Cargando…

Clinical features of cryptococcosis in patients with different immune statuses: a multicenter study in Jiangsu Province–China

BACKGROUND: Current guidelines support different management of cryptococcosis between severely immunodeficient and immunocompetent populations. However, few studies have focused on cryptococcosis patients with mild-to-moderate immunodeficiency. We performed this study to determine the clinical featu...

Descripción completa

Detalles Bibliográficos
Autores principales: Wang, Yu, Gu, Yu, Shen, Kunlu, Cui, Xuefan, Min, Rui, Sun, Siqing, Feng, Chunlai, Chen, Yanbin, Wang, Li, Cao, Min, Yang, Jian, Yao, Jian, Xu, Jing, Lin, Dang, Tao, Yujian, Ma, Guoer, Shi, Jiaxin, Chen, Bilin, Ni, Yueyan, Zhong, Huanhuan, Shi, Yi, Su, Xin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8499499/
https://www.ncbi.nlm.nih.gov/pubmed/34625036
http://dx.doi.org/10.1186/s12879-021-06752-x
_version_ 1784580320326057984
author Wang, Yu
Gu, Yu
Shen, Kunlu
Cui, Xuefan
Min, Rui
Sun, Siqing
Feng, Chunlai
Chen, Yanbin
Wang, Li
Cao, Min
Yang, Jian
Yao, Jian
Xu, Jing
Lin, Dang
Tao, Yujian
Ma, Guoer
Shi, Jiaxin
Chen, Bilin
Ni, Yueyan
Zhong, Huanhuan
Shi, Yi
Su, Xin
author_facet Wang, Yu
Gu, Yu
Shen, Kunlu
Cui, Xuefan
Min, Rui
Sun, Siqing
Feng, Chunlai
Chen, Yanbin
Wang, Li
Cao, Min
Yang, Jian
Yao, Jian
Xu, Jing
Lin, Dang
Tao, Yujian
Ma, Guoer
Shi, Jiaxin
Chen, Bilin
Ni, Yueyan
Zhong, Huanhuan
Shi, Yi
Su, Xin
author_sort Wang, Yu
collection PubMed
description BACKGROUND: Current guidelines support different management of cryptococcosis between severely immunodeficient and immunocompetent populations. However, few studies have focused on cryptococcosis patients with mild-to-moderate immunodeficiency. We performed this study to determine the clinical features of pulmonary (PC) and extrapulmonary cryptococcosis (EPC) and compared them among populations with different immune statuses to support appropriate clinical management of this public health threat. METHODS: All cases were reported by 14 tertiary teaching hospitals in Jiangsu Province, China from January 2013 to December 2018. The trends in incidence, demographic data, medical history, clinical symptoms, laboratory test indicators, imaging characteristics and diagnostic method of these patients were then stratified by immune status, namely immunocompetent (IC, patients with no recognized underlying disease or those with an underlying disease that does not influence immunity, such as hypertension), mild-to-moderate immunodeficiency (MID, patients with diabetes mellitus, end-stage liver or kidney disease, autoimmune diseases treated with low-dose glucocorticoid therapy, and cancer treated with chemotherapy) and severe immunodeficiency (SID, patients with acquired immunodeficiency syndrome, haematologic malignancies, solid organ transplantation or haematologic stem cell transplantation, idiopathic CD4 lymphocytosis, agranulocytosis, aggressive glucocorticoid or immunosuppressive therapy and other conditions or treatments that result in severe immunosuppression). RESULTS: The clinical data of 255 cryptococcosis patients were collected. In total, 66.3% of patients (169) were IC, 16.9% (43) had MID, and 16.9% (43) had SID. 10.1% of the patients (17) with IC were EPC, 18.6% of the patients (8) with MID were EPC, and 74.4% of patients (32) were EPC (IC/MID vs. SID, p < 0.001). Fever was more common in the SID group than in the IC and MID groups (69.8% vs. 14.8% vs. 37.2%, p < 0.001). Of chest CT scan, most lesions were distributed under the pleura (72.7%), presenting as nodules/lumps (90.3%) or consolidations (10.7%). Pleural effusion was more common in SID group compared to IC group (33.3% vs. 2.4%, p < 0.001). Positivity rate on the serum capsular polysaccharide antigen detection (CrAg) test was higher in the SID group than in the other two groups [100.0% vs. 84.4% (MID) vs. 78.2% (IC), p = 0.013]. Positivity rate on the serum CrAg test was also higher in cryptococcal meningitis patients than in PC patients (100.0% vs. 79.5%, p = 0.015). CONCLUSIONS: The clinical presentation of MID patients is intermediate between SID and IC patients and is similar to that of IC patients. The serum CrAg test is more sensitive for the identification of SID or EPC patients.
format Online
Article
Text
id pubmed-8499499
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-84994992021-10-08 Clinical features of cryptococcosis in patients with different immune statuses: a multicenter study in Jiangsu Province–China Wang, Yu Gu, Yu Shen, Kunlu Cui, Xuefan Min, Rui Sun, Siqing Feng, Chunlai Chen, Yanbin Wang, Li Cao, Min Yang, Jian Yao, Jian Xu, Jing Lin, Dang Tao, Yujian Ma, Guoer Shi, Jiaxin Chen, Bilin Ni, Yueyan Zhong, Huanhuan Shi, Yi Su, Xin BMC Infect Dis Research BACKGROUND: Current guidelines support different management of cryptococcosis between severely immunodeficient and immunocompetent populations. However, few studies have focused on cryptococcosis patients with mild-to-moderate immunodeficiency. We performed this study to determine the clinical features of pulmonary (PC) and extrapulmonary cryptococcosis (EPC) and compared them among populations with different immune statuses to support appropriate clinical management of this public health threat. METHODS: All cases