The clinical characteristics of adult cryptococcal meningitis patients who died within one year of treatment with a focus on those with early mortality

• Published in: Journal of clinical neuroscience 2019-09, Vol.67, p.80-84
• Main Authors: Tsai, Wan-Chen, Lien, Chia-Yi, Lee, Jun-Jun, Huang, Chi-Ren, Tsai, Nai-Wen, Chang, Chiung-Chih, Lu, Cheng-Hsien, Chang, Wen-Neng
• Format: Article
• Language: English
• Subjects: Altered consciousness; Cerebrospinal fluid; Cryptococcal meningitis; Cryptococcemia; Early mortality; Lactate level
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2019.06.015

•Cyrptococcal meningitis (CM) has high mortality and morbidity.•The CM patients with early mortality have not been examined solely.•CM patients with early mortality have a higher CSF lactate and cryptococcemia.•CM patients with cryptococcemia have a high positive CSF India ink stain. Cryptococcal meningitis (CM) is a serious infectious disease of the central nervous system, and associated brain injuries can be found in the very early stage of disease. In this study, 92 adult CM patients (59 men, 33 women; median age 54.66 years, range 20–86 years) were enrolled, and their clinical, laboratory, neuroimaging features and therapeutic outcomes were analyzed. Two main clinical comparative analyses of the clinical characteristics and laboratory and neuroimaging features were made in this study. The first compared clinical differences between the survivors and non-survivors of all enrolled patients, and the second compared differences between the following three groups: Group I, the patients who died within 14 days of initiating treatment; Group II, the patients who died within 15 days to 1 year of initiating treatment, and Group III, the patients who survived for more than 1 year after initiating treatment. Prognostic factors including initial altered consciousness, increased cerebrospinal fluid (CSF) lactate level and the presence of cryptococcemia were significantly different between the different groups. The patients with early mortality had a higher CSF lactate level and higher rate of cryptococcemia. The presence of cryptococcemia was an important prognostic factor, and the patients with cryptococcemia had a higher incidence of positive CSF India ink stain. Further large-scale studies are needed to delineate the clinical and laboratory features of CM patients with early mortality.