Cryptococcal Meningitis in 25 Non-AIDS Patients

Kim, Shin Woo; Jung, Sook In; Kim, Yeon Sook; Ki, Hyeon Kyun; Kim, Choon Kwan; Kim, Sungmin; Peck, Kyoung Ran; Lee, Nam Yong; Song, Jae Hoon

Abstract

BACKGROUND: Cryptococcal meningitis is an opportunistic infection common among patients with AIDS. Because of the low incidence of cryptococcal meningitis in Korea, there have been insufficient data on the clinical features of cryptococcal meningitis in non-AIDS Korean patients, particularly in patients with liver cirrhosis (LC). We evaluated the clinical manifestations of cryptococcal meningitis in non-AIDS patients admitted at the Samsung Medical Center and assessed the relationship between LC and cryptococcal meningitis.
METHODS
The medical records of 25 non-AIDS patients with cryptococcal meningitis admitted between May 1995 and March 1999 were reviewed. Cryptococcal meningitis was confirmed by positive culture of CSF or compatible clinical features plus a positive cry-ptococcal latex test. The mean age of the 25 patients was 55 years and the median duration of follow-up was 95.5 days. Underlying conditions were:use of immunosuppressants (including steroids) (47.8%), LC (34.8%), diabetes mellitus (34.8%), malignancy (17.4%), alcoholism (8.7%), and none (21.7%, five patients).
RESULTS
There were no differences in the clinical manifestations between the LC and non-LC groups, with the exception of mental deterioration, which was more frequent in patients with LC than without LC (P= 0.026). The outcomes were:complete cure in six cases, cure with sequelae in five, and treatment failure in ten. The crude and attributable mortality rates of cryptococcal meningitis were 62.5% (15/24) and 50.0% (12/24), respectively. LC was a significant risk factor for a poor survival rate among patients with cryptococcal meningitis (OR:3.25, 95% CI, 1.02~10.40) (P=0.045).
CONCLUSION
In Korea, liver cirrhosis is an important risk factor for cryptococcal meningitis and an attributable factor for its high mortality. Because it is possible to confuse mental obtundation in cirrhotic patients with that of hepatic encephalopathy, cryptococcal meningitis should be considered in any patients with altered consciousness and liver cirrhosis.