were reported by 14 tertiary teaching hospitals in Jiangsu Province, China from January 2013 to December 2018. The trends in incidence, demographic data, medical history, clinical symptoms, laboratory test indicators, imaging characteristics and diagnostic method of these patients were then stratified by immune status, namely immunocompetent (IC, patients with no recognized underlying disease or those with an underlying disease that does not influence immunity, such as hypertension), mild-to-moderate immunodeficiency (MID, patients with diabetes mellitus, end-stage liver or kidney disease, autoimmune diseases treated with low-dose glucocorticoid therapy, and cancer treated with chemotherapy) and severe immunodeficiency (SID, patients with acquired immunodeficiency syndrome, haematologic malignancies, solid organ transplantation or haematologic stem cell transplantation, idiopathic CD4 lymphocytosis, agranulocytosis, aggressive glucocorticoid or immunosuppressive therapy and other conditions or treatments that result in severe immunosuppression). RESULTS: The clinical data of 255 cryptococcosis patients were collected. In total, 66.3% of patients (169) were IC, 16.9% (43) had MID, and 16.9% (43) had SID. 10.1% of the patients (17) with IC were EPC, 18.6% of the patients (8) with MID were EPC, and 74.4% of patients (32) were EPC (IC/MID vs. SID, p < 0.001). Fever was more common in the SID group than in the IC and MID groups (69.8% vs. 14.8% vs. 37.2%, p < 0.001). Of chest CT scan, most lesions were distributed under the pleura (72.7%), presenting as nodules/lumps (90.3%) or consolidations (10.7%). Pleural effusion was more common in SID group compared to IC group (33.3% vs. 2.4%, p < 0.001). Positivity rate on the serum capsular polysaccharide antigen detection (CrAg) test was higher in the SID group than in the other two groups [100.0% vs. 84.4% (MID) vs. 78.2% (IC), p = 0.013]. Positivity rate on the serum CrAg test was also higher in cryptococcal meningitis patients than in PC patients (100.0% vs. 79.5%, p = 0.015). CONCLUSIONS: The clinical presentation of MID patients is intermediate between SID and IC patients and is similar to that of IC patients. The serum CrAg test is more sensitive for the identification of SID or EPC patients. BioMed Central 2021-10-08 /pmc/articles/PMC8499499/ /pubmed/34625036 http://dx.doi.org/10.1186/s12879-021-06752-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Wang, Yu
Gu, Yu
Shen, Kunlu
Cui, Xuefan
Min, Rui
Sun, Siqing
Feng, Chunlai
Chen, Yanbin
Wang, Li
Cao, Min
Yang, Jian
Yao, Jian
Xu, Jing
Lin, Dang
Tao, Yujian
Ma, Guoer
Shi, Jiaxin
Chen, Bilin
Ni, Yueyan
Zhong, Huanhuan
Shi, Yi
Su, Xin
Clinical features of cryptococcosis in patients with different immune statuses: a multicenter study in Jiangsu Province–China
title Clinical features of cryptococcosis in patients with different immune statuses: a multicenter study in Jiangsu Province–China
title_full Clinical features of cryptococcosis in patients with different immune statuses: a multicenter study in Jiangsu Province–China
title_fullStr Clinical features of cryptococcosis in patients with different immune statuses: a multicenter study in Jiangsu Province–China
title_full_unstemmed Clinical features of cryptococcosis in patients with different immune statuses: a multicenter study in Jiangsu Province–China
title_short Clinical features of cryptococcosis in patients with different immune statuses: a multicenter study in Jiangsu Province–China
title_sort clinical features of cryptococcosis in patients with different immune statuses: a multicenter study in jiangsu province–china
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8499499/
https://www.ncbi.nlm.nih.gov/pubmed/34625036
http://dx.doi.org/10.1186/s12879-021-06752-x
work_keys_str_mv AT wangyu clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT guyu clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT shenkunlu clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT cuixuefan clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT minrui clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT sunsiqing clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT fengchunlai clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT chenyanbin clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT wangli clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT caomin clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT yangjian clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT yaojian clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT xujing clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT lindang clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT taoyujian clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT maguoer clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT shijiaxin clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT chenbilin clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT niyueyan clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT zhonghuanhuan clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT shiyi clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina
AT suxin clinicalfeaturesofcryptococcosisinpatientswithdifferentimmunestatusesamulticenterstudyinjiangsuprovincechina