Cryptococcemia According to Immune Status: An Analysis of 65 Critical Cases

INTRODUCTION: Cryptococcemia is associated with poor prognosis among patients with cryptococcosis. However, there are limited data on the clinical features of cryptococcemia, particularly among patients with different immune statuses. This study assessed the largest number of cases diagnosed with cryptococcemia, to the best of our knowledge. METHODS: Demographic and clinical data of patients with positive blood culture results for Cryptococcus were obtained from medical records at the Xiangya Hospital (2010–2019). RESULTS: A total of 65 patients were diagnosed and treated for cryptococcemia, of which 53 (82%) immunosuppressed patients were afflicted with HIV (12%, 8/65), tuberculosis (8%, 5/26), liver cirrhosis (6%, 3/65), chronic renal failure (6%, 3/65), nephrotic syndrome (13%, 7/65), systemic lupus erythematosus (8%, 5/65), chronic glomerulonephritis (11%, 6/65), malignant diseases (19%, 10/65), and diabetes (11%, 6/65). Most patients (85%, 55/65) presented with fever. Other symptoms, such as cough, headache, enlarged lymph nodes, liver, or spleen, and septic shock, were also reported. Typically, the sites of infection included the central nervous system, lung, skin, bone, abdomen, endometrium, lymph node, and blood. Although early systemic antifungal therapy was administered to 61 patients within 48 h of hospitalization, the 60-day mortality rate was higher in the immunosuppressed group (53%) than in the immunocompetent group (8%). CONCLUSIONS: Our study indicated that patients with different immune statuses presented different clinical features. Immunosuppressed patients with cryptococcemia presented a higher risk of mortality with poor prognosis, which required intense attention and treatment in time.