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Abnormalities related to C. gattii may be slow to resolve
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Resolution of cryptococcomas and serum antigenemia related to Cryptococcus gattii infection was slow among patients, but late onset of treatment failure or relapse was uncommon, researchers from Canada reported, suggesting that treatment beyond recommended duration was unnecessary.
Peter Phillips, MD, of the division of infectious diseases at St. Paul’s Hospital in Vancouver, British Columbia, and colleagues reviewed medical records of 152 patients identified through surveillance and reported to the British Columbia Centre for Disease Control from 1999 through 2007. They analyzed risk factors for C. gattii mortality, as well as patterns in serum cryptococcal antigen (SCrAg) titers and the probability of developing chest cryptococcomas.
Of the 152 patients, 73% had culture-confirmed C. gattii,69.1% had isolated lung infection, and 30.9% had central nervous system infection with or without lung involvement. In 42.1% of the cohort, malignancy was provisionally diagnosed. Underlying diseases were determined in 59.9% of patients, 15.1% had compromised immune systems, and a similar percentage had asymptomatic disease. Culture-positive relapse occurred in only two patients, both occurring within 1 year of follow-up.
Lung cryptococcomas took a median of 2.8 years to resolve, while decline in SCrAg titer to less than 1:8 required a median of 2.9 years. Among the culture-confirmed cases, C. gattii-related mortality at 12 months’ follow-up was 23.3%; all-cause mortality was 27.2%. Death related to C. gattii was associated with being aged older than 50 years (HR = 15.6; 95% CI, 1.9-130.5) and compromised immunity (HR = 5.8; 95% CI, 1.5-21.6).
“Resolution of imaging abnormalities and cryptococcal antigenemia was frequently slow, over months to years,” the researchers wrote. “However, late onset of failed therapy or relapse was uncommon, suggesting that the delayed resolution of these findings does not require prolongation of treatment beyond the duration recommended by guidelines, unless clinical or microbiologic indicators of failed therapy are present.” – by Jen Byrne
Disclosure: Phillips reports receiving research funding from Astellas Pharma Canada and Pfizer Canada and has been on the speakers bureau for Astellas, Merck and Pfizer. The study was funded by Astellas Pharma Canada and Pfizer Canada.
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