ACUTE RESPIRATORY-FAILURE ASSOCIATED WITH CRYPTOCOCCOSIS IN PATIENTS WITH AIDS - ANALYSIS OF PREDICTIVE FACTORS

The incidence of acute respiratory failure (PLRF) associated with cryp tococcal disease in patients with AIDS is underestimated in the litera ture. We performed a retrospective, case-control (referent) study to d etermine the prevalence of ARF associated with cryptococcal disease an d analyzed associated factors. Potential cases of ARF were identified at four university-affiliated teaching hospitals from a cohort of 210 patients with AIDS who had positive cryptococcal antigen tests and/or Cryptococcus neoformans isolated from any body site. Twenty-nine of th e 210 (13.8%) had ARF associated with cryptococcal disease. Nineteen w ere thought to have respiratory failure due solely to C. neoformans. T he demographic, clinical, laboratory, treatment, and outcome data of 1 9 cases of respiratory failure were compared with data for 20 patients without respiratory failure. In-hospital mortality was 100% and media n survival was 2 days for cases, vs. 25% and >365 days, respectively, for referents. The clinical presentation eras identical to that of Pne umocystis carinii pneumonia. In multivariate analysis, variables indep endently predictive of ARF in patients with cryptococcal disease were black race, a lactate dehydrogenase level of greater than or equal to 500 IU/L, the presence of interstitial infiltrates, and the presence o f cutaneous lesions. ARF with cryptococcosis in patients with AIDS is associated with disseminated disease and high mortality. The diagnosis frequently is not considered before death. Serum cryptococcal antigen testing is a sensitive and rapid screening method.