Epidemiology of Cryptococcal Infections in a General Hospital Over 4 Years

Abstract

SESSION TITLE: Chest Infections SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: To evaluate the epidemiology, clinical presentation, treatments and outcomes of patients with cryptococcosis in Singapore. METHODS: A electronic medical record search was performed for patients admitted from 2012 to 2015. 7 patients were identified to have cryptococcosis. 4 patients were infected by C. neoformans and 3 by C. gattii. Diagnosis was made by imaging, serum or cerebral spinal fluid (CSF) cryptococcal antigen testing, India ink staining, and culture of CSF or bronchoalveolar lavage. RESULTS: Cryptococcosis is an uncommon fungal infection, caused by Cryptococcus neoformans or Cryptococcus gattii, that affects both immunosuppressed and immunocompetent hosts. Cryptococcosis can be localised or disseminated, giving rise to pulmonary, neurological or cutaneous manifestations. Of the 7 patients with cryptococcosis, 4 were infected by C. neoformans. 3 of those infected were immunosuppressed (43%), with HIV infection or on long-term high dosage corticosteroids. Clinical manifestations of cryptococcosis included cough (42.8%), fever (42.8%), headache (42.8%), dyspnea (28.5%), chest pain (28.5%), loss of appetite (28.5%), loss of weight (14.3%), hearing loss (14.3%), focal limb weakness (14.3%) and rash (14.3%). Abnormal radiological findings such as lung consolidations (57.1%), lung cryptococcomas (42.8%), brain cyptococcomas (42.8%), pleural effusions (4.3%), cavitations (14.3%), leptomeningeal enhancements (28.5%) were evident. All patients affected by C. gattii were immunocompetent, and had disseminated disease with pulmonary and cerebral involvement. Treatment was with fluconazole as initial therapy, with 57.1% of these patients receiving concurrent amphotericin B due to cerebral involvement. Outcome was generally good with treatment, with 85.7% survival within 6 months of diagnosis. CONCLUSIONS: Cryptococcus infections, while uncommon, can present in both immunocompromised and immunocompetent hosts. CLINICAL IMPLICATIONS: Early diagnosis and treatment of cryptococcus infections with antifungal therapy, and regular follow-up monitoring is important to achieve good outcomes. DISCLOSURE: The following authors have nothing to disclose: Jaslyn Gao, Jessica Quah, Teck Boon Low No Product/Research Disclosure Information