Journal Article

Cryptococcosis in Human Immunodeficiency Virus-Negative Patients in the Era of Effective Azole Therapy

Peter G. Pappas, John R. Perfect, Gretchen A. Cloud, Robert A. Larsen, George A. Pankey, Daniel J. Lancaster, Harold Henderson, Carol A. Kauffman, David W. Haas, Michael Saccente, Richard J. Hamill, Melissa S. Holloway, Robert M. Warren and William E. Dismukes

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 33, issue 5, pages 690-699
Published in print September 2001 | ISSN: 1058-4838
Published online September 2001 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/322597
Cryptococcosis in Human Immunodeficiency Virus-Negative Patients in the Era of Effective Azole Therapy

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We conducted a case study of human immunodeficiency virus (HIV)-negative patients with cryptococcosis at 15 United States medical centers from 1990 through 1996 to understand the demographics, therapeutic approach, and factors associated with poor prognosis in this population. Of 306 patients with cryptococcosis, there were 109 with pulmonary involvement, 157 with central nervous system (CNS) involvement, and 40 with involvement at other sites. Seventy-nine percent had a significant underlying condition. Patients with pulmonary disease were usually treated initially with fluconazole (63%); patients with CNS disease generally received amphotericin B (92%). Fluconazole was administered to approximately two-thirds of patients with CNS disease for consolidation therapy. Therapy was successful for 74% of patients. Significant predictors of mortality in multivariate analysis included age ⩾60 years, hematologic malignancy, and organ failure. Overall mortality was 30%, and mortality attributable to cryptococcosis was 12%. Cryptococcosis continues to be an important infection in HIV-negative patients and is associated with substantial overall and cause-specific mortality.

Journal Article.  5439 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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