Abstract
BackgroundCryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors.MethodsThis cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors.ResultsFifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (≥250 mm H2O).ConclusionsWe strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.
Highlights
Cryptococcal meningitis is a deadly fungal infection
This study reports a retrospective cross-sectional study for patients with confirmed cryptococcal meningitis (CM) at Changhua Christian Healthcare System (CCHS) between 2006 and 2012 with two specific aims: to characterize the epidemiology of cerebral cryptococcosis at CCHS and to define prognostic factors associated with death from CM
Patient characteristics: laboratory and radiographic findings Sixty-five CM patients were enrolled during the study period, but because of incomplete data and inconsistent diagnosis, only 59 were analyzed
Summary
Cryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors. Cryptococcosis is a severe opportunistic fungal infection causing morbidity and mortality and can manifest as meningitis, pneumonia, or cryptococcemia in both immunocompetent and immunocompromised hosts [2,3,4,5]. It is estimated that approximately one million cases and 625,000 deaths occur annually worldwide from cryptococcal meningitis (CM) among HIV-infected individuals, Outcomes and treatment failure are usually associated with underlying conditions, a delay in diagnosis or absence of treatment with a fungicidal drug [8, 9]. Prognostic factors have mostly resulted from reports of clinical trials conducted in earlier treatment periods and risks [3, 10,11,12,13]. The underlying mechanisms of CM are not yet fully understood, and so the most effective means of prevention remains unknown
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