Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012;7(8):e43582.
doi: 10.1371/journal.pone.0043582. Epub 2012 Aug 24.

Comparison and temporal trends of three groups with cryptococcosis: HIV-infected, solid organ transplant, and HIV-negative/non-transplant

Emily W Bratton  1 , Nada El Husseini, Cody A Chastain, Michael S Lee, Charles Poole, Til Stürmer, Jonathan J Juliano, David J Weber, John R Perfect
Affiliations

Comparison and temporal trends of three groups with cryptococcosis: HIV-infected, solid organ transplant, and HIV-negative/non-transplant

Emily W Bratton et al. PLoS One. 2012.

Erratum in

  • PLoS One. 2012;7(10). doi: 10.1371/annotation/a94bc542-6682-4579-a315-57019cef7e0e

Abstract

Background: The Infectious Disease Society of America (IDSA) 2010 Clinical Practice Guidelines for the management of cryptococcosis outlined three key populations at risk of disease: (1) HIV-infected, (2) transplant recipient, and (3) HIV-negative/non-transplant. However, direct comparisons of management, severity and outcomes of these groups have not been conducted.

Methodology/principal findings: Annual changes in frequency of cryptococcosis diagnoses, cryptococcosis-attributable mortality and mortality were captured. Differences examined between severe and non-severe disease within the context of the three groups included: demographics, symptoms, microbiology, clinical management and treatment. An average of nearly 15 patients per year presented at Duke University Medical Center (DUMC) with cryptococcosis. Out of 207 study patients, 86 (42%) were HIV-positive, 42 (20%) were transplant recipients, and 79 (38%) were HIV-negative/non-transplant. HIV-infected individuals had profound CD4 lymphocytopenia and a majority had elevated intracranial pressure. Transplant recipients commonly (38%) had renal dysfunction. Nearly one-quarter (24%) had their immunosuppressive regimens stopped or changed. The HIV-negative/non-transplant population reported longer duration of symptoms than HIV-positive or transplant recipients and 28% (22/79) had liver insufficiency or underlying hematological malignancies. HIV-positive and HIV-negative/non-transplant patients accounted for 89% of severe disease cryptococcosis-attributable deaths and 86% of all-cause mortality.

Conclusions/significance: In this single-center study, the frequency of cryptococcosis did not change in the last two decades, although the underlying case mix shifted (fewer HIV-positive cases, stable transplant cases, more cases with neither). Cryptococcosis had a relatively uniform and informed treatment strategy, but disease-attributable mortality was still common.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: EWB, NEH, MSL, CAC, CP, JJJ and DJW have declared that they have no competing interests. The following authors have the following conflicts to declare: JRP has research grants, consulting and honorariums from Enzon, Pfizer, Merck, Astellas and Schering-Plough. TS does not accept personal compensation of any kind from any pharmaceutical company, though he receives salary support from the UNC Center of Excellence in Pharmacoepidemiology and Public Health and from unrestricted research grants from pharmaceutical companies to UNC. TS also receives research funding as Principal Investigator of the UNC-DEcIDE center from the Agency for Healthcare Research and Quality. However, this does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Annual cases.
Annual frequency of severe and non-severe cryptococcosis cases according to underlying condition (N = 207).
Figure 2
Figure 2. Use of amphotericin B.
Amphotericin B formulation trends over time. Annual percentage of patients receiving lipid formulation amphotericin B (LF AmpB) or deoxycholate amphotericin B (AmpBd) for initial therapy (N = 132).
See this image and copyright information in PMC

References

    1. Casadevall A, Perfect JR (1998) Cryptococcus neoformans. Washington, D.C.: ASM Press. viii, 541 p.
    1. Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, et al. (2010) Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 50: 291–322. - PMC - PubMed
    1. Palella Jr FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, et al. (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 338: 853–860. - PubMed
    1. Rust DM, Jameson G (1998) The novel lipid delivery system of amphotericin B: drug profile and relevance to clinical practice. Oncol Nurs Forum 25: 35–48. - PubMed
    1. Saag MS, Graybill RJ, Larsen RA, Pappas PG, Perfect JR, et al. (2000) Practice guidelines for the management of cryptococcal disease. Infectious Diseases Society of America. Clin Infect Dis 30: 710–718. - PubMed

Publication types

Substances