Comparison of features and outcomes between HIV‐negative patients with Cryptococcus gattii meningitis and Cryptococcus neoformans meningitis in South China

Abstract

Objectives The objective of this study is to compare the epidemiologic, clinical, laboratory, and imaging features, and outcomes in patients with Cryptococcus gattii meningitis (CGM) and Cryptococcus neoformans meningitis (CNM). Methods We performed a retrospective study of HIV‐negative patients with CGM and CNM (2015–2021) distinguished by metagenomic next‐generation sequencing in cerebrospinal fluid in South China. Results A total of 81 patients (17 CGM, 64 CNM) were enrolled (72.8% male, median age 49 years, range 21–77 years), and CGM patients were younger (median, 43 vs 53 years, p = .005). Of 17 CGM, VGI and VGII accounted for 70.6% and 29.4%, respectively. CGM patients had less underlying diseases (7/17 [41.2%] vs 48/64 [75%], p = .018) and focal neurologic deficit (3/17 [17.6%] vs 35/64 [54.7%], p = .022), had higher intracranial pressure (15/17 [88.2%] vs 25/64 [39.1%], p = .002), more meningeal enhancement (14/17 [82.4%] vs 32/64 [50%], p = .034), less parenchymal involvement (median, 1 vs 3, p = .018), more lung cryptococcomas (6/12 [50%] vs 6/47 [12.8%], p = .014), faster CSF fungal clearance (p = .004), less complications (median, 1 vs 3, p < .001), and more favourable outcomes (16/17 [94.1%] vs 41/64 [64.1%], p = .035). Conclusions This study demonstrated that species identification helps to guide therapy and predict outcomes.

Cryptococcal meningitis

“…Infection with C. gattii (especially with the VGI & VGII C. gattii lineages) is more common in apparently immune-competent individuals, whereas C. neoformans is the predominant species in immunocompromised individuals with cryptococcal meningitis 6,61 . Paradoxically, Cryptococcus neoformans species complex, sequence type 5 (ST 5) is the dominant species isolated from apparently immunocompetent individuals in China and Vietnam 2,3,62 .…”