Abstract
Cryptococcosis is a lethal fungal infection mainly caused by Cryptococcus neoformans/C. gattii species. Currently, our understanding of cryptococcosis episodes in HIV-negative patients during renal dialysis remains scarce and fragmented. Here, we performed an analysis of pooled cases to systemically summarize the epidemiology and clinical characteristics of cryptococcosis among HIV-negative patients with renal dialysis. Using pooled data from our hospital and studies identified in four medical databases, 18 cases were identified and analyzed. The median duration time of renal dialysis for peritoneal renal dialysis and hemodialysis cases was 8 months and 36 months, respectively. Several non-neoformans/gattii species were identified among the renal dialysis recipients with cryptococcosis, particularly Cryptococcus laurentii and Cryptococcus albidus, which share similar clinical manifestations as those caused by C. neoformans and C. gattii. Our analyses suggest that physicians should consider the possibility of the occurrence of cryptococcosis among renal dialysis recipients even when cryptococcal antigen test result is negative. The timely removal of the catheter is crucial for peritoneal dialysis patients with cryptococcosis. In addition, there is a need for optimized antifungal treatment strategy in renal dialysis recipients with cryptococcal infections.
Highlights
Dialysis is a successful therapeutic process used for removing metabolic waste from the body fluids of patients with end-stage renal disease (ESRD)
Recent studies suggested that non-C. neoformans/C. gattii species, which have higher MICs of current antifungal drugs, accounted for a large proportion of cryptococcal infections among renal dialysis patients [13–17]
The current study showed that male adult patients were dominant among renal dialysis recipients with cryptococcosis, which is consistent with previous studies [30, 31]
Summary
Dialysis is a successful therapeutic process used for removing metabolic waste from the body fluids of patients with end-stage renal disease (ESRD). There are two primary types of dialysis, namely peritoneal dialysis (PD) and hemodialysis [1]. More than one million ESRD people worldwide regularly undergo renal dialysis [1, 2]. Microbial infection remains one of the most common complications among patients receiving renal dialysis [3]. According to a retrospective study of 327,993 renal dialysis patients conducted in the USA, chronic dialysis recipients have nearly 10 times the risk of fungal infections compared to the general population [4]. The cumulative annual incidence of infection-related hospitalization during renal dialysis was 26% for children and 31% for adults in the USA [5]
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