We aimed to describe features and outcomes of cryptococcosis among HIV-seronegative individuals in a large surveillance network for cryptococcosis in France. We included incident cases of cryptococcosis in HIV-seronegative individuals from 2005 to 2020. We compared patient characteristics, disease presentations, cryptococcal antigen results, and induction antifungal treatments according to underlying disease. We examined factors associated with 90-day mortality. Among patients with disseminated infections, we investigated whether receipt of flucytosine and polyene combination was associated with lower mortality. Among 652 individuals, 209 (32.1%) had malignancy, 130 (19.9%) were solid-organ transplant recipients, 204 (31.3%) had other immunocompromising conditions, and 109 (16.7%) had no reported underlying factor. The commonest presentations were disseminated infections (63.3%, 413/652) and isolated pulmonary infections (25.3%, 165/652). Solid-organ transplant patients were most likely to have disseminated infections and a positive serum cryptococcal antigen result. Patients with malignancy were older and less likely to receive a flucytosine-containing regimen for disseminated infections than others (58.7%, 78/133 vs. 73.2%, 194/265; p 0.029). The crude 90-day case-fatality ratio was 27.2% (95% CI, 23.5%–31.1%). Age ≥60 years (aOR: 2.75 [1.78–4.26]; p < 0.001), meningitis/fungaemia (aOR: 4.79 [1.80–12.7]; p 0.002), and malignancy (aOR: 2.4 [1.14–5.07]; p 0.02) were associated with higher 90-day mortality. Receipt of flucytosine and polyene combination was associated with lower 90-day mortality (aOR: 0.40 [0.23–0.71]; p 0.002) in multivariable analysis and inverse probability of treatment weighted analysis (aOR: 0.45 [0.25–0.80]; p 0.006). HIV-seronegative individuals with cryptococcosis comprise a wide range of underlying conditions with different presentations and outcomes, requiring a tailored approach to diagnosis and management.

中文翻译：

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法国 652 名 HIV 血清阴性个体的隐球菌病特征：一项横断面观察研究（2005-2020 年）

我们的目的是描述法国大型隐球菌病监测网络中艾滋病毒血清阴性个体的隐球菌病的特征和结果。我们纳入了 2005 年至 2020 年 HIV 血清阴性个体中发生的隐球菌病病例。我们比较了患者特征、疾病表现、隐球菌抗原结果以及根据基础疾病诱导抗真菌治疗。我们研究了与 90 天死亡率相关的因素。在患有播散性感染的患者中，我们调查了接受氟胞嘧啶和多烯组合治疗是否与较低的死亡率相关。在 652 人中，209 人（32.1%）患有恶性肿瘤，130 人（19.9%）接受实体器官移植，204 人（31.3%）患有其他免疫功能低下疾病，109 人（16.7%）没有报告潜在因素。最常见的表现是播散性感染（63.3%，413/652）和孤立性肺部感染（25.3%，165/652）。实体器官移植患者最有可能出现播散性感染且血清隐球菌抗原结果呈阳性。与其他患者相比，恶性肿瘤患者年龄较大，接受含氟胞嘧啶治疗播散性感染的方案的可能性较小（58.7%, 78/133 vs. 73.2%, 194/265；p = 0.029）。 90 天粗病死率为 27.2%（95% CI，23.5%–31.1%）。年龄≥60岁（aOR：2.75 [1.78–4.26]；p < 0.001）、脑膜炎/真菌血症（aOR：4.79 [1.80–12.7]；p < 0.002）和恶性肿瘤（aOR：2.4 [1.14-5.07]；p < 0.02） ）与较高的 90 天死亡率相关。在多变量分析和治疗加权逆概率分析中，接受氟胞嘧啶和多烯组合与较低的 90 天死亡率相关（aOR：0.40 [0.23–0.71]；p < 0.002）（aOR：0.45 [0.25–0.80]；p < 0.006） 。患有隐球菌病的 HIV 血清阴性个体包含多种潜在病症，具有不同的表现和结果，需要量身定制的诊断和管理方法。