Gender-specific contributing risk factors and outcome of female cryptococcal meningoencephalitis patients

Abstract

BackgroundAlthough male predominance was documented in previous studies on cryptococcal meningoencephalitis (CM), there has been no statistical study about female CM patients despite recently noticeable increase in female prevalence. In the current study, we aimed to investigate the independent gender-specific contributing risk factors for onset of CM and factors related to survival time in female patients by chosen statistical tools.MethodsThere have been 108 patients diagnosed with CM from July 1, 1998 to June 30, 2013 in Nanfang Hospital that were included in our study. This 15-year retrospective study compared demographic and clinical features of 31 female patients with 77 males. Multivariate analysis was performed for detection of the contributors to the onset of CM in female patients. The independent variables for multivariate analysis were selected according to statistical significance in univariate analysis. Furthermore, Cox regression model was used to evaluate the factors related to survival length.ResultsUse of corticosteroids or other immunosuppressants (32.3 % versus 11.7 %; p = 0.011) and history of systemic lupus erythematosus (SLE) and other autoimmune diseases (29 % versus 3.9 %; p < 0.001) were more common in females, but only the history of SLE or other autoimmune diseases was significant (OR 10.59, 95 % CI 1.49-74.77, p = 0.02) by multivariate analysis. The ratio of cerebrospinal fluid (CSF) glucose-to-blood glucose was related to the survival time (p = 0.03, 95 % CI 0-0.71).ConclusionsThe results showed that the history of SLE or other autoimmune diseases rather than chronic use of corticosteroids and/or immunosuppressants was the independent gender-specific contributing risk factor in female CM patients. Therefore, more attention should be made to the prevention of infection from the genus Cryptococcus spp. in female patients with SLE or other autoimmune diseases. In addition, decreased ratio of CSF glucose-to-blood glucose before antifungal therapy predicted the worse prognosis.

An Overview of Sex Bias in C. neoformans Infections

“…Thus, there may be a decreased incidence of females with cryptococcosis, at least in part, because they have higher levels of estrogen. Some anecdotal evidence to support this is that female patients with cryptococcal meningitis are more likely to have other comorbidities that depress the immune response, such as systemic lupus erythematosus [ 51 ], which is often associated with T-cell abnormalities [ 52 ]. In addition, Tamoxifen, a selective estrogen receptor modulator (SERM), has shown anti-cryptococcal properties [ 53 ], not because it modulates estrogen binding but because it interferes with C. neoformans calmodulin signaling.…”