Cryptococcaemia: Clinical features and prognostic factors

S. S. Jean, C. T. Fang, W. Y. Shau, Y. C. Chen, S. C. Chang, P. R. Hsueh, C. C. Hung, K. T. Luh

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Background: Limited data are available on the clinical significance of cryptococcaemia, which occurs in 10-30% of patients with cryptococcal diseases. Aim: To describe the clinical features of cryptococcaemia and identify its prognostic factors. Study design: Retrospective cohort study. Methods: All adult patients with Cryptococcus neoformans isolated from blood culture at the National Taiwan University Hospital, Taipei, 1981-2001, were included. Demographic and clinical information was obtained from medical records. Results: Fifty-two patients were diagnosed and treated for cryptococcaemia. Acquired immunodeficiency syndrome (24/52, 46%), immunosuppressive therapy (12/52, 23%) and decompensated liver cirrhosis (11/52, 21%) were the three major predisposing conditions. Forty-two patients (81%, n = 52) had sepsis, including four patients with septic shock, when blood cultures were obtained. Of the 38 patients in whom lumbar puncture was done, cerebrospinal fluid culture showed meningeal involvement in 32 (84%). The 30-day fatality rate was 37%. Liver cirrhosis, septic shock at presentation, an initial APACHE II score ≥ 20, age ≥ 60 years and female gender were associated with mortality under univariate analysis. Starting antifungal therapy within 48 h after blood culture was associated with improved survival. Under multivariate analysis, liver cirrhosis remained a strong independent predictor of mortality at 30 days after blood culture (HR 16.3, 95%Cl 2.6-101.7, P = 0.003). Discussion: Patients with cryptococcaemia have a high risk of mortality within 30 days. Sepsis and meningeal involvement are common. Those with liver cirrhosis have a particularly poor prognosis.

Original languageEnglish
Pages (from-to)511-518
Number of pages8
JournalQJM
Volume95
Issue number8
Publication statusPublished - Aug 2002
Externally publishedYes

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Liver Cirrhosis
Septic Shock
Mortality
Sepsis
Cryptococcus neoformans
APACHE
Spinal Puncture
Immunosuppressive Agents
Taiwan
Medical Records
Cerebrospinal Fluid
Acquired Immunodeficiency Syndrome
Cohort Studies
Multivariate Analysis
Retrospective Studies
Demography
Survival
Blood Culture
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Jean, S. S., Fang, C. T., Shau, W. Y., Chen, Y. C., Chang, S. C., Hsueh, P. R., ... Luh, K. T. (2002). Cryptococcaemia: Clinical features and prognostic factors. QJM, 95(8), 511-518.

Cryptococcaemia : Clinical features and prognostic factors. / Jean, S. S.; Fang, C. T.; Shau, W. Y.; Chen, Y. C.; Chang, S. C.; Hsueh, P. R.; Hung, C. C.; Luh, K. T.

In: QJM, Vol. 95, No. 8, 08.2002, p. 511-518.

Research output: Contribution to journalArticle

Jean, SS, Fang, CT, Shau, WY, Chen, YC, Chang, SC, Hsueh, PR, Hung, CC & Luh, KT 2002, 'Cryptococcaemia: Clinical features and prognostic factors', QJM, vol. 95, no. 8, pp. 511-518.
Jean SS, Fang CT, Shau WY, Chen YC, Chang SC, Hsueh PR et al. Cryptococcaemia: Clinical features and prognostic factors. QJM. 2002 Aug;95(8):511-518.
Jean, S. S. ; Fang, C. T. ; Shau, W. Y. ; Chen, Y. C. ; Chang, S. C. ; Hsueh, P. R. ; Hung, C. C. ; Luh, K. T. / Cryptococcaemia : Clinical features and prognostic factors. In: QJM. 2002 ; Vol. 95, No. 8. pp. 511-518.
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