A retrospective study of contributing factors for prognosis and survival length of cryptococcal meningoencephalitis in Southern part of China (1998–2013)

Abstract

BackgroundCryptococcal meningoencephalitis (CM) is the most common opportunistic infection of the central nervous system (CNS). Despite this observation, there have only been a few studies analyzing clinical characteristics as well as cerebrospinal fluid (CSF), electroencephalograph (EEG), and magnetic resonance imaging (MRI) features in CM patients of all ages.MethodsWe reviewed the medical records of all patients diagnosed with cryptococcal meningoencephalitis from 1998 to 2013 in the Nanfang Hospital in China and gathered data on the underlying diseases, bird exposure history, and clinical features, including those from CSF, EEG and MRI.ResultsCM is more likely to infect adults younger than 60 years old. 71.3% of CM patients were male. Unlike data from other countries, we found that chronic use of corticosteroids or other immunosuppressants (17.59%) was the most frequent risk factor in CM patients rather than HIV infection (1.85%). Clear exposure with bird/ bird droppings before CM onset is obvious in a previous study in CM children. However, our study found that 4.63% CM patients had such an exposure. More importantly, patients with brain tissue damage (p = 0.021) and decreased CSF/blood glucose ratio (p = 0.008) were significantly associated with death, but only the decreased CSF/blood glucose ratio was the contributing factor of prognosis (odds ratio, 0.047; p = 0.025). Decreased CSF/blood glucose ratio was significantly related to the survival length of CM (odds ratio, 0.134; p = 0.033).ConclusionsOur study shows that CM has predilection for young male adults. The chronic use of corticosteroids or other immunosuppressants, rather than HIV infection or bird/bird droppings exposure, was the most frequent risk factor in CM patients in our study. Decreased CSF/blood glucose ratio was both an independent contributing factor to death and was significantly related to the survival length of CM patients. The more decreased the CSF/blood glucose ratio was, the worse prognosis and shorter survival length CM patients had.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0826-y) contains supplementary material, which is available to authorized users.

Cryptococcosis in patients with diabetes mellitus II in mainland China: 1993‐2015

“…In their 15‐year retrospective survey, Zheng et al. revealed that cryptococcosis more likely occurs in younger than in older people . However, in our study, 93% and 30% cases were >40 and 60 years old, respectively, indicating the different distribution characteristics of cryptococcosis between the overall patients and the DM II population.…”

“…Most of the published and hospital cases occurred in North and East China, where the DM epidemic is the most serious (Fig. S1).In their 15-year retrospective survey, Zheng et al revealed that cryptococcosis more likely occurs in younger than in older people 31.…”

Comparison of Clinical Features and Prognostic Factors of Cryptococcal Meningitis Caused by Cryptococcus neoformans in Patients With and Without Pulmonary Nodules

“…Poor prognostic factors for CM in previous findings included CSF protein [ 1000 mg/L, CSF glucose \ 2.5 mmol/L, and decreased CSF/serum glucose ratio. Zheng et al [24] insisted that a decreased CSF glucose level was associated with high Cryptococcus titer and weakened immunity. The CSF/serum albumin ratio has been recognized as an indicator of blood-CSF barrier (BCB) function [25].…”

Comparison of clinical features and prognostic factors in HIV-negative adults with cryptococcal meningitis and tuberculous meningitis: a retrospective study

“…Previous studies showed there were many poor prognostic factors for CM, including Cryptococcus growth from sites other than CSF, altered mentation, intracranial pressure (ICP) >400 mmH 2 O, CSF glucose < 40 mg/dl, high CSF CrAg titer, decreased CSF/blood glucose ratio, papilledema, chronic use of corticosteroids or other immunosuppressants, absence of headache and low GCS score [7, 20, 22–24]. Our study showed that CrAg test was highly specific to the diagnosis of cryptococcal meningitis, and it also had prognostic value, similar to previous studies [25].…”