{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T08:17:20Z","timestamp":1762157840794,"version":"3.40.5"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T00:00:00Z","timestamp":1603843200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007268","name":"Washington University in St. Louis","doi-asserted-by":"publisher","award":["ULTR002345"],"award-info":[{"award-number":["ULTR002345"]}],"id":[{"id":"10.13039\/100007268","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Determining the extent of cryptococcal disease (CD) is key to therapeutic management. Treatment with fluconazole is only recommended for localised pulmonary disease. Induction therapy with amphotericin B (AmB) and flucytosine is recommended for disease at other sites, irrespective of central nervous system (CNS) involvement, but this is not often followed in patients without meningitis. In this study, we compared treatment and mortality between patients with CD of the CNS and other extrapulmonary (OE) sites.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective, single\u2010centre study of all hospitalised patients with nonpulmonary cryptococcal infection from 2002 to 2015 who underwent lumbar puncture. Demographics, predisposing factors, comorbidities, clinical presentation, laboratory values, antifungal treatment and mortality data were collected to evaluate 90\u2010day mortality and treatment differences between patients with OE and CNS CD. Survival analysis was performed using multivariable Cox regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 193 patients analysed, 143 (74%) had CNS CD and 50 (26%) had OE CD. Ninety\u2010day mortality was 23% and similar between the OE and CNS CD groups (22% vs 23%, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.9). In the comorbidity\u2010adjusted multivariable Cox regression model, mortality risk was similar in the OE and CNS groups. Fewer patients with OE CD received induction therapy with AmB and flucytosine compared to those with CNS disease (28% vs 71.3%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with OE CD had similar 90\u2010day mortality compared to those with CNS disease. Despite current guideline recommendations, patients with OE disease were less likely to receive appropriate induction therapy with AmB and flucytosine compared to patients with CNS disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.13199","type":"journal-article","created":{"date-parts":[[2020,10,16]],"date-time":"2020-10-16T21:14:00Z","timestamp":1602882840000},"page":"174-180","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Treatment and mortality outcomes in patients with other extrapulmonary cryptococcal disease compared with central nervous system disease"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0528-4252","authenticated-orcid":false,"given":"Carlos","family":"Mejia\u2010Chew","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases Department of Medicine Washington University School of Medicine St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abby","family":"Sung","sequence":"additional","affiliation":[{"name":"Department of Medicine Washington University School of Medicine St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1987-9786","authenticated-orcid":false,"given":"Lindsey","family":"Larson","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Medicine Washington University School of Medicine St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William G.","family":"Powderly","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Medicine Washington University School of Medicine St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7612-4710","authenticated-orcid":false,"given":"Andrej","family":"Spec","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Medicine Washington University School of Medicine St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,10,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0056269"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2019.04.026"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40588-017-0064-8"},{"key":"e_1_2_7_5_1","first-page":"61","article-title":"Cryptococcal infections in non\u2010hiv\u2010infected patients","volume":"124","author":"Pappas PG","year":"2013","journal-title":"Trans Am Clin Climatol 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