Retrospective analysis of pulmonary cryptococcosis and extrapulmonary cryptococcosis in a Chinese tertiary hospital

Abstract Cryptococcosis is an invasive fungal disease with increased morbidity in China. Cryptococci can infect immunocompromised hosts as well as immunocompetent ones. In this study, we reviewed data of inpatients with cryptococcosis at Ningbo First Hospital from May 2010 to May 2020 and compared the clinical profiles of pulmonary cryptococcosis (PC) and extrapulmonary cryptococcosis (EPC). Of 71 patients enrolled, 70 were non-HIV with dramatically increased prevalence especially in PC. 77.46% of cases were PC confirmed by pathology. The rest were EPC including intracranial infection (15.49%) and cryptococcemia (7.04%). Comparing to PC, a larger proportion of EPC patients were found to have immunocompromised conditions including predisposing factors (p<0.01), or detectable humoral or cellular immunodeficiency. Fever and headache were more common in EPC patients (p<0.001). Patients with EPC had lower serum sodium level (p=0.041), lower monocyte counts (p=0.025) and higher C-reactive protein (p=0.012). Cryptococcal antigen tests for serum and cerebrospinal fluid showed 100% sensitivity in diagnosing EPC while serum lateral flow assay (LFA) tested negative in 25% of PC. All in all, underlying immunocompromised conditions may predict dissemination in PC without HIV which can be identified by LFA.