The Clinical Research Of Cryptococcosis Patients With Different Immune Status

Cryptococcosis is a potential life-threatening systemic mycosis with heterogeneous susceptible population.Disseminated cryptococcosis,especially CNS involvement,the aggressive treatment based on Amphotericin B and 5-fluorocytosine is recommended by the practical guidelines published in 2010.If the patients without timely diagnosis and treatment,this infection of Cryptococcus is always fatal.The immune status of cryptococcosis patient has been a study hotspot because of a tight link with the disseminated cryptococcosis and a consequent influence on the outcome of patients.Recent studies suggest cell immunity plays a significant role in protecting against the infection of Cryptococcus.However,the practical guidelines recommended that the initial treatment was made according to the underlying disease of cryptococcosis patients,which is not sufficient to the need of clinical treatment.As the clinical research of non-AIDS cryptococcosis patients was rare,the clinical data was mainly from a few small-size retrospective studies or case reports.The evidences recommended in practical guidelines also came from the researches of AIDS patients.At first,our study applied retrospective design to summarize the clinical data of the cryptococcosis patients with different underlying disease and further illustrate the influence of underlying disease on the clinical characteristics and outcome of cryptococcosis patients.Secondly,T lymphocyte subgroups analysis was applied in our study to discuss the role of cell immunity in assessing the disease severity and clinical outcome of cryptococcosis patients.Part one:The influence of underlying disease on the clinical characteristics and prognosis of cryptococcosis patientsObjection:Our study is aimed to summarize the clinical characterization of cryptococcosis with different underlying diseases and further discuss the influence of underlying disease on the clinical characteristics and prognosis of cryptococcosis patients.Method:Our study applied a retrospective design and retrieved the clinical data of hospitalized adult patients of cryptococcosis who have been treated at Jingling Hospital and the second hospital of Nanjing.The immunodeficiency patients or the patients with the basic diseases which may increase the risk of infection were collected into basic diseases group,the remainder patients were in non-basic diseases group.Results:Between January 2009 and December 2014,131 cases were included into our study from Jingling Hospital and the Second Hospital of Nanjing.The study included 93 male and 38 female patients whose mean age was 41.7±14.1 years old.The proportion of disseminated disease in AIDS group and OTR group were 86.7%and 76.9%respectively,which were greater than 54.8%in NHNT-1 group and 23.9%in NHNT-2 group(P<0.001).The proportion of the patients who were in absence of clinical symptom when first diagnosed as cryprococcosis in OTR group and NHNT-2 group were 15.4%and 23.9%,which was more than 0%in AIDS group and 2.4%in NHNT-1group(P=0.001).The proportion of the patients with the symptom of fever in AIDS,OTR and NHNT-1 group were 83.3%,84.6%and 69%,which was higher than 32.6%in NHNT-2 group(P<0.001).The proportion of the patients who have the symptom of cough and phlegm in four groups were 90%,80%,92.3%and 63.9%,the difference between groups reached statistical significant(P=0.027).Concerning to the manifestation of chest scan,the proportion of the nodule/mass sign in OTR group,NHNT-1group and NHNT-2 group were 71.4%,73.9%and 88.2%,which is greater than 33.3%in AIDS group(P<0.001).The proportion of patchy shadow and consolidation in AIDS group,OTR group and NHNT-1 group were 19.0%,28.6%,39.1%,which is more than NHNT-2 group(P=0.177).The proportion of mixed lesion in four group were 4.8%,14.3%,26.1%and 2.9%,the difference reached statistical significant(P=0.031).The proportion of the cavity sign in four groups were76.2%,57.1%,30.4%and 26.5%,the difference between groups were statistical significant(P=0.001).The positive rate of cryptococcal capsular polysaccharide antigen test in four groups were 100%,100%,85.7%and 66.7%,the difference between groups were statistical significant(P=0.028).Concerning to the clinical outcome of the patients,the mortality in AIDS group,OTR group and NHNT-1 group were 26.7%,30.8%,26.7%,which is higher than 6.5%in NHNT-2 group(P=0.046).Conclusion:Underlying diseases make a great impact on the clinical feature and prognosis of cryptococcosis.The patients with underlying diseases are inclined to have disseminated diseases and severer symptom.The mortality is high if CNS involvement.Part two:T lymphocyte subgroups is an important predictive factor for disease severity of patients with cryptococcosisObjective:To compare the role of underlying diseases and cell immunity in assessing the disease severity and clinical outcome of cryptococcosis patients.Method:Our study applied a retrospective design and retrieved the clinical data of hospitalized adult patients of cryptococcosis who have been treated at Jingling Hospital and the second hospital of Nanjing.T lymphocyte subgroups were applied to assess the cell-immunity function.Results:Between January 2009 and December 2014,83 cases were included into our study from Jingling Hospital and the second hospital of Nanjing.The study included 62 male and 21 female patients whose mean age was 40.6±13.9 years old.When CD4~+ T lymphocyte is lower than 400/?L,the odds ratio of the patients suffered from disseminated cryptococcosis is 41.9,95%confidence interval is 6.1?293.1(P<0.001).There was a moderate negative correlation between CD4T cell count and APACHE II score.The correlation coefficient is-0.543(p<0.001),which versus-0.355 and-0.182 in underlying disease and CD4/CD8 ratio respectively.The mortality of the patients with decreased CD4~+T lymphocyte is 26.3%,which is higher than 3.8%in the patients with normal CD4~+T lymphocyte(P=0.017).The mortality of the patients in severe underlying disease and non-severe underlying disease were 27.9%and 10%,the difference didn't reach statistical significant(P=0.052).Conclusion:Cell immunity,especially CD4~+ Tlymphocyte is better than underlying disease in effective prediction of disseminated cryptococcosis and provides a more accurate assessment of the disease severity and clinical outcome of cryptococcosis.