Coussement, Julien

Heath, Christopher H

Roberts, Matthew B

Lane, Rebekah J

Spelman, Tim

Smibert, Olivia C

Longhitano, Anthony

Morrissey, Orla

Nield, Blake

Tripathy, Monica

Davis, Joshua S

Kennedy, Karina J

Lynar, Sarah

Crawford, Lucy

Crawford, Simeon J

Smith, Benjamin J

Gador-Whyte, Andrew P

Haywood, Rose

Mahony, Andrew A

Howard, Julia C

Walls, Genevieve B

O'Kane, Gabrielle M

Broom, Matthew T

Keighley, Caitlin L

Bupha-Intr, Olivia

Cooley, Louise

O'Hern, Jennifer A

Jackson, Justin D

Morris, Arthur J

Bartolo, Caroline

Tramontana, Adrian R

Grimwade, Katherine C

Au Yeung, Victor

Chean, Roy

Woolnough, Emily

Teh, Benjamin W

Chen, Sharon C A

Slavin, Monica A

2023-10-05

BACKGROUND: Patients without human immunodeficiency virus (HIV) are increasingly recognized as being at risk for cryptococcosis. Knowledge of characteristics of cryptococcosis in these patients remains incomplete. METHODS: We conducted a retrospective study of cryptococcosis in 46 Australian and New Zealand hospitals to compare its frequency in patients with and without HIV and describe its characteristics in patients without HIV. Patients with cryptococcosis between January 2015 and December 2019 were included. RESULTS: Of 475 patients with cryptococcosis, 90% were without HIV (426 of 475) with marked predominance in both Cryptococcus neoformans (88.7%) and Cryptococcus gattii cases (94.3%). Most patients without HIV (60.8%) had a known immunocompromising condition: cancer (n = 91), organ transplantation (n = 81), or other immunocompromising condition (n = 97). Cryptococcosis presented as incidental imaging findings in 16.4% of patients (70 of 426). The serum cryptococcal antigen test was positive in 85.1% of tested patients (319 of 375); high titers independently predicted risk of central nervous system involvement. Lumbar puncture was performed in 167 patients to screen for asymptomatic meningitis, with a positivity rate of 13.2% where meningitis could have been predicted by a high serum cryptococcal antigen titer and/or fungemia in 95% of evaluable cases. One-year all-cause mortality was 20.9% in patients without HIV and 21.7% in patients with HIV (P = .89). CONCLUSIONS: Ninety percent of cryptococcosis cases occurred in patients without HIV (89% and 94% for C. neoformans and C. gattii, respectively). Emerging patient risk groups were evident. A high level of awareness is warranted to diagnose cryptococcosis in patients without HIV.

Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.

Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.

Department of Microbiology, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, Washington, Australia.

Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.

Department of Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia.

Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Flinders Medical Centre, Bedford Park, South Australia, Australia.

Te Toka Tumai, Auckland, New Zealand.

Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.

Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.

Burnet Institute, Melbourne, Victoria, Australia.

University of Melbourne Department of Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.

Austin Health, Heidelberg, Victoria, Australia.

Monash Health, Clayton, Victoria, Australia.

Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia.

Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.

Gold Coast Hospital and Health Service, Southport, Queensland, Australia.

John Hunter Hospital, Newcastle, New South Wales, Australia.

ACT Pathology, Canberra Health Services, Canberra, Australian Capital Territory, Australia.

Royal Darwin and Palmerston Hospitals, Darwin, Northern Territory, Australia.

Menzies School of Health Research, Darwin, Northern Territory, Australia.

Wollongong Hospital, Wollongong, New South Wales, Australia.

Eastern Health, Box Hill, Victoria, Australia.

St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.

Prince of Wales Hospital, Sydney, New South Wales, Australia.

Bendigo Health, Bendigo, Victoria, Australia.

Te Whatu Ora Waikato, Hamilton, New Zealand.

Middlemore Hospital, Te Whatu Ora Counties Manukau, Auckland, New Zealand.

Gosford Hospital, Gosford, New South Wales, Australia.

Wyong Hospital, Hamlyn Terrace, New South Wales, Australia.

North Shore Hospital, Auckland, New Zealand.

Waitakere Hospital, Auckland, New Zealand.

Southern IML Pathology, Wollongong, New South Wales, Australia.

Capital, Coast and Hutt Valley District, Wellington, New Zealand.

Royal Hobart Hospital, Hobart, Tasmania, Australia.

Launceston General Hospital, Launceston, Tasmania, Australia.

Albury Wodonga Health, Albury, Victoria, Australia.

Barwon Health, Geelong, Victoria, Australia.

Western Health, Footscray, Victoria, Australia.

Western Clinical School, Melbourne Medical School, University of Melbourne, St. Albans, Victoria, Australia.

Tauranga Hospital, Hauora a Toi Bay of Plenty, Tauranga, New Zealand.

Whakatane Hospital, Hauora a Toi Bay of Plenty, Whakatane, New Zealand.

Ballarat Health Services, Ballarat, Victoria, Australia.

Latrobe Regional Hospital, Traralgon, Victoria, Australia.

St. John of God Midland Public and Private Hospital, Midland, Western Australia, Australia.

Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.

Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia.

Clin Infect Dis. 2023 Oct 5;77(7):976-986. doi: 10.1093/cid/ciad321.

0000-0002-4302-6599

https://pubmed.ncbi.nlm.nih.gov/37235212/?otool=iaurydwlib

https://hdl.handle.net/10137/12595

77

Humans

HIV

Retrospective Studies

New Zealand/epidemiology

Australia/epidemiology

*Cryptococcosis/diagnosis/epidemiology

*Cryptococcus neoformans

*Cryptococcus gattii

*Meningitis

Hospitals

Antigens, Fungal

*HIV Infections/complications/epidemiology

Current Epidemiology and Clinical Features of Cryptococcus Infection in Patients Without Human Immunodeficiency Virus: A Multicenter Study in 46 Hospitals in Australia and New Zealand.

Journal Article

Publication