Clinical features of pulmonary cryptococcosis among patients with different levels of peripheral blood CD4+ T lymphocyte counts

BACKGROUND The clinical manifestation of pulmonary cryptococcosis varies notably between immunocompromised and immunocompetent patients. To better understand pulmonary cryptococcosis, we compared the clinical features of pulmonary cryptococcosis patients with or without decreased peripheral blood CD4+ T cell counts. METHODS We retrospectively reviewed the medical records of 80 patients with cryptococcosis who had been treated in Jingling Hospital from January 2011 to January 2016. According to the normal range of peripheral blood CD4 + T-lymphocyte counts in our population, we chose CD4 = 378/μL as a cut-off value. RESULTS The proportion of fever in the patients with decreased CD4+ T cells was higher than that of the patients with a normal amount of CD4+ T cells (86.7% vs 28.6%, P < 0.001). The incidence of clinical symptoms, such as cough (60.6% vs 64.7%, P = 0.729), chest pain (9.1% vs 26.5%, P = 0.064), and dyspnea (27.3% vs 23.5%, P = 0.725) showed no difference between patients with low CD4+ T cell counts and those with normal CD4+ T cell counts. The number of asymptomatic patients in the CD4+ T cell normal group was higher than that in the decreased CD4+ T cell group (17.1% vs 0%, P = 0.005). Nodules, masses, and halo signs were more common in the CD4+ T cell normal patients than in the low-CD4+ T cell patients (79.4% vs 54.5%, P = 0.03). The opposite trend was observed for cavitations (14.7% vs 51.5%, P = 0.001). The other CT findings, including pulmonary consolidation (P = 0.205), and pleural effusion (P = 0.641), did not differ significantly between the two groups. CONCLUSIONS CD4+ T lymphocytes have a significant impact on the clinical and radiological characteristics of pulmonary cryptococcosis. The patients with normal CD4+ T cell counts were found to have less fever and more nodule-like radiographic findings. TRIAL REGISTRATION 2011NJKY-023-01. Registered on January 10, 2011.