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Clinical spectrum, immune status, and prognostic factors of cryptococcosis: insights from a large, multi-center, ambispective cohort study in southeastern China

Summary

This study examined cryptococcosis, a serious fungal infection, in 396 non-HIV patients across hospitals in southeastern China. The researchers found that patients’ immune status, whether the infection spread to the brain, and blood inflammation markers were key predictors of survival. Most patients treated with azole medications (a common antifungal) improved or recovered, though those with brain involvement or severe immune deficiency had worse outcomes. The findings help doctors identify which patients need more intensive treatment.

Background

Cryptococcosis is a major opportunistic fungal infection with heterogeneous clinical outcomes. While classically associated with advanced HIV infection, an increasing proportion of cases are now recognized in non-HIV populations. Data on clinical features and prognostic factors in non-HIV populations remain limited.

Objective

To provide real-world evidence on the clinical characteristics, immune stratification, diagnostic performance, treatment patterns, and outcomes of cryptococcosis in a non-HIV population. The study aimed to identify key determinants of clinical outcomes and support risk-stratified diagnostic and therapeutic strategies.

Results

Of 396 patients, 57.1% were immunocompetent, 33.1% had mild immunodeficiency, and 9.9% had severe immunodeficiency. Pulmonary disease predominated (89.7%), with 10.1% having meningitis/dissemination. Overall 89.0% recovered or improved, while 6.0% deteriorated or died. Poor outcomes were associated with older age, severe immunodeficiency, CNS involvement, lymphopenia, and elevated CRP. Azole monotherapy was effective in 95% of pulmonary cases.

Conclusion

Host immune status, CNS involvement, and systemic inflammation are key predictors of outcome in cryptococcosis. Quantitative and qualitative CrAg assays demonstrate high diagnostic performance. Azole monotherapy remained effective for pulmonary disease. These findings support risk-stratified diagnostic and therapeutic strategies, particularly in resource-limited settings.
  • Published in:Infectious Diseases of Poverty,
  • Study Type:Ambispective Cohort Study,
  • Source: PMID: 41485003, DOI: 10.1186/s40249-025-01408-3
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