Coussement Julien, Heath Christopher H, Roberts Matthew B, Lane Rebekah J, Spelman Tim, Smibert Olivia C, Longhitano Anthony, Morrissey C Orla, Nield Blake, Tripathy Monica, Davis Joshua S, Kennedy Karina J, Lynar Sarah A, Crawford Lucy C, 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, Slavin Monica A, Chen Sharon C A
Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Department of Infectious Diseases, Guadeloupe University Hospital, Pointe-a-Pitre, Guadeloupe.
Clin Infect Dis. 2025 Apr 30;80(4):817-825. doi: 10.1093/cid/ciae630.
Limited data exist regarding outcomes of cryptococcosis in patients without human immunodeficiency virus (HIV), and few studies have compared outcomes of Cryptococcus gattii versus Cryptococcus neoformans infection.
We conducted a retrospective study in 46 Australian and New Zealand hospitals to determine the outcomes of cryptococcosis in patients without HIV diagnosed between 2015 and 2019 and compared outcomes of C. gattii versus C. neoformans infections. Multivariable analysis identified predictors of mortality within 1 year.
Of 426 patients, 1-year all-cause mortality was 21%. Cryptococcus gattii infection was associated with lower mortality than C. neoformans (adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], .23-.95), while severe neurological symptoms at presentation were the strongest predictor of death (adjusted OR, 8.46; 95% CI, 2.99-23.98). Almost all (99.5%) patients with central nervous system (CNS) infection received induction antifungal therapy versus 27.7% with isolated pulmonary cryptococcosis. The most common regimen in CNS disease was liposomal amphotericin B with flucytosine (93.8%; mean duration, 31 ± 13 days). Among patients with CNS cryptococcosis, C. gattii infection was associated with higher risk of immune reconstitution inflammatory response (C-IRIS) than C. neoformans (21% versus 3%, P < .001). Nineteen patients received amphotericin B-based re-induction therapy for suspected relapse, but none had microbiological relapse. Serum cryptococcal antigen positivity and lung imaging abnormalities resolved slowly (resolution at 1 year in 25% and 34% of patients, respectively).
Compared with C. neoformans, C. gattii infection demonstrated lower mortality but higher C-IRIS risk in CNS infection. Severe neurological symptoms were the strongest predictor of mortality.
关于无人类免疫缺陷病毒（HIV）患者的隐球菌病结局的数据有限，且很少有研究比较加氏隐球菌与新型隐球菌感染的结局。
我们在澳大利亚和新西兰的46家医院进行了一项回顾性研究，以确定2015年至2019年间诊断出的无HIV患者的隐球菌病结局，并比较加氏隐球菌与新型隐球菌感染的结局。多变量分析确定了1年内死亡率的预测因素。
426例患者中，1年全因死亡率为21%。加氏隐球菌感染的死亡率低于新型隐球菌（调整后的优势比[OR]，0.47；95%置信区间[CI]，0.23 - 0.95），而就诊时出现严重神经症状是死亡的最强预测因素（调整后的OR，8.46；95%CI，2.99 - 23.98）。几乎所有（99.5%）中枢神经系统（CNS）感染患者接受了诱导抗真菌治疗，而孤立性肺隐球菌病患者接受治疗的比例为27.7%。CNS疾病中最常用的治疗方案是脂质体两性霉素B联合氟胞嘧啶（93.8%；平均疗程，31±13天）。在CNS隐球菌病患者中，加氏隐球菌感染比新型隐球菌感染发生免疫重建炎症反应（C-IRIS）的风险更高（21%对3%，P<0.001）。19例患者因疑似复发接受了基于两性霉素B的再次诱导治疗，但无一例有微生物学复发。血清隐球菌抗原阳性和肺部影像学异常缓解缓慢（分别在1年时25%和34%的患者得到缓解）。
与新型隐球菌相比，加氏隐球菌感染在CNS感染中死亡率较低，但C-IRIS风险较高。严重神经症状是死亡率的最强预测因素。
