Imaging and serum antigen levels that influence the treatment and prognosis of cryptococcosis in immunocompetent and immuno-compromised patients: A 10-year retrospective study.

Abstract

This article was to summarize the treatment course and prognosis of immunocompetent and immunocompromised patients with pulmonary cryptococcal infections and to analyse the relevant factors. The chisquared test was used to test for differences in categorical variables, and the independent samples t test was used to compare continuous variables. Multivariable analyses using the Cox proportional hazards model were used to estimate the effect of prognostic factors on treatment time and improvement time. A total of 243 patients were included in the analysis. Immunocompetent patients with diffuse imaging infiltrates had an extension of the treatment course within six months (P = 0.048) and an extension of the improvement days within four weeks (P = 0.008). In immunocompromised patients, an antigen assay ≥ 40 (P = 0.013) is an unfavourable factor leading to an extension of treatment by nine months. The serum antigen assay in 26/98 (26.53%) immunocompetent patients who did not turn negative when the treatment had finished was significantly lower than that in 14/29 (48.28%) immunocompromised patients (P = 0.027). All patients who underwent surgical resection had a good prognosis. Diffuse imaging infiltrates suggest longer treatment days and a longer improvement time in immunocompetent patients. Higher serum antigen levels in immunocompromised patients indicate longer treatment. Serum antigen assays in immunocompromised patients are difficult to negative.