964. Features of Cryptococcosis in Non-Immunocompromised Patients
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Cryptococcosis (crypto) in phenotypically normal, non-immunocompromised (non-IC) pts presents diagnostic and therapeutic challenges, and data addressing these issues are lacking.  In Canada and the US, the decline in HIV-associated crypto due to ART use and emergence of C. gattii emphasize the importance of characterizing non-IC pts with crypto to engender better understanding of clinical features and outcomes.

Methods: We conducted a retrospective cohort study of all pts at UAB diagnosed with crypto from 1998 – 2009.  Data collected included demographics, underlying conditions, clinical features, diagnostics, treatment, and outcomes.  Non-IC and IC pts were compared using chi-square analysis.

Results: Among 237 pts with crypto, 33 (14%) were non-IC.  Please see table 1 for the remainder of the results.

Table 1. Results of comparisons between IC and non-IC patients with crypto

Characteristic

IC

Non-IC

P-value

 

N=204

N=33

 

Mean age, years (SD)

49 (14.7)

48 (15.7)

0.689

Male gender (%)

139 (68)

21 (64)

0.609

Caucasian

109 (53)

26 (79)

0.006

Site of involvement (%)

 

 

 

CNS

138 (68)

22 (67)

0.911

Cryptococcemia

76 (37)

1 (3)

<0.001

Pulmonary

49 (24)

13 (39)

0.062

Clinical presentation (%)

 

 

 

Headache

103 (50)

16 (48)

0.831

Fever

78 (38)

8 (24)

0.121

Altered mental status

68 (33)

5 (15)

0.036

Mean length of symptoms (LOS), days

36

91

<0.001

Serum crypto antigen (CrAg) ≥ 1:512 (%)

62 (30)

3 (9)

0.011

CSF CrAg ≥ 1:512 (%)

58 (28)

5 (15)

0.109

Mean opening pressure (OP), cm H2O

30

35

0.266

Mean CSF WBC, cells/mm3

70

304

<0.001

Mean CSF glucose, mg/dL

48

37

0.100

Mean CSF protein, mg/dL

127

182

0.372

Permanent CSF shunt (%)

17 (12)

10 (45)

<0.001

One-year mortality (%)

61 (30)

6 (18)

0.165

Conclusion: Symptom duration, CSF pleocytosis, and requirement for permanent CSF shunting were significantly greater in non-IC pts compared to IC pts with crypto.  These findings suggest a difference in host response which may in part explain differences in clinical presentation, management, and outcome between these two groups.


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

Kyle Brizendine, MD, Department of Medicine Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, John Baddley, MD, MSPH, Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL and Peter Pappas, MD, Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL

Disclosures:

K. Brizendine, None

J. Baddley, Pfizer: Consultant and Grant Investigator, Consulting fee
Merck: Scientific Advisor, Consulting fee
Abbott: Scientific Advisor, Consulting fee

P. Pappas, Pfizer: Research Contractor, Research support
Merck: Research Contractor, Research support
Schering Plough: Research Contractor, Research support
Astellas: Research Contractor, Research support

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