Abstract
There is great heterogeneity of immunity among patients with cryptococcosis, and severe immunodeficiency can lead to negative clinical outcomes. Underlying disease is a poor surrogate for immune status and inferior in predicting an individual’s prognosis. This study was intended to determine whether T-lymphocyte subgroups would be more suitable indicators regarding the severity of infection and clinical outcomes of such patients. We retrieved clinical data on 101 patients with cryptococcosis and compared the validity of multiple parameters (underlying disease and T-lymphocyte subgroups) in predicting the severity of infection and clinical outcome in these patients. For patients with CD4+ T-lymphocyte counts lower than 400/μL, the odds ratio of disseminated cryptococcosis was 23.3 (P = 0.005). There was a moderate negative correlation between CD4+ T-cell count and Apache II score (−0.609, P < 0.001). Mortality among patients with low levels of CD4+ T lymphocytes was significantly higher than among those with normal levels (23.8% vs 5.3%, P = 0.016). However, the difference was not significant if the patients were grouped by underlying disease (P = 0.067). The CD4+ T-lymphocyte count in peripheral blood is a simple and more accurate biomarker for predicting severity of infection and clinical outcome in patients with cryptococcosis.
Highlights
Cryptococcosis is a potentially life-threatening systemic mycosis [1]
According to the classification criteria of the clinical practice guidelines for the management of cryptococcal disease published by the Infectious Disease Society of America in 2010, patients with cryptococcosis fall into several groups: the adult immunodeficiency syndrome (AIDS) group, organ transplantation recipient (OTR) group, and NHNT group
The AIDS patients were characterized by a substantial decrease in the number of CD4+ T cells, and OTR patients had to be treated with immunosuppressants, so their T-lymphocyte counts were low
Summary
Cryptococcosis is a potentially life-threatening systemic mycosis [1]. Inhalation of Cryptococcus spores is the main route of infection; such spores may remain isolated in the lungs or spread to other organs, depending on the host’s immune status [2]. The risk factors for dissemination (i.e., the host’s immune status or underlying diseases) are always the top concerns of clinicians seeking to manage this infection. Clinical guidelines have recommended that clinicians evaluate their patients’ underlying diseases and take the findings as one of the main classification criteria for planning a therapeutic regimen. It is imperative to find other parameters for evaluating patients’ immune status and predicting disease severity and clinical outcome
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