Abstract
Cryptococcal meningitis is the most common intracranial infectious fungal disease. After a period of antifungal treatment, as the number of cells in the cerebrospinal fluid decreases, the biochemical indexes improve and the number of cryptococcus reduces, the patient’s condition suddenly worsen. Most of the symptoms are severe headache, raised intracranial pressure, together with impaired clinical nerve function. These presentations are often mistaken for a failure of antifungal treatment. In fact it’s an encephalitis syndrome which is unrecognized by most clinicians: Immune reconstitution inflammatory syndrome (IRIS). To increase awareness we retrospectively analyzed clinical data of 100 cases of cryptococcal neoformans meningitis, among which 26 patients develop CM-IRIS. All patients have been divided into three groups: Group 1, patients who were not treated with glucocorticoid and didn’t experienced IRIS; Group 2, patients who were not treated with glucocorticoid although developed CM-IRIS; Group 3, patients started treatment with glucocorticoid for two weeks with new onset CM-IRIS. Compared with the group treated with glucocorticoid, treatment without glucocorticoid was subjected to a higher risk of incident IRIS. The difference was statistically significant (P < 0.05). Imaging findings demonstrated diseased area of the white matter area, and it looked like commonly in the supratentorial region. Moreover, if it appears in the infratentorial region then must be combined with supratentorial region.
Highlights
We compared the baseline data of these subgroups and checked if any difference exists on gender ratio, ages and length of stay: cryptococcal meningitis (CM)-Immune reconstitution inflammatory syndrome (IRIS) and CM non-IRIS, CM-IRIS treated with GCs and without GCs
Gender ratio of CM-IRIS and CM non-IRIS patients was evaluated by Chi-square test with four-fold table; Average age and average length of stay of CM-IRIS and CM non-IRIS, CM-IRIS treated with GCs and CM-IRIS without GCs applied T-test to do statistical comparison
While CM-IRIS treated with GCs is 21 cases (14 males and 7 females) with a mean age of 45.43 ± 14.89 years and an average hospital stay of 146.57 ± 89.70 days
Summary
From December 2001 to December 2013 we enrolled 193 patients presented with cryptococcal meningitis and admitted to the Department of Neurology, the First Affiliated Hospital of Fujian Medical University. There were 118 men aged 45.41 ± 14.36, 75 women for ages 41.87 ± 16.09. The cases collected in this study have been approved by the Medical Ethics Committee of the First Affiliated Hospital of Fujian Medical University. All cases met the diagnosis of cryptococcal meningitis by Azure T. Makadzange, et al.[8] The informed consent was obtained from all subjects and their family
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