Acute respiratory failure associated with pulmonary cryptococcosis in non-AIDS patients

Purpose: To determine the incidence of acute respiratory failure (ARF) in non-AIDS patients with pulmonary cryptococcosis (PC). Design: Retrospective cohort study. Setting: University of Pittsburgh Medical Center, Pittsburgh, Ph. Subjects: All patients in whom PC without HN infection was diagnosed between February 1989 and March 1999. Results: Thirty-three patients with PC were identified, and 11 of those patients (33%) developed ARF and comprised the study group. Underlying diseases included solid-organ transplant recipients (seven patients; 64%) and other underlying medical conditions (four patients; 36%), The most common symptoms were cough, shortness of breath, and temperature elevation. Extrapulmonary involvement was seen in six patients (meningitis, four patients; peritonitis, one patient; laryngeal mass, one patient), Six of the 11 patients (55%) died. Conclusion: ARF may develop in one third of non-AIDS patients with PC, This clinical syndrome is associated with the dissemination to extrapulmonary sites and high mortality rates. PC should be recognized as a possible cause of respiratory failure in non-AIDS patients.