Cryptococcal meningitis in systemic lupus erythematosus patients: pooled analysis and systematic review

Abstract

Cryptococcal meningitis is an important fungal infection among systemic lupus erythematosus patients. We conducted a pooled analysis and systematic review to describe the epidemiological and clinical profile of cryptococcal meningitis in systemic lupus erythematosus patients. From two hospitals in China and nine literature databases, cases and prevalence data were collected for pooled analysis and meta-analysis, respectively. Categorical variables of cases were compared using a χ2-test on the statistical program of SAS. A multiple regression analysis was performed to ascertain independent predictors significantly correlated with prognosis. Meta-analysis was conducted by the statistical program of R. The prevalence of cryptococcal meningitis in systemic lupus erythematosus patients was 0.5%. Patients were predominantly females and adults. A prednisone equivalent of more than 30 mg/day before infection was associated with higher mortality (odds ratio (OR)=9.69 (1.54, 60.73)). In all, 36.8–38.9% patients showed low lupus activity when they developed the crytococcal infection. Moreover, 38.2% of the patients were misdiagnosed. The estimated case-fatality rate was 23.6%. Our results suggest that more emphasis should be placed to further understand lupus-related cryptococcal meningitis and to develop better prophylaxis and management strategies to combat this condition.

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

“…The cryptococcosis cases in this study were characterised by the relatively frequent existence of underlying diseases besides DM II (43%). Similarities were also found in other researches on cryptococcosis with certain underlying diseases, 50% (n=7/14) of the cryptococcosis in kidney transplant recipients were with secondary underlying diseases; 34.8% (n=8/23) of the cryptococcosis/tuberculosis co‐infected cases were diagnosed as another comorbid condition; 16.7% of the cryptococcosis in SLE patients were noticed to be with other underlying diseases . Among other underlying diseases besides DM II, posttransplant diabetes was the most frequent (46%) in our study.…”

“…In the post‐highly active antiretroviral therapy (HAART) era, the changing epidemiology of cryptococcal diseases among HIV patients has been characterised by decreases in incidence and mortality . However, among non‐communicable diseases (NCDs) that affect the human population, such as systemic lupus erythematosus, kidney transplantation, nephrotic syndrome and diabetes mellitus II (DM II), cryptococcosis has received continued attention . In contrast with HIV‐related cryptococcosis, the clinical features of which have been adequately described in previous studies, the epidemiology and manifestations of cryptococcosis in NCDs that affect the human population, including DM II, are unclear.…”

Sepsis with cerebral lupus…. or is it? A case report on Cryptococcaemia

“…5 The reasons for this are multifactorial and include its non-specific clinical presentation in the early stage of infection, misjudging the risk for cryptococcal meningitis and misdiagnosis as psychosis due to steroids, cerebral lupus and other non-fungal pathogens. 2 This leads to inappropriate therapy and delays in administration of antifungal agents.…”

“…Importantly, cryptococcal meningitis is the foremost cause of mortality (85.7%) among SLE patients due to invasive fungal infections. 2 138 SLJID • www. http://sljol.info/index.php/SLJID • Vol.…”

Assessing the virulence ofCryptococcus neoformanscausing meningitis in HIV infected and uninfected patients in Vietnam

“…Cryptococcal meningitis (CM) is a life-threatening fungal infection caused principally by Cryptococcus neoformans and Cryptococcus gattii 1–3 . Despite CM being more common in immunocompromised patients, CM can also arise in apparently immunocompetent patients.…”