The clinical epidemiology of pulmonary cryptococcosis in non-AIDS patients at a tertiary care medical center

Although the lungs are thought to be the portal of entry for Cryptococcus neoformans, pulmonary infection is relatively rare. We examined the clinical presentation, manifestations, and predictors of outcome of pulmonary cryptococcosis (PC) in non-AIDS (acquired immunodeficiency syndrome) patients. Between January 1991 and June 1999, 38 cases of PC were identified for study enrollment: 25 (66%) were solid-organ transplant (SOT) recipients and 13 (34%) were nontransplant (non-SOT) patients. Seventy-two percent of the study patients were symptomatic at the time of diagnosis. Factors associated with cryptococcus-related mortality in SOT and non-SOT patients were acute respiratory failure requiring mechanical ventilation (50% versus 13%, p = 0.04), pleural effusion (57% versus 13%, p = 0.022), and bilateral parenchymal lung disease (35% versus 9%, p = 0.059). A multivariate regression analysis found pleural effusion to be the only factor associated with cryptococcus-related mortality (hazard rate ratio = 5.4; 95% confidence intervals: 1.3-21.9). PC in immunocompromised non-AIDS patients usually presents as symptomatic disease and may have a more rapid clinical course than previously reported. The presence of pleural effusion in these patients is a prognostic marker of poor outcome.