Clinical characteristics of pulmonary cryptococcosis patients with different immune statuses: A 10-year multicenter retrospective study in China

Hansheng Wang; Wenya Han; Chengqing Yang; Hongling Hu; Yulan Zheng; Li He; Miaojuan Zhu; Qiujie Tu; Lulu Nan; Fuying Hu; Wentian Li; Yijun Tang; Meifang Wang

doi:10.1016/j.rmed.2024.107866

Clinical characteristics of pulmonary cryptococcosis patients with different immune statuses: A 10-year multicenter retrospective study in China

Respir Med. 2024 Nov 15:107866. doi: 10.1016/j.rmed.2024.107866. Online ahead of print.

Authors

Hansheng Wang¹, Wenya Han¹, Chengqing Yang², Hongling Hu³, Yulan Zheng⁴, Li He⁵, Miaojuan Zhu⁶, Qiujie Tu⁷, Lulu Nan⁸, Fuying Hu⁹, Wentian Li¹⁰, Yijun Tang¹, Meifang Wang¹¹

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, P.R. China.
² Department of Pulmonary and Critical Care Medicine, Wuhan pulmonary hospital, Wuhan, 430000, Hubei, P.R. China.
³ Department of Pulmonary and Critical Care Medicine, The central hospital of Wuhan, Huazhong University of Science and Technology Tongji Medical College, Wuhan, 430000, Hubei, P.R. China.
⁴ Department of Pulmonary and Critical Care Medicine, Xiangyang Central Hospital, Hubei University of Arts and Sciences, Xiangyang, 441000, Hubei, P.R. China.
⁵ Department of Pulmonary and Critical Care Medicine, Jingzhou Central Hospital, Yangtze University, Jingzhou, 434020, Hubei, P.R. China.
⁶ Department of Pulmonary and Critical Care Medicine, Zhongnan hospital of Wuhan University, Wuhan, 430000, Hubei, P.R. China.
⁷ Department of Pulmonary and Critical Care Medicine, The first people's hospital of Jingzhou, the First Affiliated Hospital of Yangtze University, Jingzhou, 434020, Hubei, P.R. China.
⁸ Department of Pulmonary and Critical Care Medicine, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, 441300, Hubei, P.R. China.
⁹ Department of Pulmonary and Critical Care Medicine, The first people's hospital of Tianmen, Hubei University of Science and Technology, Tianmen, 431700, Hubei, P.R. China.
¹⁰ Department of Pulmonary and Critical Care Medicine, Yichang Central People's Hospital, Three Gorges University, Yichang, 443000, Hubei, P.R. China. Electronic address: [email protected].
¹¹ Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, P.R. China. Electronic address: [email protected].

PMID: 39551250
DOI: 10.1016/j.rmed.2024.107866

Abstract

Background and objective: We aimed to evaluate clinical characteristics and therapeutic efficacy of pulmonary cryptococcosis (PC) in patients with different immune status in a large multicenter population to support appropriate clinical management of this public health threat.

Methods: We retrospectively investigated the medical records of 510 patients with PC from January 2014 to June 2023 in 10 representative regional tertiary teaching hospitals in Hubei province of China, and clinical data of these patients were then stratified by different immune statuses.

Results: Immunocompetent (IC) patients accounted for 68.8% (351/510), mild-to-moderate immunodeficiency (MID) patients accounted for 16.7% (85/510), and severe immunodeficiency (SID) patients accounted for 14.5% (74/510). PC patients in the MID and SID groups had a higher incidence of central nervous system (CNS) involvement than that in the IC group [4.7% (MID) vs. 8.1% (SID) vs. 1.1% (IC), p = 0.002]. Patients with fever in SID group (35.1%, 26/74) was more common (p<0.01). Solitary nodule/mass were more common in the IC group than the MID and SID groups (p<0.05); in contrast, diffuse nodules in MID or SID groups was significantly greater than that in IC groups (p<0.01). The follow-up showed that the overall treatment improvement rate for PC showed a significant difference between the 3 groups [90.3% (IC) vs. 75.3% (MID) vs. 54.1% (SID), p=0.00].

Conclusion: The incidence of PC is increasing in Central China, especially for the immunocompetent PC population. In addition, there are significant differences in age, systemic symptoms, certain radiographic characteristics and some laboratory results between immunosuppressed and immunocompetent PC hosts. And finally, limited nodules/masses and mild symptoms in patients with PC often lead to misdiagnosis and unnecessary pulmonary resection, but CrAg assay contributes to early noninvasive diagnosis.

Keywords: cryptococcus capsular antigen (CrAg); culture; histopathology; immunocompetent; immunodeficiency; pulmonary cryptococcosis.