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Published on: September 1, 2015

Cryptococcosis and idiopathic CD4 lymphocytopenia

Dimitrios I Zonios1, Judith Falloon, Chiung-Yu Huang

  • 1From Clinical Mycology Section, Laboratory of Clinical Infectious Diseases (DIZ, JEB); Laboratory of Immunoregulation (JF); and Biostatistics Research Branch (C-YH), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; and Critical Care Medicine Department (DC), Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland.

Medicine
|April 17, 2007
PubMed

Insights

Idiopathic CD4 lymphocytopenia (ICL) patients with cryptococcosis show a male predominance and a median age of 41. Identification of ICL predicts a favorable outcome and increased risk of dermatomal zoster.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Neurology

Background:

  • Cryptococcosis is a serious fungal infection, particularly in immunocompromised individuals.
  • Idiopathic CD4 lymphocytopenia (ICL) is a condition characterized by a low CD4+ T-cell count without an identifiable cause.
  • Understanding the interplay between cryptococcosis and ICL is crucial for patient management.

Purpose of the Study:

  • To characterize the clinical features of cryptococcosis in patients with idiopathic CD4 lymphocytopenia (ICL).
  • To compare the presentation and outcomes of cryptococcosis in ICL patients with those in immunocompetent individuals.
  • To assess the prognostic value of identifying ICL in patients with cryptococcal infections.

Main Methods:

  • A retrospective review of 11 patients with cryptococcosis and ICL at a single institution.
  • Inclusion of 42 similar cases from existing literature for a total cohort of 53 patients.
  • Analysis of demographic data, clinical presentation, cerebrospinal fluid findings, CD4 counts, and patient outcomes.

Main Results:

  • The ICL cohort had a slight male predominance and a median age of 41 years.
  • Cerebrospinal fluid analysis revealed common abnormalities, including low glucose and elevated protein.
  • Patients with ICL experienced an increased incidence of dermatomal zoster, but Pneumocystis pneumonia was rare.
  • A favorable outcome was observed more frequently in ICL patients compared to previously normal individuals with cryptococcal meningitis.

Conclusions:

  • Identifying ICL in patients with cryptococcosis is valuable as it predicts a favorable prognosis.
  • Patients with cryptococcosis and ICL have a higher likelihood of developing dermatomal zoster.
  • Long-term follow-up suggests a generally favorable prognosis for cryptococcosis in the context of ICL.

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