Abstract
BackgroundCryptococcal infection has become a public health challenge globally. However, information about cryptococcal infection in patients with hematological diseases remains relatively rare.MethodsHIV-uninfected cryptococcosis cases with hematological diseases admitted to Huashan Hospital from January 2001 to December 2014 were reviewed.ResultsIn total, 33 cryptococcosis patients were enrolled, including 12 malignant and 21 non-malignant hematological cases. Twenty-six patients had central nervous system (CNS) involvement, which was observed more often in patients with non-malignancies than with malignancies (20/21 vs. 6/12, P = 0.001) Most patients (25/26) with CNS infection were confirmed by cerebrospinal fluid (CSF) culture or smear, and 100% (20/20) of them tested positive for the CSF cryptococcal antigen test. Eighteen out of 26 cryptococcal meningitis patients were treated with amphotericin B (AmB)-based therapy, 16 of them with AmB deoxycholate (d-AmB) and 2 patients with liposomal AmB. The clinical success rate was 55.6%. D-AmB was well-tolerated at 0.35–0.59 mg/kg/d (median 0.43 mg/kg/d) and only 12 patients had mild adverse events.ConclusionsCNS cryptococcal infection was more frequent in patients with hematological non-malignancies, and cryptococcal antigen test as well as the CSF fungal culture or smear are suggested for early diagnosis. D-AmB could be used as an alternative therapy for CNS-infected patients with hematological diseases.
Highlights
Cryptococcal infection has become a public health challenge globally
Demographic and clinical characteristics During the study period, we identified 33 cryptococcosis patients with hematological diseases, among which 30 were proven and 3 were probable cases
Demographic data and clinical characteristics of each patient were summarized in Table 1, and detailed information is listed in the Additional file 1
Summary
Cryptococcal infection has become a public health challenge globally. Information about cryptococcal infection in patients with hematological diseases remains relatively rare. Cryptococcosis is a life threatening disease in patients with immunocompromised conditions, such as human immunodeficiency virus (HIV) infection, solid organ transplants (SOT), autoimmune diseases, administration of corticosteroids and other immunosuppressants [1, 2]. About 957,900 cryptococcal meningitis cases occur each year, resulting in 624,700 deaths by 3 months after infection among HIV-infected patients [3]. Cryptococcal infection could occur in 2.8–8.0% of SOT recipients, and is the third most common invasive. We retrospectively reviewed a series of cryptococcosis cases with hematological diseases admitted to our hospital from 2001 through 2014 to evaluate the possible risk factors, clinical characteristics, and prognosis of cryptococcosis in this population
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