1554. Epidemiology and Outcomes of Non-HIV-associated Cryptococcosis at a University Medical Center
Session: Poster Abstract Session: Infections in the Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA Crypto Poster-Upload.pdf (198.2 kB)
  • Background: Cryptococcus is a cause of invasive fungal infections, especially in immunocompromised patients. While up to 90% of cases occur in the context of HIV/AIDS, it has emerged as an important pathogen in other populations.

    Methods: We conducted a single center retrospective cohort study during the 89-month period spanning Jan 2000 through May 2012 to determine epidemiology and outcomes of non-HIV-associated cryptococcosis (CRYPTO). Cases were defined by Mycoses Study Group criteria. Continuous variables were analyzed by student’s T-test, and categorical variables by chi-square or Fisher’s exact test. Multivariable analysis was performed by logistic regression.

    Results: 45 CRYPTO cases were identified; 80% had C. neoformans isolated in culture and the remaining had positive cryptococcal antigen +/- histopathology. The cohort was predominately male (62.2%) and Caucasian (64.4%), with mean age of 57.3 y. The most frequent predisposing conditions were receipt of immunosuppressive therapy (53%), liver failure (28.9%), malignancy (28.9%), and organ transplantation (24.4%). Disseminated CRYPTO occurred in 21 patients (45.7%) involving blood (13.3%), lung (20%), central nervous system (28.8%), bone (4.4%), skin/soft tissue (2.2%), and prostate (2.2%). Empyema (2.2%) and peritonitis (6.7%) occurred only in cirrhotics. In multivariate models, there was a trend toward higher baseline serum creatinine (sCr) in disseminated CRYPTO cases (OR 3.69, CI 0.89-15.3), and use of amphotericin (AmB)-based therapy (OR 36.5, CI 2.31-577) was significantly higher for disseminated CRYPTO. In-hospital mortality was 22.2% and was associated with liver failure (OR 6.15, CI 1.17-32.3) after controlling for age, male gender, sCr, and disseminated CRYPTO.  In-hospital mortality remained associated with liver failure in models examining pulmonary CRYPTO (OR 5.59, CI 1.05-29.7) and receipt of AmB-based therapy (OR 6.19, CI 1.18-32.2).

    Conclusion: At our center, liver failure has emerged as a leading predisposing condition associated with cryptococcosis with distinct clinical presentations.  Furthermore, liver failure is associated with higher in-hospital mortality, indicating that future research efforts should focus on cryptococcal infections in patients with liver disease.

    Sarah Sanders, Sudhir Penugonda, MD MPH, Michael Angarone, DO and Valentina Stosor, MD, Northwestern University Feinberg School of Medicine, Chicago, IL

    Disclosures:

    S. Sanders, None

    S. Penugonda, None

    M. Angarone, None

    V. Stosor, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.