1046. Cerebrospinal Fluid Complement Fixation Titer as a Predictor of Outcome in Coccidioidal Meningitis
Session: Poster Abstract Session: Fungal Diagnosis
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • Poster 1046_IDSA_49_CSF CF titers and outcome__Arash_Heidari.pdf (440.4 kB)
  • Background: Cerebrospinal fluid (CSF) pleocytosis, differential, protein, glucose and complement fixation (CF) titers have traditionally been used in the diagnosis and prognosis of Coccidioidal Meningitis (CM). Even though, prior studies have shown the correlation between CSF pleocytosis and protein levels with morbidity and mortality of CM, to our knowledge similar association for CF titers of CSF as a predictor of outcome has never been studied.

    Methods: This is a retrospective review of 148 medical records of CM patients that were registered in coccidioidomycosis clinic at Kern Medical Center (KMC) between 1987 and 2010.  Twenty-nine patients were excluded due to unavailability of initial CF titers.  Patients were followed for an average of 102 months (2 - 281).  After conversion of titers to 2n log and analysis with One-way ANOVA test by SAS® JMP® 8.0, titers were correlated with patient incidence of hydrocephalus, cerebrovascular infarction, arachnoiditis, seizures, cerebral hemorrhage and mortality.  Individual CF titers by mortality were assessed with Epi Info™ for chi square.

    Results:  Mean age was 34 (14-74) with 73% Hispanic, 14% African American, 11% Caucasian, and 2% others.   The overall ratio of male to female was 69% to 31 %. (n=119). Mortality was lower in CM patients with initial CSF CF titers of ≤1:4. This association was statistically significant. [OR: 6.25, CI 95(1.63-26.0); P=0.0017]. Mortality, on the other hand was higher in patients with initial CSF CF titers of ≥1:64. This association was also statistically significant. [Mean 26.7(25.6 – 27.9); P=0.0497]. Incidence of hydrocephalus [Mean 25.8(25.2 – 26.5); P=0.18] and cerebrovascular infarction [Mean 26.0(25.3 – 26.9); P=0.12] were increased in patients with higher initial CF titers, but were not statistically significant.

    Conclusion:  Cerebrospinal fluid complement fixation titer is a predictor of mortality in Coccidioidal Meningitis.  There is a trend for increased incidence of hydrocephalus and cerebrovascular infarction with higher titers.   


    Subject Category: M. Mycology including clinical and basic studies of fungal infections

    Arash Heidari, M.D.1, Grant Karno, M.S.IV2, Vinutha Chandrasekaran, M.D.2, Jasjit Khurana, M.D.2 and Royce H. Johnson, M.D., F.A.C.P.1, (1)Infectious Diseases, Kern Medical Center/UCLA, Bakersfield, CA, (2)Internal Medicine, Kern Medical Center/UCLA, Bakersfield, CA

    Disclosures:

    A. Heidari, Ortho-McNeil: Grant Investigator, Research grant
    Pfizer: Grant Investigator, Research grant

    G. Karno, None

    V. Chandrasekaran, None

    J. Khurana, None

    R. H. Johnson, Pfizer: Grant Investigator, Research grant
    Ortho-McNeil: Grant Investigator, Research grant
    Bio-K plus International Inc.: Scientific Advisor and Speaker's Bureau, Speaker honorarium
    Allermed Lab. Inc.: Grant Investigator, Research grant
    Forest Pharmaceuticals: Speaker's Bureau, Speaker honorarium

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