ArticleEClinicalMedicine2020
Potential missed opportunities for diagnosis of cryptococcosis and the association with mortality: A cohort study.
Article in EClinicalMedicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 28 citations in OpenAlex.
- Cryptococcal Meningitis: Comparison of Short- (≤ 1 Week) Versus Longer-duration (> 1 Week) Liposomal Amphotericin B Induction Therapy and Factors Associated With Clinical Outcomes in HIV and Non-HIV Patients.Open forum infectious diseases · 2026Trial
- Cryptococcal Meningitis Treatment Beyond HIV: Recognizing the Need for Individualized Immune-Based Strategies.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- Rapid respiratory cryptococcosis detection using targeted next-generation sequencing.PLoS neglected tropical diseases · 2025Article
- Comparative evaluation of sensititre YeastOne and VITEK2 antifungal susceptibility tests with CLSI broth microdilution method of clinicalMicrobiology spectrum · 2025Article
- Severe Disseminated Cryptococcosis Leading to Multi-organ Failure in a Renal Transplant Patient: A Case ReportCurrent medical imaging · 2025Article
- A Systematic Literature Review to Determine Gaps in Diagnosing Suspected Infection in Solid Organ Transplant Recipients.Open forum infectious diseases · 2025Article
- Metagenomic next-generation sequencing facilitates precision treatment and prognostic improvement in pulmonary cryptococcosis.Frontiers in cellular and infection microbiology · 2025Article
- Shared Vision for Improving Outcomes for Serious Fungal Diseases: Report of a Patient, Caregiver, and Clinician Summit.Open forum infectious diseases · 2024Article
- The Role of Frequent Screening or Diagnostic Testing of Serum Cryptococcal Antigen in Liver Transplant Recipients: A Descriptive Epidemiology.Open forum infectious diseases · 2024Article
- Epidemiology of Cryptococcosis Among Patients With Commercial Health Insurance and Patients With Medicaid, United States, 2016-2022.Open forum infectious diseases · 2024Article
- The incidences and clinical outcomes of cryptococcosis in Taiwan: A nationwide, population-based study, 2002-2015.Medical mycology · 2024Article
- Shared and unique antibody and B cell profiles in HIV-positive and HIV-negative individuals with cryptococcal meningoencephalitis.Medical mycology · 2023Article
- A clinically-guided unsupervised clustering approach to recommend symptoms of disease associated with diagnostic opportunities.Diagnosis (Berlin, Germany) · 2023Article
- Testing for Cryptococcosis at a Major Commercial Laboratory-United States, 2019-2021.Open forum infectious diseases · 2022Article
- The Sweet Side of Fungal Infections: Structural Glycan Diversity and Its Importance for Pathogenic Adaptation.Medicines (Basel, Switzerland) · 2022Article
- Delays in Cryptococcal Meningitis Diagnosis and Care: A Mixed Methods Study in Rural Uganda.Annals of global health · 2022Article
- Orthostatic hypotension as the initial presentation of disseminated cryptococcosis in a kidney transplant recipient.IDCases · 2022Article
- Epidemiological trends and clinical outcomes of cryptococcosis in a medically insured population in the United States: a claims-based analysis from 2017 to 2019.Therapeutic advances in infectious diseaseArticle
- Missed opportunities to identify cryptococcosis in COVID-19 patients: a case report and literature review.Therapeutic advances in infectious diseaseArticle
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
Abstract
backgroundCryptococcosis is one of the most common life-threatening opportunistic mycoses worldwide. Insidious presentation and slow onset of symptoms make it difficult to recognize, complicating the diagnostic process. Delays in diagnosis may lead to increased mortality. We aim to determine the frequency of missed opportunities for diagnosis of cryptococcosis and its effects on mortality.
methodsTo estimate the proportion of individuals with a potentially missed diagnosis for cryptococcosis in hospitalized patients, we conducted a retrospective cohort study using the Healthcare Cost and Utilization Project State Inpatient Databases from 2005 to 2015 from eight states. All hospitalized adult patients diagnosed with cryptococcal infection or cryptococcal meningitis were included. Potentially missed diagnoses were defined as admissions coded for a procedure or diagnosis suggestive of cryptococcosis in the 90-days prior to the initial cryptococcosis admission. Generalized estimating equations models were used to evaluate the association between underlying comorbidities and potential missed diagnosis of cryptococcosis and 90-day all-cause in-hospital mortality.
findingsOf 5,354 patients with cryptococcosis, 2,445 (45·7%) were people living with HIV (PLWH). Among PLWH, 493/2,445 (20·2%) had a potentially missed diagnosis, of which 83/493 (16·8%) died while hospitalized compared with 265/1,952 (13·6%) of those without a potentially missed diagnosis (relative risk [RR] 1·04, 95% CI 0·99-1·09). Among HIV-negative patients, 977/2,909 (33·6%) had a potentially missed diagnosis, of which 236/977 (24·2%) died while hospitalized compared with 298/1,932 (15·4%) of those not missed (RR 1·12, 95% CI 1·07-1·16).
interpretationMissed opportunities to diagnose cryptococcosis are common despite highly efficacious diagnostic tests and are associated with increased risk of 90-day mortality in HIV-negative patients. A high index of clinical suspicion is paramount to promptly diagnose, treat, and improve cryptococcosis-related mortality.
fundingNational Center for Advancing Translational Sciences, Washington University Institute of Clinical and Translational Sciences, and the Agency for Healthcare Research and Quality.
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