Cryptococcosis in sarcoidosis: cryptOsarc, a comparative study of 18 cases.
C. Bernard
(1)
,
D. Maucort-Boulch
(2, 3, 4)
,
L. Varron
(1)
,
C. Charlier
(5, 6)
,
K. Sitbon
(7)
,
N. Freymond
(2)
,
D. Bouhour
(1)
,
A. Hot
(8)
,
A. C. Masquelet
(9)
,
D. Valeyre
(9)
,
N. Costedoat-Chalumeau
(10)
,
M. Etienne
(11)
,
I. Gueit
(11)
,
Stephane Jouneau
(12)
,
Philippe Delaval
(12)
,
L. Mouthon
(13)
,
Jean Pouget
(14)
,
J. Serratrice
(14)
,
J.-P. Brion
(15)
,
F. Vaylet
(16)
,
C. Bremont
(13)
,
J. M. Chennebault
(17)
,
S. Jaffuel
(18)
,
C. Broussolle
(1)
,
O. Lortholary
(7, 6, 5)
,
P. Sève
(1)
1
Hôpital de la Croix-Rousse [CHU - HCL]
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
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
D. Maucort-Boulch
- Fonction : Auteur
- PersonId : 1267466
- IdHAL : delphine-maucort-boulch
- ORCID : 0000-0003-0042-7787
- IdRef : 094595771
L. Mouthon
- 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.