Infective patterns of cryptococcosis in patients with connective tissue disease: a retrospective study
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ORIGINAL ARTICLE
Infective patterns of cryptococcosis in patients with connective tissue disease: a retrospective study Minxi Lao 1,2 & Yingying Gong 2 & Chuyu Shen 1 & Cuicui Wang 1 & Liuqin Liang 1 & Zhongping Zhan 1 & Dongying Chen 1 Received: 11 November 2019 / Revised: 26 February 2020 / Accepted: 23 March 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Objectives To explore the clinical features and associated factors of cryptococcosis in patients with connective tissue disease (CTD) from Southern China. Methods Demographic and clinical data were collected between 2007 and 2018. Associated factors were analyzed by logistic regression analysis. Results A total of 6809 inpatients with CTD were included. Cryptococcosis was diagnosed in 30 patients (prevalence, 0.4%). Cryptococcosis was predominant in patients with ANCA-associated vasculitis (AAV) (prevalence, 6/530, 1.1%). Lung was commonly involved (18/30, 60.0%), followed by meninges (6/30, 20.0%), blood stream (5/30, 16.7%), and disseminated cryptococcosis (involved blood stream and meninges) (1/30, 3.3%). Infiltrates (10/18, 55.6%) and small nodules (8/18, 44.4%) were the main radiographic manifestation of pulmonary cryptococcosis (PC). The positive rate of serum cryptococcal antigen (CrAg) in patients with PC was 88.2%. Cryptococcus spp. were found in 75% (3/4) patients who underwent lung biopsy. Most of the patients with cryptococcal meningitis (CM) had elevated cerebrospinal fluid (CSF) opening pressure (6/7, 85.7%) and decreased CSF glucose level (5/7, 71.4%). Positive blood culture confirmed the diagnosis of cryptococcal sepsis (CS). Three patients died (10.0%), including one with CM and two with PC. Multivariate logistic regression analysis showed that accumulated dose of glucocorticoid (GC) [odds ratio (OR) = 1.42, 95% confidence interval (CI) 1.04–1.93, P = 0.03] was associated with cryptococcosis in patients with CTD. Conclusions Cryptococcosis develops in various organs. Typical radiological manifestation accompanied with positive serum CrAg provides helpful clues for the diagnosis. Lumbar puncture is a critical diagnostic method to distinguish CM. The accumulated dose of GC is associated with cryptococcosis in patients with CTD. Key Points • Pulmonary cryptococcosis is suspected if pulmonary nodules adjacent to the pleura are present, with serum CrAg positive. • Cryptococcal meningitis has insidious onset and the diagnosis mainly depends on lumber puncture. • Cryptococcal sepsis is not rare and needs timely blood culture in suspected patients.
Keywords Connective tissue disease . Cryptococcosis . Glucocorticoid
Minxi Lao, Yingying Gong and Chuyu Shen contributed equally to this work. The work should be attributed to: The First Affiliated Hospital of Sun Yatsen University. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10067-020-05068-6) contains supplementary material, which is available to authorized users. * Zhongping Zhan [email protected] * Dongying Chen cdo
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