Abstract
BackgroundThe elderly, and especially those with an immuno-compromised status, are vulnerable to infectious diseases. The purpose of this study was to examine the clinical characteristics and therapeutic outcomes of cryptococcal meningitis (CM) in elderly patients in Taiwan.MethodsNinety-nine adult patients with CM were identified during a 15-year study period (2002–2016), of whom 38 elderly (≥ 65 years) patients (16 men and 22 women, median age 72.9 years; range 65–86 years) were included for analysis. The clinical characteristics and therapeutic outcomes of these patients were analyzed and compared to non-elderly adult patients (< 65 years) with CM.ResultsAmong the 38 patients, diabetes mellitus was the most common underlying condition (15), followed by adrenal insufficiency (7), malignancy (6), hematologic disorders (5), chronic obstructive pulmonary disease (5), autoimmune diseases (3), liver cirrhosis (3) and acquired immunodeficiency syndrome (1). Altered consciousness (29), fever (21) and headache (17) were the leading clinical manifestations. Positive cerebrospinal fluid and blood cultures for Cryptococcus (C.) neoformans were found in 26 and 9 patients, respectively. There were significant differences in gender, altered consciousness and recent cerebral infarction between the elderly and non-elderly groups. The elderly group had a high mortality rate (36.8%, 14/38), and the presence of cryptococcemia was the most significant prognostic factor.ConclusionsThis study offers a preliminary view of the clinical characteristics of CM in the elderly. The results suggest that elderly patients (≥ 65 years) are more vulnerable to CM than adults aged < 65 years. Compared to the non-elderly group, the elderly group had female predominance, higher rates of altered consciousness and recent cerebral infarction as the clinical presentation. The presence of cryptococcemia was a significant prognostic factor in the elderly group. This study is limited by the small number of patients, and further large-scale studies are needed to better delineate this specific infectious syndrome.
Highlights
The elderly, and especially those with an immuno-compromised status, are vulnerable to infectious diseases
Because of the aging population in Taiwan as well as in many other countries [5], we conducted this study to analyze the clinical and laboratory features and therapeutic outcomes of elderly patients with cryptococcal meningitis (CM) compared to non-elderly adults with CM in order to delineate the clinical characteristics of this specific group of patients
Of the 99 adult patients with CM, 64 were men and 35 were women.Thirty-eight patients were classified as being elderly (≥65 years) and 61 as non-elderly (< 65 years)
Summary
The elderly, and especially those with an immuno-compromised status, are vulnerable to infectious diseases. In contrast to acute bacterial meningitis, patients with CM, which is classified as chronic meningitis, have a slower onset of symptoms, evolving over days to a few weeks [10] Laboratory studies such as the measurement of cryptococcal antigen (Ag) titer and/or culture of C. neoformans are still the mainstay for a definite diagnosis. Because of the aging population in Taiwan as well as in many other countries [5], we conducted this study to analyze the clinical and laboratory features and therapeutic outcomes of elderly patients with CM compared to non-elderly adults with CM in order to delineate the clinical characteristics of this specific group of patients
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