Infect Chemother.  2010 Oct;42(5):285-290. 10.3947/ic.2010.42.5.285.

Cryptococcal Meningitis : 12 Years Experience in a Single Tertiary Health Care Center

• Jeong SJ
• Chae YT
• Jin SJ
• Baek JH
• Chin BS
• Han SH
• Kim CO
• Choi JY
• Song YG
• Kim JM

• KMID: 1806890
• DOI: http://doi.org/10.3947/ic.2010.42.5.285

Abstract

BACKGROUND
Cryptococcal infections are frequent in human immunodeficiency virus (HIV)-infected patients. This infection may occur in other immunocompromised patients, and the diagnosis is often delayed in these cases. There are a few reports on cryptococcal meningitis in non-HIV-infected patients in Korea. We reviewed the clinical features and efficacy of antifungal therapy in 33 patients who were treated at a single tertiary health care center of Korea.
MATERIALS AND METHODS
The medical records of 33 consecutive patients who were admitted to one tertiary hospital for cryptococcal meningitis between 1995 and 2008 were reviewed retrospectively. Cryptococcal meningitis was confirmed by positive cerebral spinal fluid (CSF) cultures or compatible clinical features plus a positive cryptococcal antigen test of CSF.
RESULTS
Of the 33 patients analyzed, 30 cases were non-HIV patients. The outcomes were complete cure in 23 cases, relapse after initial treatment in four cases, and death due to treatment failure in six cases. The main initial manifestations were headache (84.8%), fever (54.5%), and seizure (33.3%). Factors significantly associated with unfavorable outcomes, including mortality and relapse, were afebrile condition, mental change, hearing impairment, initial high opening pressure of CSF (>250 mmH2O), and low initial absolute neutrophil count. On multivariate analysis, afebrile condition was an independent predictor of an unfavorable outcome (odds ratio 17.3; 95% confidence interval 1.0-28.3; P=0.045).
CONCLUSIONS
It is necessary to observe closely cryptococcal meningitis patients without fever on admission.

Keyword

Cryptococcal infection; Cryptococcal meningitis; Fever

MeSH Terms

Delivery of Health Care
Fever
Headache
Hearing Loss
HIV
Humans
Immunocompromised Host
Korea
Medical Records
Meningitis, Cryptococcal
Multivariate Analysis
Neutrophils
Recurrence
Retrospective Studies
Seizures
Tertiary Care Centers
Treatment Failure

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