Postoperative Antifungal Treatment of Pulmonary Cryptococcosis in Non-HIV-Infected and Non-Transplant-Recipient Patients: A Report of 110 Cases and Literature Review

Open Forum Infect Dis. 2020 Jan 13;7(1):ofaa004. doi: 10.1093/ofid/ofaa004. eCollection 2020 Jan.

Abstract

Background: To explore the efficacy of postoperative antifungal treatment for preventing the recurrence of pulmonary cryptococcosis (PC) and occurrence of cryptococcal meningitis (CM), a retrospective study was conducted in 112 hospitalized PC patients with or without antifungal treatment following surgery.

Methods: The treatment failure rate, PC recurrence rate, and CM incidence were compared. Additionally, the effectiveness of postoperative antifungal therapy was assessed by gathering and analyzing the published literature.

Results: The failure rate (P = .054) and recurrence rate (P = .178) were similar in the 2 groups, but the incidence of CM was lower in the group that received postoperative antifungal treatment (P = .039).

Conclusions: This study did not show any difference in the PC recurrence rate or failure rate in the different treatment duration groups. Thus, a shorter antifungal treatment course of 2 months may be an optional treatment. In addition, upon review of the literature, no case of CM occurrence was reported among the 169 cases given postoperative antifungal treatment.

Keywords: antifungal therapy; cryptococcal meningitis; pulmonary cryptococcosis; surgery.