PULMONARY CRYPTOCOCCOSIS - LOCALIZED AND DISSEMINATED INFECTIONS IN 27 PATIENTS WITH AIDS

We reviewed the records of 85 patients infected with both human immuno deficiency virus and Cryptococcus neoformans. Twenty-seven patients (3 2%) had pulmonary cryptococcosis. C. neoformans was cultured from bron choalveolar lavage (BAL) or pleural fluid in 25 cases; the remaining t wo patients had cryptococcal antigen (CA) detected in BAL fluid and C. neoformans cultured from other sites. All but one of the 27 patients had detectable CA in serum. The CD4+ lymphocyte count was low in all c ases (median, 24/mm(3)). Clinical manifestations of pulmonary cryptoco ccosis included fever (94%), cough (71%), dyspnea (7%), expectoration (4%), chest pain (2%), and hemoptysis (1%). Diffuse interstitial opaci ties (70.5%), focal interstitial abnormalities, alveolar opacities, ad enopathies, cavitary lesions, and pleural effusions were evident. Outc ome was poor (mean survival time, 23 weeks) despite treatment. Patient s with localized pulmonary cryptococcosis appeared to have a higher CD 4+ lymphocyte count, an earlier diagnosis, lower serum CA titers, fewe r previous or concomitant infections, and a better prognosis than pati ents with disseminated cryptococcosis.