Risk Factors for Cryptococcal Meningitis: A Single United States Center Experience

Abstract

Cryptococcal meningitis carries a high mortality. Further understanding of immune suppression factors associated with neuroinvasive infection will improve risk stratification and enhance early diagnosis and treatment with antifungal therapy. The aim of the study was to corroborate established or find novel clinical predictors for cryptococcal meningitis. We performed a matched case-control study of Cryptococcus infection in immunocompromised patients with or without cryptococcal meningitis. All patients with a diagnosis of cryptococcal disease were collected at University of Colorado Hospital between 2000 and 2015 (n=51). Thirty patients were diagnosed with cryptococcal meningitis. We built a logistic regression model for risk factors associated with cryptococcal meningitis. The single predictor univariate model found that a positive blood culture, positive serum cryptococcal antigen, current malignancy, and headaches were significantly associated with cryptococcal meningitis (p= 0.02). In the adjusted multivariate model, central nervous system disease was significantly associated with a diagnosis of HIV infection (OR: 24.45, 95% CI: 1.62 – 350.37; p=0.022) and a positive serum cryptococcal antigen test (OR: 42.92, 95% CI: 3.26 – 555.55; p=0.0055). In patients with HIV infection or a positive serum cryptococcal antigen, the pre-test probability of neuroinvasive Cryptococcus infection is increased and an aggressive diagnostic evaluation should be conducted to exclude infection and consider empiric therapy.

Community-Acquired Meningitis in HIV-Infected Patients in the United States

“…Previous studies have had smaller sample sizes, not documented the degree of HIV testing, included only patients with bacterial meningitis or cryptococcal meningitis, or evaluated patients in developing countries with high incidence of tuberculosis or cryptococcal meningitis. [1][2][3][4]6,9,10 In contrast to previous studies of meningitis in HIV-infected patients, we analyzed data of allcause etiologies of CAM over a 15-year period and evaluated prognostic factors.…”

“…8 Despite the availability of antiretroviral therapy, HIV-infected patients continue to be at higher risk of developing bacterial meningitis 9 and cryptococcal meningitis. 10 The aim of our study was to characterize the epidemiology, clinical manifestations, cerebrospinal fluid (CSF) characteristics, and outcomes of CAM in the posteffective antiretroviral therapy (ART) era between HIV-infected and HIV-uninfected patients and to identify risk factors for adverse outcomes in patients with CAM.…”

Cryptococcosis and cryptococcal meningitis: New predictors and clinical outcomes at a United States academic medical centre

“…A detailed description of the definition of each variable is already published . For a direct access, please see Appendix .…”

Surgical treatment and operation time in human immunodeficiency virus-negative cryptococcal meningitis

“…[ 1 , 2 ] Cryptococcal meningitis (CM) can lead to higher rates of mortality and disability if not treated in a timely manner. [ 3 ] A recent study has documented that the CD4 expression is correlated with the prognosis of CM patients. [ 4 ] HIV is the most important risk factor for CM patients.…”