected via a secure, web-based REDCap survey, ensuring patient anonymity.
- Sixty-nine cases of cryptococcosis following SARS-CoV-2 infection were identified from 29 institutions.
Main Results:
- Cryptococcosis was diagnosed a median of 22 days after SARS-CoV-2 infection.
- Mortality was higher in immunocompetent patients (72%) compared to immunocompromised patients (48%).
- Disease manifestation (CNS, disseminated, respiratory) correlated significantly with mortality (P = .002).
Conclusions:
- The observed 59% mortality rate for cryptococcosis post-SARS-CoV-2 exceeds rates in modern Cryptococcus cohorts.
- Immunocompromised status was associated with specific disease manifestations and increased mortality.
- Clinical and laboratory evaluation for opportunistic infections is recommended beyond 30 days post-SARS-CoV-2 infection if concerning symptoms arise.
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