1822. Cryptococcal Disease is Associated with Low Incidence but High Mortality in Patients with Cirrhosis
Session: Oral Abstract Session: Fungal Infections
Saturday, October 5, 2013: 2:45 PM
Room: The Moscone Center: 300
Background: Cryptococcal meningitis and disseminated cryptococcal disease are most often associated with the HIV infected population. Cirrhosis has been cited as a risk factor with high mortality rates reported in small case series and literature reviews.  This has not been evaluated in larger prospective case series.   The incidence of cryptococcosis in this population is not well described, nor has the potential for antifungal prophylaxis been investigated.

 Methods: We conducted a retrospective review of patients enrolled in a cryptococcal disease database between 1/1/2003 and 12/31/2012.  MELD (Model for End-stage Liver Disease) scores were determined for each case.  Diagnosis codes for any patient seen in the MUSC system with an underlying diagnosis of HIV (042) or cirrhosis (571.2, 571.5, 571.6) were used as denominator data for incidence calculations.

Results: Among 87cases of cryptococcosis, 12 patients with coexisting cirrhosis were identified.  Two patients were HIV coinfected, and had MELD scores below 15, the lower limit for liver transplant eligibility. The remaining 10 patients had no other risk factors for cryptococcosis, and all had MELD scores >15 (range 19-43). The incidence of cryptococcal disease in all patients (n=7173) with cirrhosis was 0.18% over the 10 years studied. Mortality in these patients was 83.3% (10/12), and was 100% (10/10) in patients without HIV coinfection. Incidence in the HIV infected population (n=3206) was 1.37% over the same time period, with an observed mortality of 31.4% (11 of 35).

Conclusion: Cryptococcal disease in patients with liver cirrhosis as a primary risk factor is associated with very high mortality, but is relatively rare in this population.  MELD scores >15, as a marker of severe liver disease, may better define those at risk.

E Chandler Church, BSPH, Medical University of South Carolina, Charleston, SC, L.W. Preston Church, MD, Ralph H. Johnson VAMC, Charleston, SC; Infectious Diseases, MED. UNIV. OF SOUTH CAROLINA, Charleston, SC and Dannah Wray, MD, Infectious Diseases, Medical Univ. of South Carolina, Charleston, SC


E. C. Church, None

L. W. P. Church, None

D. Wray, None

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