Epidemiological characterization and prognostic factors in patients with confirmed cerebral cryptococcosis in central Taiwan

Abstract

BackgroundCryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors.MethodsThis cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors.ResultsFifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (≥250 mm H2O).ConclusionsWe strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.

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

“…Reviewing the clinical manifestations of the 76 patients in the present study, headache (71/76,93.4%), fever (71/ 76,93.4%), vomiting (38/76, 50%) were common but not significantly different between the good outcome group and unfavorable groups, almost consistent with previous studies [5,9].. Several studies focused on non-HIV patients reported the correlation between initial consciousness level and therapeutic outcome [19,23,24].…”

“…Consistently, in the present study, logistic regression analysis demonstrated that CM patients with impaired consciousness had a significantly higher probability of an unfavorable outcome. Several previous studies confirm that high CSF opening pressure is prognostic factors independently associated with unfavorable outcome or increased odds of mortality [5,25], in present study, CSF opening pressure(>300mmH2O) is associated with unfavorable outcome, but our multivariate logistic regression analyses did not identify it as a significant prognostic factor for outcome which may due to small sample size. CSF opening pressure requires further analysis in larger cohorts of immunocompetent patients.…”

Epidemiology of central nervous system infectious diseases: a meta-analysis and systematic review with implications for neurosurgeons worldwide

“…All included studies originated from HICs, and the overall pooled estimate of incidence was 4 cases/100,000 people (95% CI 1-9). Case fatality for non-TB osteomyelitis was available in six studies, 24,37,76,82,186,187 giving an overall rate of 13.6% (95% CI 3.8%-23.5%), with the highest report of 26.8% in an elderly population in New Zealand 76 and the lowest (< 0.01%) in England. 187 Study quality was not a source of heterogeneity in a metaregression analysis (p = 0.99).…”

Disseminated cryptococcosis with varicella-zoster virus coinfection of idiopathic CD4 + T lymphocytopenia: a case report and literature review

“…Cryptococcal meningitis is linked to a high rate of morbidity and death. Poor outcomes have previously been linked to advanced age (≥ 60 years), solid malignancy, hematologic malignancy, liver cirrhosis, respiratory failure, long-term ICU stay, corticosteroid treatment, and disturbed mental state (coma, seizure, herniation) [ 38 – 41 ]. Low CSF leukocyte counts (less than 20 cells/microL), low CSF glucose, high CSF CrAg titers (> 1:1024), high CSF opening pressure (≥ 250 mm H 2 O), lower Glasgow Coma Scale (GCS) scores, hematogenous dissemination of cryptococcosis, hydrocephalus, and cerebral infarction have all been linked to poor outcomes [ 38 , 40 – 46 ].…”