Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy

We conducted a case study of human immunodeficiency virus (HIV)-negative pa tients with cryptococcosis at 15 United States medical centers from 1990 th rough 1996 to understand the demographics, therapeutic approach, and factor s associated with poor prognosis in this population. Of 306 patients with c ryptococcosis, there were 109 with pulmonary involvement, 157 with central nervous system (CNS) involvement, and 40 with involvement at other sites. S eventy-nine percent had a significant underlying condition. Patients with p ulmonary disease were usually treated initially with fluconazole (63%); pat ients with CNS disease generally received amphotericin B (92%). Fluconazole was administered to approximately two-thirds of patients with CNS disease for consolidation therapy. Therapy was successful for 74% of patients. Sign ificant predictors of mortality in multivariate analysis included age great er than or equal to 60 years, hematologic malignancy, and organ failure. Ov erall mortality was 30%, and mortality attributable to cryptococcosis was 1 2%. Cryptococcosis continues to be an important infection in HIV-negative p atients and is associated with substantial overall and cause-specific morta lity.