![]() ![]() In this study, we hypothesized that CM patients may have latent PC if pulmonary nodules are detected by chest CT. It is essential to identify several features that could help recognize the difference between patients with CM alone and patients who had pulmonary plus neurological cryptococcosis, guiding the diagnostic and treatment evaluation. ![]() In addition, the management of CM in the presence of PC was not described in the 2010 Infectious Diseases Society of America guidelines. identified several factors (including weight loss, fever, altered mental status, high-dose corticosteroid administration) that may help distinguish patients with PC alone from patients with coexisting PC and disseminated complications such as meningitis. Although some case series reported clinical features of disseminated cryptococcosis, the differential diagnosis of CM with a coexisting PC could be difficult. However, few studies have investigated the clinical features of concurrent pulmonary and neurological cryptococcosis, since concomitant PC is often not identified in most CM patients. Various clinical features of CM in patients with HIV (or hepatitis B virus) and in uninfected patients have been reported. Although the common route of cryptococcal infection was considered to be Cryptococcus inhalation into the lung, it mainly affects the central nervous system, causing fever, headache, and other symptoms, while symptomatic pulmonary infection is uncommon. The most common presentation of PC on chest computed tomography (CT) is pulmonary nodules, both in HIV-infected and in HIV-uninfected patients. When asymptomatic, it may be discovered incidentally on radiological imaging. PC may cause vague symptoms including fever, dyspnea, or cough. neoformans is usually acquired by inhalation and then exhibits a propensity to disseminate to the brain, causing CM, the most severe form of cryptococcosis, after a period of latency within pulmonary lymph nodes. neoformans mainly causes pulmonary cryptococcosis (PC) and cryptococcal meningitis (CM). While the infection site could be anywhere in the human body, C. Future studies should be performed to further examine these factors.Ĭryptococcus neoformans is an uncommon human fungal pathogen that can infect both apparently normal hosts and immunocompromised individuals, especially patients with human immunodeficiency (HIV) infection. Certain clinical features showed significant differences between CM patients with and without pulmonary nodules, and several independent contributing factors impacted the clinical outcomes for CM patients. Amphotericin B in the initial therapy was a protective factor for PN-negative patients ( p = 0.008). Multivariate analysis showed that immunocompromise ( p = 0.037) and CSF glucose < 2.5 mmol/L ( p = 0.044) indicated poor outcome in PN-positive patients, while CSF glucose < 2.5 mmol/L ( p = 0.025) also indicated poor outcome in PN-negative patients. Compared with PN-negative patients, PN-positive patients had higher cerebrospinal fluid (CSF)/serum albumin ratios, higher rates of CSF protein > 1000 mg/L, CSF glucose < 2.5 mmol/L, worse overall treatment response, higher rates of abnormal head CT and magnetic resonance imaging manifestations, and more unfavorable clinical outcomes. Forty (44.4%) patients had pulmonary nodules (PN-positive), and 50 (55.6%) patients had no pulmonary nodules (PN-negative). Baseline demographics, laboratory and radiographic findings, clinical managements, and outcomes were analyzed. The medical records of CM patients hospitalized in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 1, 2010, to December 31, 2016, were retrospectively reviewed. ![]() ![]() This study aimed to compare the clinical features of CM in patients with and without pulmonary nodules detected by chest computed tomography (CT). Whether the clinical features of cryptococcal meningitis (CM) patients vary with the coexistence of pulmonary nodules is not clear. ![]()
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