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Published on: December 19, 2014

Cryptococcosis in apparently immunocompetent patients

G Lui1, N Lee, M Ip

  • 1Division of Infectious Diseases, Department of Medicine and Therapeutics, 9/F Clinical Sciences Building, Prince of Wales Hospital, Hong Kong.

QJM : Monthly Journal of the Association of Physicians
|March 1, 2006
PubMed

Insights

Cryptococcosis affects immunocompetent individuals, often presenting as indolent meningitis with better outcomes. This fungal infection requires careful diagnosis and management in all patient groups.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Clinical Microbiology

Background:

  • Cryptococcosis is a fungal infection with limited reported data on immunocompetent patients.
  • Understanding cryptococcosis in immunocompetent individuals is crucial due to its potential impact.

Purpose of the Study:

  • To compare the clinical presentations and outcomes of cryptococcosis between immunocompetent and immunocompromised patients.
  • To identify differences in disease manifestation and prognosis based on immune status.

Main Methods:

  • A retrospective case series of 46 confirmed cryptococcosis cases in Hong Kong hospitals (1995-2005).
  • Data collected included clinical presentations, fungemia rates, cerebrospinal fluid (CSF) parameters, and outcomes.
  • Cases were categorized into immunocompetent, immunocompromised (non-HIV), and HIV-positive groups.

Main Results:

  • Nearly half (43.5%) of patients were immunocompetent, with *Cryptococcus gattii* being a common cause in this group.
  • Immunocompetent patients more frequently presented with meningitis (80.0%) and showed a trend towards lower fungemia (10.0%) and mortality rates (25.0%).
  • In cryptococcal meningitis, immunocompetent patients experienced longer onset-to-presentation times, more intense inflammatory responses, less fungemia, and better clinical outcomes (81.3%) compared to immunocompromised patients (46.7%).

Conclusions:

  • A significant portion of cryptococcosis cases occur in apparently immunocompetent individuals.
  • Both *Cryptococcus neoformans* var. *grubii* and *Cryptococcus gattii* are identified as common causative agents.
  • Immunocompetent patients typically exhibit localized, indolent neurological disease with robust inflammatory responses but favorable prognoses.
Abstract

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