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Clinical features of pulmonary cryptococcosis in non-HIV patients in Japan

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Title: Clinical features of pulmonary cryptococcosis in non-HIV patients in Japan
Authors: Kohno, Shigeru / Kakeya, Hiroshi / Izumikawa, Koichi / Miyazaki, Taiga / Yamamoto, Yoshihiro / Yanagihara, Katsunori / Mitsutake, Kotaro / Miyazaki, Yoshitsugu / Maesaki, Shigefumi / Yasuoka, Akira / Tashiro, Takayoshi / Mine, Mariko / Uetani, Masataka / Ashizawa, Kazuto
Issue Date: Jan-2015
Publisher: 日本化学療法学会・日本感染症学会 / Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases
Citation: Journal of Infection and Chemotherapy, 21(1), pp.23-30; 2015
Abstract: OBJECTIVE: To clarify the clinical features of pulmonary cryptococcosis in Japanese non-HIV population. METHODS: Retrospective investigation of 151 pulmonary cryptococcosis cases between 1977 and 2012 was executed. The underlying disease (UDs), aggravating factors, radiological characteristics, and treatment were examined. RESULTS: Sixty-seven patients (44.4%) had no UDs. The common UDs were diabetes (32.1%) followed by hematologic disease (22.6%), and collagen disease (22.6%). Peripherally distributed pulmonary nodules/masses were most commonly seen. Lesions in the right middle lobe (p = 0.01) and air bronchogram (P = 0.05) were significantly more frequent, respectively, in patients with UDs than patients without them. Azoles were mainly selected for the patients without meningoencephalitis. Mean treatment duration for patients with and without UDs was 6.64 and 2.87 months, respectively. Patients whose pulmonary nodules improved after treatment continued to experience gradual reduction of cryptococcosis antigen titers, even if antigen titers were positive at the time of treatment cessation. The average time for antigen titers to become negative after treatment cessation was 13.1 and 10.7 months for patients with and without UDs, respectively. When groups were compared according to the presence of meningoencephalitis complications, deaths, and survivals, factors contributing to cryptococcosis prognosis included higher age, hypoproteinemia, hypoalbuminemia, steroid use, high C-reactive protein levels, and meningoencephalitis complications. CONCLUSIONS: It is crucial to consider the presence of UDs and meningoencephalitis for the choice of antifungals and treatment duration for cryptococcosis in non-HIV patients. Three- and six months-administration of azoles for pulmonary cryptococcosis with or without UDs, respectively is reasonable.
Keywords: Computed tomography / Cryptococcal antigen / Immune status / Meningoencephalitis / Non-HIV patient / Pulmonary cryptococcosis
URI: http://hdl.handle.net/10069/35900
ISSN: 1341321X
DOI: 10.1016/j.jiac.2014.08.025
Rights: © 2014 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. / NOTICE: this is the author’s version of a work that was accepted for publication in Journal of infection and chemotherapy. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of infection and chemotherapy, 21, 1, (2015)
Type: Journal Article
Text Version: author
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/35900

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