Impaired consciousness and decreased glucose concentration of CSF as prognostic factors in immunocompetent patients with cryptococcal meningitis

Chen Zhang,Fafa Tian,Zheren Tan

doi:10.1186/s12879-020-4794-5

Abstract

BackgroundCryptococcal meningitis (CM) is the most common fungal infection of the central nervous system and has high morbidity and mortality. Almost studies about prognostic factors have largely focused on the immunocompromised population rather than immunocompetent patients. So that we sought to conduct a retrospective study to determine prognostic factors which predict the outcomes in immunocompetent patients with CM.MethodsWe retrospectively collected and analyzed the demographic and clinical data of 76 apparently immunocompetent patients with cryptococcal meningitis from January 2003 to June 2019 in China. The clinical outcome was graded by the Glasgow outcome scale (GOS) at discharge, and patients were divided into good (score of 5) and unfavorable (score of 1–4) outcome groups, potential prognostic factors were analyzed.ResultsNon-parametric test confirmed that unfavorable outcome was associated with lower glucose level of CSF(P = 0.001), and Pearson’s χ2 analysis confirmed that unfavorable outcome was associated with opening pressure of CSF(>300mmH20, P = 0.038), impaired consciousness (P = 0.001), hydrocephalus(P = 0.045), and Shunt surgery (P = 0.045), and then multiple logistic regression analysis confirmed that impaired consciousness(P = 0.015) and lower glucose concentration of CSF(P = 0.012) increased the likelihood of unfavorable outcome in CM patients.ConclusionImpaired consciousness and decreased glucose concentration of CSF were independently prognostic factors which predict the unsatisfactory outcome in immunocompetent patients with CM.

Highlights

Cryptococcal meningitis (CM) is the most common fungal infection of the central nervous system and has high morbidity and mortality
The delay in diagnosis and treatment result in a high morbidity and a mortality rate [4,5,6]. majority of cryptococcosis have occurred in Human Immunodeficiency Virus (HIV)-positive patients, but it is been found in cases with comorbidities that result in immunosuppression, such as hematological malignancies, solid-organ transplant recipients, and in patients on
Overall, a total of 76 apparently immunocompetent patients with CM were included in this study

Summary

Introduction

Cryptococcal meningitis (CM) is the most common fungal infection of the central nervous system and has high morbidity and mortality. That we sought to conduct a retrospective study to determine prognostic factors which predict the outcomes in immunocompetent patients with CM. Cryptococcal meningitis (CM) is the most common type of chronic infectious meningitis caused by Cryptococcus neoformans [1, 2], the reservoirs of them are mainly pigeon or other bird droppings [3]. The delay in diagnosis and treatment result in a high morbidity and a mortality rate [4,5,6]. We sought to conduct a retrospective study to characterize clinical features, laboratory findings, imaging findings and determine potential prognostic factors which predict the outcomes in immunocompetent patients with CM. The delay in diagnosis and treatment result in a high morbidity and a mortality rate [4,5,6]. majority of cryptococcosis have occurred in HIV-positive patients, but it is been found in cases with comorbidities that result in immunosuppression, such as hematological malignancies, solid-organ transplant recipients, and in patients on

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Discussion

Conclusion