Galanis Eleni, MacDougall Laura, Rose Caren, Chen Sharon C A, Oltean Hanna N, Cieslak Paul R, DeBess Emilio, Chong Mei, Sorrell Tania C, Baddley John W, Hoang Linda M N, Lockhart Shawn R, Pappas Peter G, Phillips Peter
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
Clin Infect Dis. 2025 Jun 4;80(5):1088-1094. doi: 10.1093/cid/ciae640.
Infection by Cryptococcus gattii can lead to pulmonary or central nervous system (CNS) disease, or both. Whether the sites of infection and disease severity are associated with C. gattii species and lineages or with certain underlying medical conditions, or both is unclear. We conducted a retrospective cohort study to identify factors associated with site of infection and mortality among C. gattii cases.
We extracted data on 258 C. gattii cases from Australia, Canada, and the United States reported from 1999 to 2011. We conducted unadjusted and multivariable logistic regression analyses to evaluate factors associated with site of infection and C. gattii mortality among hospitalized cases (N = 218).
Hospitalized C. gattii cases with CNS and other extrapulmonary disease were younger, more likely to reside in Australia, and be infected with variety gattii I (VGI) lineage but less likely to have comorbidities and die as compared to cases with pulmonary disease. The odds of having CNS and/or other extrapulmonary disease were 9 times higher in cases with VGI infection (adjusted odds ratio [aOR] = 9.21, 95% confidence interval [CI] = 3.28-25.89). Age ≥70 years (aOR = 6.69, 95% CI = 2.44-18.30), chronic lung disease (aOR = 2.62, 95% CI = 1.05-6.51) and an immunocompromised status (aOR = 2.08, 95% CI = 1.05-6.51) were associated with higher odds of C. gattii mortality.
Among hospitalized cases, C. gattii species and lineage are associated with site of infection but not with the risk of death, whereas older age and comorbidities increase the risk of death.
加氏隐球菌感染可导致肺部或中枢神经系统（CNS）疾病，或两者皆有。感染部位和疾病严重程度是否与加氏隐球菌的种类和谱系有关，或与某些潜在的医疗状况有关，或两者皆有关，目前尚不清楚。我们进行了一项回顾性队列研究，以确定加氏隐球菌病例中与感染部位和死亡率相关的因素。
我们从1999年至2011年报告的澳大利亚、加拿大和美国的258例加氏隐球菌病例中提取数据。我们进行了未调整和多变量逻辑回归分析，以评估住院病例（N = 218）中与感染部位和加氏隐球菌死亡率相关的因素。
与肺部疾病病例相比，患有中枢神经系统和其他肺外疾病的住院加氏隐球菌病例更年轻，更有可能居住在澳大利亚，感染gattii I变种（VGI）谱系，但合并症和死亡的可能性较小。VGI感染病例发生中枢神经系统和/或其他肺外疾病的几率高9倍（调整后的优势比[aOR] = 9.21，95%置信区间[CI] = 3.28 - 25.89）。年龄≥70岁（aOR = 6.69，95% CI = 2.44 - 18.3）、慢性肺病（aOR = 2.62，95% CI = 1.05 - 6.51）和免疫功能低下状态（aOR = 2.08，95% CI = 1.05 - 6.51）与加氏隐球菌死亡率较高的几率相关。
在住院病例中，加氏隐球菌的种类和谱系与感染部位有关，但与死亡风险无关，而年龄较大和合并症会增加死亡风险。
