1610. Clinical outcome of cryptococcal meningitis of HIV-infected and non-HIV-infected patients in Hong Kong: a two-center retrospective review
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Epidemiology
Friday, October 28, 2016
Room: Poster Hall
Posters
  • idwk2016.pdf (1.7 MB)
  • Background:

    While cryptococcal meningitis is a common opportunistic infection in AIDS patients, it also causes substantial morbidity and mortality in immunocompromised patients without HIV infection.

    Methods:

    This is a retrospective analysis of patients with cryptococcal meningitis in two regional referral centers, namely Pamela Youde Nethersole Eastern Hospital and Queen Elizabeth Hospital from 2002 to 2014. Laboratory information systems were used to identify patients with positive cerebrospinal fluid (CSF) cultures. VITEK 2 and API 20C AUX systems were used for microbiological identification. Clinical records, mortality data and time for CSF sterilization (number of days from antifungal therapy initiation to first negative CSF cultures) were reviewed. We performed survival analysis to compare 100-day mortality and time for CSF sterilization in HIV-infected and non-HIV-infected patient groups.

    Results:

    37 patients were identified. 26 (70.2%) were male. Median age was 48 years (IQR 38-66). 18 were HIV-infected. Non-HIV-infected group was significantly older than HIV-infected group (p=0.006819). Among the 19 non-HIV-infected, 8 (44.4%) have received prednisolone >=5mg/day for at least 3 weeks. 3 of them were kidney transplant recipients. Time from hospital admission to first diagnostic lumbar puncture was significantly longer in non-HIV-infected patients (median 6 days, IQR 2-21 days) when compared to HIV-infected (median 2.5 days, IQR 1-4.25 days) (p=0.01483). All patients received amphotericin B and flucytosine for induction. Median serum but not CSF cryptococcal antigen titer was significantly higher in HIV-infected group (1:1024 versus 1:128 in non-HIV-infected group, p<0.005). There was significantly higher 100-day mortality in non-HIV-infected group with a hazard ratio of 4.8 (95% CI 1.4-16.6, p=0.02) compared to HIV-infected groups (figure 2). CSF sterilization was faster in non-HIV-infected group with a hazard ratio of 3.2 (95% CI 1.4-6.9, p<0.01) compared to HIV-infected group (figure 3).

    Conclusion:

    There was significantly higher mortality and slower CSF sterilization rate in non-HIV-infected patients. Longer duration for diagnosis might contribute the poorer outcome in the latter group.

    Figure 1

    Figure 2

    Figure 3

    Tommy Hing-Cheung Tang, MRCP(UK), MPH1, Wan-Man Ting, MRCP(UK)1, Alan Ka-Lun Wu, FRCPath(UK)2, Helen Shuk-Ying Chan, MRCP(UK)1, Kwok-Wai Lam, MRCP(UK)1, Ruby Tsz-Shan Kwong, MRCP(UK)1, Man-Yee Chu, MRCP(UK)1, Wilson Lam, MRCP(UK)1, Philip Chan, MD, MS3 and Tak-Chiu Wu, FRCP(Edin)1, (1)Department of Medicine, Queen Elizabeth Hospital, Hong Kong, Hong Kong, (2)Department of Pathology, Pamela Youde Eastern Nethersole Hospital, Hong Kong, Hong Kong, (3)Search-Thailand, Thai Red Cross AIDS Research Center, Bangkok, Thailand

    Disclosures:

    T. H. C. Tang, None

    W. M. Ting, None

    A. K. L. Wu, None

    H. S. Y. Chan, None

    K. W. Lam, None

    R. T. S. Kwong, None

    M. Y. Chu, None

    W. Lam, None

    P. Chan, None

    T. C. Wu, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.