Mycoses. 2022 Jun 3. doi: 10.1111/myc.13476. Online ahead of print.
BACKGROUND: It is unclear if there is an association between COVID-19 and cryptococcosis. Therefore, this study aimed to describe the clinical features, risk factors, and outcomes associated with cryptococcosis in hospitalized patients with COVID-19.
OBJECTIVES: To determine the incidence of and examine factors associated with cryptococcosis after a diagnosis of COVID-19.
METHODS: We used TriNetX to identify and sort patients 18 years and older hospitalized with COVID-19 into two cohorts based on the presence or absence of a diagnosis of cryptococcosis following diagnosis of COVID-19. Outcomes of interest included the incidence of cryptococcosis following the diagnosis of COVID-19 as well as the proportion of patients in each group who had underlying comorbidities, received immunomodulatory therapy, required ICU admission or mechanical ventilation (MV), or who died. Propensity score matching was used to adjust for confounding.
RESULTS: Among 212,479 hospitalized patients with COVID-19, 65 developed cryptococcosis. The incidence of cryptococcosis following COVID-19 was 0.022%. Patients with cryptococcosis were more likely to be male and have underlying comorbidities. Among cases, 32% were people with HIV. Patients with cryptococcosis were more likely to have received tocilizumab (p<0.0001) or baricitinib (p<0.0001), but not dexamethasone (p=0.0840). ICU admission (38% vs 29%), MV (23% vs 11%), and mortality (36% vs 14%) were significantly higher among patients with cryptococcosis. Mortality remained elevated after adjusted propensity score matching.
CONCLUSION: Cryptococcosis occurred most often in hospitalized patients with COVID-19 who had traditional risk factors, comparable to findings in patients without COVID-19. Cryptococcosis was associated with increased ICU admission, MV, and mortality.