1523. Cryptococcosis in Patients with Cirrhosis: A Review of Cryptococcal Cases Among Hospitalized Patients from 1992-2013 at an Academic Transplant Center in Massachusetts
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Crypto IDSA Poster Draft-final.pdf (298.7 kB)
  • Background: Cirrhosis is a recognized risk factor for cryptococcal infection (CI) and published case series indicate a high mortality. Limited data are available comparing clinical features and outcome of CI in patients with cirrhosis vs. patients with other underlying risk factors. The purpose of this study is to describe and compare the clinical presentation and outcome of CI among cirrhotic vs. non-cirrhotic patients.

    Methods: Patients hospitalized from January 1992 to April 2013 with CI were identified using ICD-9 codes and microbiology and pathology databases. Annual changes in frequency of CI, patient demographics, underlying risk factors, etiology of liver disease if present, symptoms, microbiology, treatment, side effects and outcome information were collected and compared among patients with and without cirrhosis.

    Results: Among 77 patients identified with CI, 44(57%) were HIV infected, 19(24%) were non-HIV/non-transplant/non-cirrhotic, 12(16%) had cirrhosis and 2(3%) were transplant recipients. CNS infection was present in 59(77%) and 12(16%) had lung involvement. Five of 12 cirrhotics had autoimmune hepatitis and were on immunosuppression. Among 12 cirrhotics, 7 had CNS infection, 3 had antigenemia alone and 2 had lung lesions. Median age (years) for cirrhotics was higher than non-cirrhotics (56 vs. 42; p<0.05). No significant difference in proportion of severe CI was observed (67% vs. 82%; p=0.25). Cirrhotics had significantly higher proportion of hypotension (50% vs. 6%; p<0.05), renal insufficiency (67% vs. 11%; p<0.05) and post-treatment renal insufficiency (67% vs. 23%; p<0.05) compared to the non-cirrhotic group. We observed a higher 2-month mortality (58% vs. 12%; p<0.05) among cirrhosis patients. Of 12 patients with cirrhosis, 5 died within 2 months despite treatment, 4 underwent liver transplant. Three of the 4 have survived and the other died of bacterial sepsis. The proportion of CI cases with HIV decreased and with cirrhosis increased over the study period.

    Conclusion: In our limited sample, cirrhotic patients with CI have certain distinct clinical manifestations and complications associated with treatment compared to non-cirrhotics. We observed high mortality in cirrhotic patients with CI, however in some patients this diagnosis does not seem to preclude eventual successful liver transplant.

    Thrissawan Sungkapalee, MD1, Sumanth Gandra, MD, MPH1, Sonia Chimienti, MD1, Stuart Levitz, MD, FIDSA1, Adel Bozorgzadeh, MD2 and Jennifer Daly, MD, FIDSA1, (1)Infectious Disease and Immunology, University of Massachusetts Medical School, Worcester, MA, (2)Transplant Surgery, University of Massachusetts Medical School, Worcester, MA

    Disclosures:

    T. Sungkapalee, None

    S. Gandra, None

    S. Chimienti, None

    S. Levitz, None

    A. Bozorgzadeh, None

    J. Daly, None

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