Unique characteristics of cryptococcosis identified after death in patients with liver cirrhosis

comparison with concurrent cohort diagnosed antemortem

Nina Singh, Costi D. Sifri, Fernanda P. Silveira, Rachel Miller, Kevin S. Gregg, Shirish Huprikar, Erika D. Lease, Andrea Zimmer, J. Stephen Dummer, Cedric W. Spak, Christine Koval, David B. Banach, Miloni Shroff, Jade Le, Darin Ostrander, Robin Avery, Albert Eid, Raymund R Razonable, Jose Montero, Emily Blumberg & 8 others Ahlaam Alynbiawi, Michele I. Morris, Henry B. Randall, George Alangaden, Jeffrey Tessier, Thomas V. Cacciarelli, Marilyn M. Wagener, Hsin Yun Sun

Research output: Contribution to journalArticle

Abstract

Characteristics of cirrhosis-associated cryptococcosis first diagnosed after death are not fully known. In a multicenter study, data generated as standard of care was systematically collected in 113 consecutive patients with cirrhosis and cryptococcosis followed for 80 patient-years. The diagnosis of cryptococcosis was first established after death in 15.9% (18/113) of the patients. Compared to cases diagnosed while alive, these patients had higher MELD score (33 vs. 22, P = .029) and higher rate of cryptococcemia (75.0% vs. 41.9%, P = .027). Cases diagnosed after death, in comparison to those diagnosed during life were more likely to present with shock (OR 3.42, 95% CI 1.18-9.90, P = .023), require mechanical ventilation at admission (OR 8.5, 95% CI 2.74-26.38, P = .001), less likely to undergo testing for serum cryptococcal antigen (OR 0.07, 95% CI 0.02-0.21, P < .001) and have positive antigen when the test was performed (OR 0.07, 95% CI 0.01-0.60, P = .016). In a subset of cirrhotic patients with advanced liver disease cryptococcosis was first recognized after death. These patients had the characteristics of presenting with fulminant fungemia, were less likely to have positive serum cryptococcal antigen and posed a diagnostic challenge for care providers.

Original languageEnglish (US)
Pages (from-to)278-284
Number of pages7
JournalMedical Mycology
Volume55
Issue number3
DOIs
StatePublished - Apr 1 2017

Fingerprint

Cryptococcosis
Liver Cirrhosis
Antigens
Fibrosis
Fungemia
Standard of Care
Serum
Artificial Respiration
Multicenter Studies
Liver Diseases
Shock

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Unique characteristics of cryptococcosis identified after death in patients with liver cirrhosis : comparison with concurrent cohort diagnosed antemortem. / Singh, Nina; Sifri, Costi D.; Silveira, Fernanda P.; Miller, Rachel; Gregg, Kevin S.; Huprikar, Shirish; Lease, Erika D.; Zimmer, Andrea; Dummer, J. Stephen; Spak, Cedric W.; Koval, Christine; Banach, David B.; Shroff, Miloni; Le, Jade; Ostrander, Darin; Avery, Robin; Eid, Albert; Razonable, Raymund R; Montero, Jose; Blumberg, Emily; Alynbiawi, Ahlaam; Morris, Michele I.; Randall, Henry B.; Alangaden, George; Tessier, Jeffrey; Cacciarelli, Thomas V.; Wagener, Marilyn M.; Sun, Hsin Yun.

In: Medical Mycology, Vol. 55, No. 3, 01.04.2017, p. 278-284.

Research output: Contribution to journalArticle

Singh, N, Sifri, CD, Silveira, FP, Miller, R, Gregg, KS, Huprikar, S, Lease, ED, Zimmer, A, Dummer, JS, Spak, CW, Koval, C, Banach, DB, Shroff, M, Le, J, Ostrander, D, Avery, R, Eid, A, Razonable, RR, Montero, J, Blumberg, E, Alynbiawi, A, Morris, MI, Randall, HB, Alangaden, G, Tessier, J, Cacciarelli, TV, Wagener, MM & Sun, HY 2017, 'Unique characteristics of cryptococcosis identified after death in patients with liver cirrhosis: comparison with concurrent cohort diagnosed antemortem', Medical Mycology, vol. 55, no. 3, pp. 278-284. https://doi.org/10.1093/mmy/myw079
Singh, Nina ; Sifri, Costi D. ; Silveira, Fernanda P. ; Miller, Rachel ; Gregg, Kevin S. ; Huprikar, Shirish ; Lease, Erika D. ; Zimmer, Andrea ; Dummer, J. Stephen ; Spak, Cedric W. ; Koval, Christine ; Banach, David B. ; Shroff, Miloni ; Le, Jade ; Ostrander, Darin ; Avery, Robin ; Eid, Albert ; Razonable, Raymund R ; Montero, Jose ; Blumberg, Emily ; Alynbiawi, Ahlaam ; Morris, Michele I. ; Randall, Henry B. ; Alangaden, George ; Tessier, Jeffrey ; Cacciarelli, Thomas V. ; Wagener, Marilyn M. ; Sun, Hsin Yun. / Unique characteristics of cryptococcosis identified after death in patients with liver cirrhosis : comparison with concurrent cohort diagnosed antemortem. In: Medical Mycology. 2017 ; Vol. 55, No. 3. pp. 278-284.
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AU - Silveira, Fernanda P.

AU - Miller, Rachel

AU - Gregg, Kevin S.

AU - Huprikar, Shirish

AU - Lease, Erika D.

AU - Zimmer, Andrea

AU - Dummer, J. Stephen

AU - Spak, Cedric W.

AU - Koval, Christine

AU - Banach, David B.

AU - Shroff, Miloni

AU - Le, Jade

AU - Ostrander, Darin

AU - Avery, Robin

AU - Eid, Albert

AU - Razonable, Raymund R

AU - Montero, Jose

AU - Blumberg, Emily

AU - Alynbiawi, Ahlaam

AU - Morris, Michele I.

AU - Randall, Henry B.

AU - Alangaden, George

AU - Tessier, Jeffrey

AU - Cacciarelli, Thomas V.

AU - Wagener, Marilyn M.

AU - Sun, Hsin Yun

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N2 - Characteristics of cirrhosis-associated cryptococcosis first diagnosed after death are not fully known. In a multicenter study, data generated as standard of care was systematically collected in 113 consecutive patients with cirrhosis and cryptococcosis followed for 80 patient-years. The diagnosis of cryptococcosis was first established after death in 15.9% (18/113) of the patients. Compared to cases diagnosed while alive, these patients had higher MELD score (33 vs. 22, P = .029) and higher rate of cryptococcemia (75.0% vs. 41.9%, P = .027). Cases diagnosed after death, in comparison to those diagnosed during life were more likely to present with shock (OR 3.42, 95% CI 1.18-9.90, P = .023), require mechanical ventilation at admission (OR 8.5, 95% CI 2.74-26.38, P = .001), less likely to undergo testing for serum cryptococcal antigen (OR 0.07, 95% CI 0.02-0.21, P < .001) and have positive antigen when the test was performed (OR 0.07, 95% CI 0.01-0.60, P = .016). In a subset of cirrhotic patients with advanced liver disease cryptococcosis was first recognized after death. These patients had the characteristics of presenting with fulminant fungemia, were less likely to have positive serum cryptococcal antigen and posed a diagnostic challenge for care providers.

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