Cryptococcosis in sarcoidosis: cryptOsarc, a comparative study of 18 cases.
2 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
3 Service de Biostatistiques [Lyon]
4 HCL - Hospices Civils de Lyon
5 CNRMA - Centre National de Référence Mycologie et Antifongiques-Mycologie Moléculaire
6 Mycologie moléculaire
7 Centre d'infectiologie Necker-Pasteur [CHU Necker]
8 Hôpital Edouard Herriot [CHU - HCL]
9 Hôpital Avicenne [AP-HP]
10 CHU Pitié-Salpêtrière [AP-HP]
11 CHU Rouen
12 Contaminants Chimiques, immunité et Inflammation
13 Hôpital Cochin [AP-HP]
14 TIMONE - Hôpital de la Timone [CHU - APHM]
15 Service des Maladies Infectieuses
16 Hôpital d'instruction des Armées Percy
17 CHU Angers - Centre Hospitalier Universitaire d'Angers
18 CHU - BREST - Hôpital Morvan - CHRU de Brest
- Fonction : Auteur
- PersonId : 1267466
- IdHAL : delphine-maucort-boulch
- ORCID : 0000-0003-0042-7787
- IdRef : 094595771
- Fonction : Auteur
- PersonId : 768024
- ORCID : 0000-0002-1555-9021
- Fonction : Auteur
- PersonId : 1330915
- ORCID : 0000-0002-9838-246X
- IdRef : 069140634
Résumé
AIM: To describe the main characteristics and the treatment of cryptococcosis in patients with sarcoidosis. DESIGN: Multicenter study including all patients notified at the French National Reference Center for Invasive Mycoses and Antifungals. METHODS: Retrospective chart review. Each case was compared with two controls without opportunistic infections. RESULTS: Eighteen cases of cryptococcosis complicating sarcoidosis were analyzed (13 men and 5 women). With 2749 cases of cryptococcosis registered in France during the inclusion period of this study, sarcoidosis accounted for 0.6% of all the cryptococcosis patients and for 2.9% of the cryptococcosis HIV-seronegative patients. Cryptococcosis and sarcoidosis were diagnosed concomitantly in four cases; while sarcoidosis was previously known in 14/18 patients, including 12 patients (67%) treated with steroids. The median rate of CD4 T cells was 145 per mm(3) (range: 55-1300) and not related to steroid treatment. Thirteen patients had cryptococcal meningitis (72%), three osteoarticular (17%) and four disseminated infections (22%). Sixteen patients (89%) presented a complete response to antifungal therapy. After a mean follow-up of 6 years, no death was attributable to cryptococcosis. Extra-thoracic sarcoidosis and steroids were independent risk factors of cryptococcosis in a logistic regression model adjusted with the sex of the patients. CONCLUSIONS: Cryptococcosis is a significant opportunistic infection during extra-thoracic sarcoidosis, which occurs in one-third of the cases in patients without any treatment; it is not associated to severe CD4 lymphocytopenia and has a good prognosis.