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

Abstract

Whether the clinical features of cryptococcal meningitis (CM) patients vary with the coexistence of pulmonary nodules is not clear. This study aimed to compare the clinical features of CM in patients with and without pulmonary nodules detected by chest computed tomography (CT). The medical records of CM patients hospitalized in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 1, 2010, to December 31, 2016, were retrospectively reviewed. Baseline demographics, laboratory and radiographic findings, clinical managements, and outcomes were analyzed. A total of 90 CM patients were enrolled. Forty (44.4%) patients had pulmonary nodules (PN-positive), and 50 (55.6%) patients had no pulmonary nodules (PN-negative). Compared with PN-negative patients, PN-positive patients had higher cerebrospinal fluid (CSF)/serum albumin ratios, higher rates of CSF protein> 1000 mg/L, CSF glucose < 2.5 mmol/L, worse overall treatment response, higher rates of abnormal head CT and magnetic resonance imaging manifestations, and more unfavorable clinical outcomes. Multivariate analysis showed that immunocompromise (p = 0.037) and CSF glucose < 2.5 mmol/L (p = 0.044) indicated poor outcome in PN-positive patients, while CSF glucose < 2.5 mmol/L (p = 0.025) also indicated poor outcome in PN-negative patients. Amphotericin B in the initial therapy was a protective factor for PN-negative patients (p = 0.008). Certain clinical features showed significant differences between CM patients with and without pulmonary nodules, and several independent contributing factors impacted the clinical outcomes for CM patients. Future studies should be performed to further examine these factors.

Microbiological, Epidemiological, and Clinical Characteristics of Patients With Cryptococcal Meningitis at a Tertiary Hospital in China: A 6-Year Retrospective Analysis

“…Its clinical presentation is often not specific (Liu et al, 2017;Alves Soares et al, 2019). In the current study, headache was the most common presentation (85, 77.3%), followed by fever (52, 47.3%), and nausea/vomiting (32, 29.09%), in accordance with another study involving 90 cryptococcal meningitis patients (Cao et al, 2019). In 45 cryptococcosis cases caused by C. gattii species complex, their clinical features also included headache (80.5%) and nausea/vomiting (56.1%) (Lizarazo et al, 2014).…”

“…In our study, male patients accounted for 60.9% (67/110). Similarly, male predominance was also shown in Wuhan, China (75.6%, 68/90 cryptococcal meningitis cases) ( Cao et al, 2019 ), in Beijing, China (73%, 38/52 pediatric patients with disseminated cryptococcosis) ( Gao et al, 2017 ), in Colombia (79.6% in the general population and 84.4% in HIV/AIDS patients) ( Escandon et al, 2018 ), and in Brazil (69% in 5,755 recorded deaths related to cryptococcosis) ( Alves Soares et al, 2019 ). Furthermore, in our study, 16.4% (18/110) were elderly patients (≧65 years, 13 males and 5 females).…”

“…Cryptococcus, usually acquired by inhalation, causes pneumonia and cryptococcemia, and exhibits a propensity to disseminate to the brain and presents as meningitis (Fan et al, 2016;O'Halloran et al, 2017;Cao et al, 2019;Tsai et al, 2019). Cryptococcal meningitis is the most severe and common form of cryptococcosis (Yuchong et al, 2012;Rajasingham et al, 2017).…”

“…Understanding the epidemiological characteristics of local Cryptococcus strains and clinical features of cryptococcal meningitis is essential for the development of efficient diagnosis and treatment strategy. Studies on that are rare in China (Fan et al, 2016;Guo et al, 2016;Liu et al, 2017;Cao et al, 2019), and they focused on pediatric patients (Guo et al, 2016), clinical features (Liu et al, 2017;Cao et al, 2019), or molecular and antifungal resistance characteristics (Fan et al, 2016), respectively. Continuous and comprehensive monitoring of the epidemical changes is crucial for the treatment and prevention of cryptococcosis.…”

Impaired consciousness and decreased glucose concentration of CSF as prognostic factors in immunocompetent patients with cryptococcal meningitis

“…Decreased CSF glucose concentration is used as indicators in the process of diagnosing community-acquired meningitis [26]. In previous studies from china, patients with Decreased CSF glucose level tended to have worse outcome [18,27], and this also occurred in our patient population. Infection with Cryptococcus neoformans caused dysfunction of the blood-brain barrier and presentation of cryptococcus in CSF [28], which result in the abnormality of glucose transportation and increased glycolysis, respectively [29].…”