647. Cryptococcosis Among HIV-Negative, Non-Solid Organ Transplant Patients at Duke University Medical Center (DUMC): 1996-2009
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Cryptococcus causes disease in immune-compromised patients including HIV-positive individuals and solid organ transplant (SOT) recipients. HIV-negative and non-SOT cases of cryptococcosis (crypto) are a diverse patient group that is becoming more prevalent. Our objective was to examine risk factors, management strategies and outcomes among HIV-negative, non-SOT crypto patients at DUMC.

Methods: From 1996-2009, all adult crypto cases admitted and/or treated at DUMC (n=209) were identified. Demographics, risk factors, disease characteristics, treatment and mortality information from the HIV-negative, non-SOT cases (n=76) were used for descriptive statistics and calculating mortality rates. 

Results: Median follow-up time was 0.43 years (range: 3 days – 12.6 years).  Twenty-seven (36%) patients did not have any known risk factor for crypto.  CNS crypto patients (n=31) were treated with AmB induction therapy and 70.9% received a lipid-formulation of AmB sometime during induction.  Twenty-seven (87.1%) received flucytosine (5FC) with AmB induction.  Twenty-six (81.3%) of the 31 pulmonary crypto patients were treated with fluconazole.  Patient mortality was 28.9% (n=22) within one-year of crypto diagnosis and 18.4% (n=14) died directly due to crypto disease.  Comparing the first 7 years (1996-2002) of follow-up to the latter 7 years (2003-2009) and adjusting for age and having ≥1 risk factor for crypto, the rate ratios (RRs) of one-year mortality and mortality due to crypto were significantly higher during the period before 2003 (RR 7.39, 95%CI 2.26-24.2 and RR 12.11, 95%CI 2.94 - 49.7, respectively).  CNS disease, receipt of 5FC, switching initial therapy and steroid exposure did not significantly differ between time periods. 

Conclusion: HIV-negative/non-SOT crypto cases have increased from 1996 to 2009; however there has been a decreasing trend in mortality rates since 2003. Genetic risk factors for crypto disease remain an area for further investigation and improved management strategies need to continue to focus on this group.

Subject Category: M. Mycology including clinical and basic studies of fungal infections

Emily W. Bratton, MSPH , Epidemiology, UNC-Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC
Nada El Husseini, MD , Duke Univ Med Ctr, Durham, NC
Cody A. Chastain, MD , Duke Univ Med Ctr, Durham, NC
Michael S. Lee, MD , Internal Medicine, Brigham and Women's Hospital, Boston, MA
John Perfect, MD, FIDSA , Duke Univ Med Ctr, Durham, NC


E. W. Bratton, None

N. El Husseini, None

C. A. Chastain, None

M. S. Lee, None

J. Perfect, Yes
Merck, Pfizer, Schering/Plough, Enzon, and Astellas: Consultant, Grant Investigator, Research Contractor and Scientific Advisor, Consulting fee and Research support

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