Characteristics, Mortality, Associated Variables with Death and Therapeutic Response Among Hiv-Positive, Solid Organ Transplant (SOT), and Non-Hiv-Positive/Non-Transplant (NHNT) Patients with Cryptococcosis: First Multicenter Cohort Study in Brazil.
Francelise Bridi CavassinJosé Ernesto VidalJoão Luiz Baú-CarneiroCássia Silva de Miranda GodoyRenata de Bastos Ascenço SoaresMarcello Mihailenko Chaves MagriDiego Rodrigues FalciCarla Sakuma De OliveiraAna Verena Almeida MendesGiovanni Luís BredaCaroline Martins RegoMaíra Araujo FélixPaula Pacheco KatopodisJulia Raquel da Silva do ÓMirela Pereira Lima AbrãoMariane TabordaTalita Teles Teixeira PereiraFlávio Queiroz-TellesPublished in: Medical mycology (2023)
Cryptococcosis is traditionally associated with immunocompromised patients but is increasingly being identified in those without the human immunodeficiency virus (HIV) or other immunocompetent individuals. We aim to describe the characteristics, mortality, and associated variables with death among hospitalized patients with cryptococcosis in Brazil. This is the first multicenter retrospective cohort study conducted in seven public tertiary Brazilian hospitals. Three hundred eighty-four patients were included; the median age was 39 years and 283 (73.7%) were men. Hosts were 304 (79.2%) HIV-positive, 16 (4.2%) solid organ transplant (SOT), and 64 (16.7%) non-HIV-positive/non-transplanted (NHNT). Central nervous system (CNS) cryptococcosis had a significantly higher number across disease categories, with 313 cases (81.5%). Two hundred and seventy-one (70.6%) patients were discharged home and 113 (29.4%) died during hospitalization. In-hospital mortality among HIV-positive, SOT, and NHNT was 30.3% (92/304), 12.5% (2/16), and 29.7% (19/64), respectively. Induction therapy with conventional AMB mainly in combination with fluconazole (234; 84.2%) was the most used. Only 80 (22.3%) patients received an AMB lipid formulation: liposomal (n = 35) and lipid complex (n = 45). Patients with CNS cryptococcosis had lower mortality (83/313, 26.5%) when compared with the other categories (P = 0.017). Multivariate analysis showed that age and disseminated cryptococcosis had a higher risk of death [odds ratio (OR), 1.03; 95% Confidence Interval (CI), 1.01 to 1.05; P = 0.008 and OR, 1.84; 95% CI, 1.01 to 3.53; P = 0.048, respectively]. Understanding the epidemiology of cryptococcosis in our settings will help to recognize the burden and causes of mortality and identify strategies to improve this scenario.
Keyphrases
- hiv positive
- antiretroviral therapy
- men who have sex with men
- human immunodeficiency virus
- south africa
- end stage renal disease
- hiv infected
- newly diagnosed
- chronic kidney disease
- ejection fraction
- hiv testing
- hepatitis c virus
- risk factors
- peritoneal dialysis
- cardiovascular events
- clinical trial
- candida albicans
- coronary artery disease
- fatty acid