Epidemiology and Clinical Features of Cryptococcosis Among Individuals Without HIV Infection: An Observational International Multicenter Study (MSG-11)

Background: Infections due to Cryptococcus species occur globally, mostly reported as central nervous system (CNS) infection among persons with HIV infection. Among persons without HIV infection, cryptococcosis is a growing concern both among immunocompromised and non-immunocompromised individuals. There are few detailed descriptions of these patients outside of North America and Western Europe. Methodology: This prospective, observational, multinational study enrolled HIV-uninfected patients with proven/probable cryptococcosis from 7 countries on 4 continents located in temperate, subtropical and tropical zones. Patients were identified based on culture, histopathology and/or serologic testing. Relevant clinical and epidemiologic data were collected. Results: We identified 103 subjects with proven and probable cryptococcosis. Mean age was 53.8 years and 72% were male. Predisposing conditions were present in 70 patients (68%); most commonly malignancy, non-transplant related immunosuppressive therapy, and solid organ transplantation. Median time to diagnosis in non-immunocompromised individuals was 67 days compared to 19.7, 31.3 and 61 days for organ transplant, hematologic malignancy and other conditions, respectively. Survival at 3 and 12 months was similar across all risk groups. Conclusions: Epidemiology, time to diagnosis, treatment and outcomes for HIV-uninfected persons with cryptococcosis in very diverse geographic regions are similar to data from North America and Western Europe.