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