{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:55:45Z","timestamp":1791449745414,"version":"4.3.3"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cryptococcosis increasingly affects non-HIV, non-transplant (NHNT) adults, but factors associated with extrapulmonary dissemination remain incompletely defined. We evaluated associations between comorbidities, immunosuppressive therapy, and cryptococcal disease phenotype.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>NHNT adults with cryptococcosis in Merative MarketScan were classified as having pulmonary or extrapulmonary disease. Extrapulmonary disease was further classified as central nervous system (CNS) or non-CNS disseminated disease. Comorbidities and immunosuppressant, systemic glucocorticoid, and antineoplastic exposures during the 6 months before diagnosis were evaluated. Multivariable logistic regression identified factors associated with extrapulmonary disease, with secondary phenotype-specific analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 722 NHNT adults, 52% had extrapulmonary cryptococcosis, including 82% with CNS involvement. Extrapulmonary disease was associated with longer hospitalization, greater ICU utilization, and lower community discharge (all P &amp;lt; .001). Renal disorders (aOR 1.51, 95% CI 1.05\u20132.18) and immunosuppressant exposure (aOR 2.75, 95% CI 1.61\u20134.86) were associated with extrapulmonary disease. Immunosuppressant exposure was also associated with both CNS and non-CNS disseminated disease. Among glucocorticoid-exposed patients, longer exposure was associated with extrapulmonary disease (aOR 1.05 per week, 95% CI 1.02\u20131.08), primarily CNS disease, whereas higher average daily dose was associated with non-CNS disseminated disease only within shorter exposure windows.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Extrapulmonary cryptococcosis was common among NHNT adults and was associated with substantially greater morbidity than pulmonary disease. Immunosuppressant exposure was consistently associated with both CNS and non-CNS disseminated disease, whereas associations with glucocorticoid duration and average daily dose varied by phenotype and timing. These findings support guideline-recommended systematic evaluation for dissemination and suggest that pre-diagnostic immunosuppressive therapy history may inform assessment of extrapulmonary disease risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag597","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:34:59Z","timestamp":1789673699000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinical Phenotypes, Immunosuppressive Exposures, and Outcomes in Pulmonary vs Extrapulmonary Cryptococcosis Among Non-HIV, Non-Transplant Adults: A U.S. Claims Analysis"],"prefix":"10.1093","volume":"13","author":[{"given":"Ameera","family":"Jamshad","sequence":"first","affiliation":[{"name":"Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy , Athens, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3545-2492","authenticated-orcid":false,"given":"Bayard A","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy , Athens, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7361-1847","authenticated-orcid":false,"given":"Guozheng","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology & Biostatistics, University of Georgia College of Public Health , Athens, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhetao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology & Biostatistics, University of Georgia College of Public Health , Athens, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1806-0883","authenticated-orcid":false,"given":"Xianyan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology & Biostatistics, University of Georgia College of Public Health , Athens, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3656-1144","authenticated-orcid":false,"given":"David B","family":"Cluck","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University , Johnson City, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7363-8652","authenticated-orcid":false,"given":"Andr\u00e9s F","family":"Henao-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of Colorado , Aurora, Colorado ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4018-0195","authenticated-orcid":false,"given":"Daniel B","family":"Chastain","sequence":"additional","affiliation":[{"name":"Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy , Augusta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"2026100804370284600_ofag597-B1","article-title":"Epidemiological trends and clinical outcomes of cryptococcosis in a medically insured population in the United States: a claims-based analysis from 2017 to 2019","volume":"11","author":"Chastain","year":"2024","journal-title":"Ther Adv Infect Dis"},{"key":"2026100804370284600_ofag597-B2","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1093\/cid\/ciad321","article-title":"Current 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