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Multicenter Study
. 2007 Feb;4(2):e21.
doi: 10.1371/journal.pmed.0040021.

Determinants of disease presentation and outcome during cryptococcosis: the CryptoA/D study

Françoise Dromer  1 , Simone Mathoulin-Pélissier, Odile Launay, Olivier Lortholary; French Cryptococcosis Study Group
Affiliations
Multicenter Study

Determinants of disease presentation and outcome during cryptococcosis: the CryptoA/D study

Françoise Dromer et al. PLoS Med. 2007 Feb.

Abstract

Background: Cryptococcosis is a life-threatening opportunistic fungal infection in both HIV-positive and -negative patients. Information on clinical presentation and therapeutic guidelines, derived mostly from clinical trials performed before introduction of highly active antiretroviral therapy in patients with cryptococcal meningoencephalitis, is missing data on extrameningeal involvement and infections by serotype D as opposed to serotype A of Cryptococcus neoformans.

Methods and findings: The prospective multicenter study CryptoA/D was designed in France (1997-2001) to analyse the factors influencing clinical presentation and outcome without the bias of inclusion into therapeutic trials. Of the 230 patients enrolled, 177 (77%) were HIV-positive, 50 (22%) were female, and 161 (72.5%) were infected with serotype A. Based on culture results at baseline, cryptococcosis was more severe in men, in HIV-positive patients, and in patients infected with serotype A. Factors independently associated with mycological failure at week 2 independent of HIV status were initial dissemination (OR, 2.4 [95% confidence interval (CI), 1.2-4.9]), high (>1:512) serum antigen titre (OR, 2.6 [1.3-5.4]), and lack of flucytosine during induction therapy (OR, 3.8 [1.9-7.8]). The three-month survival was shorter in patients with abnormal neurology or brain imaging at baseline, and in those with haematological malignancy.

Conclusions: Thus sex, HIV status, and infecting serotype are major determinants of presentation and outcome during cryptococcosis. We propose a modification of current guidelines for the initial management of cryptococcosis based on systematic fungal burden evaluation.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Number of Patients Alive, Assessable, and Dead at Each Study Point
Data are from the French prospective multicentre CryptoA/D study. Pts, patients.
Figure 2
Figure 2. Overall Survival at Three Months after the Diagnosis of Cryptococcosis
(A) Patients presenting with and without abnormal neurology at baseline. (B) Patients with and without haematological malignancies. (C) Patients presenting with and without abnormal brain imaging at baseline (data missing for 39 patients).
See this image and copyright information in PMC

Comment in

References

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