Chest
Clinical InvestigationsInfectionPulmonary Cryptococcosis in Patients Without HIV Infection
Section snippets
Patients
All of the patients who received care at Cleveland Clinic Hospital, Cleveland, OH, or at Barnes Hospital, St. Louis, MO, between January 1986 and February 1996 were eligible for study enrollment. The inclusion criteria accepted patients with a growth of C neoformans from a respiratory specimen noted in the clinical mycology laboratory log book of their respective institution. The respiratory specimens were defined as expectorated sputum, induced sputum, BAL, lung biopsy, or lung histopathology
Results
Sixty of 174 patients (34.5%) with isolates of the Cryptococcus spp in their clinical mycology laboratories had respiratory specimens and were eligible for study enrollment. Nineteen patients were excluded, including 11 with a known HIV infection, 5 with a final isolate identified as Cryptococcus albidus, and 3 with unavailable medical records.
Forty-two patient presentations comprised the overall study group. Thirty-six patients (85.7%) had no evidence of dissemination, and 6 patients (14.3%)
Discussion
Cryptococcosis is usually a systemic invasive fungal infection that typically presents as meningitis. In such circumstances, the diagnosis and treatment are relatively straightforward. It is assumed that C neoformans generally gains access to the host by inhalation and that the respiratory system is the usual portal of entry. The evaluation of the significance of respiratory cryptococcal isolates becomes an important part of the decision-making process. Critical decisions in the clinical
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