Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi City, Taiwan.
J Microbiol Immunol Infect. 2011 Oct;44(5):338-45. doi: 10.1016/j.jmii.2010.08.011. Epub 2011 Jan 20.
Cryptococcosis is a systemic infection caused by Cryptococcus neoformans, and cryptococcal meningitis can occur in patients with late-stage human immunodeficiency virus (HIV) infection and other forms of immunosuppressive status. This study was designed to compare clinical features and laboratory findings of cryptococcal meningitis in HIV-positive and HIV-negative patients.
From January 1, 2000 to December 31, 2009, all patients aged more than 18 years hospitalized at National Taiwan University Hospital with a diagnosis of cryptococcal meningitis were analyzed retrospectively.
In total, 88 patients with cryptococcal meningitis were identified and 37 (42%) were HIV infected. Cryptococcal meningitis occurred in young (mean, 38 vs. 60; p < 0.001) and male (97% vs. 63%, p < 0.001) populations more frequently among HIV-positive group with higher Charlson comorbidity score (mean, 7 vs. 4; p < 0.001), higher initial complaint of cough (36% vs. 16%; p = 0.032), lower cerebrospinal fluid (CSF) white count (mean, 26 vs. 86; p = 0.024), lower total protein of the CSF (mean, 88 vs. 149; p = 0.012), higher percentage of serum latex agglutination cryptococcal antigen titer exceeding 1:512 (77% vs. 50%; p = 0.026), more extraneural involvement (70% vs. 49%; p = 0.046), more cryptococcemia (68% vs. 35%; p = 0.003), and higher proportion of normal brain images (44% vs. 13%; p = 0.003) than HIV-negative group. The all-cause mortality rates on Day 30 and Day 90 were 23.9% and 31.8%, respectively. The independent risk factors for Day 30 mortality were altered mental status, extraneural involvement, absence of lymphocyte predominance, and absence of leptomeningeal enhancement (odds ratio: 7.84, 9.71, 0.22, and 0.07, respectively; 95% confidence interval): 2.03-30.27, 2.01-46.94, 0.06-0.80, and 0.01-0.49, respectively). Those for Day 90 mortality were serum white count more than 11,000/μL, higher Charlson comorbidity score, and absence of normal brain images (odds ratio: 5.39, 1.40, and 0.09, respectively; 95% confidence interval: 1.22-23.72, 1.11-1.76, and 0.01-0.78, respectively).
The clinical features of cryptococcal meningitis between HIV and non-HIV patients have some divergences, including age, sex, underlying diseases, CSF parameters, extraneural site involvement, fungemia, and so on. We also identified risk factors for mortality of this disease. However, the mortality of cryptococcal meningitis was not different in HIV-positive and HIV-negative patients in terms of Day 30 and Day 90 mortality.
cryptococcosis 是一种由 cryptococcus neoformans 引起的全身性感染， cryptococcal 脑膜炎可发生在晚期人类免疫缺陷病毒（HIV）感染和其他形式的免疫抑制状态的患者中。本研究旨在比较 HIV 阳性和 HIV 阴性患者 cryptococcal 脑膜炎的临床特征和实验室发现。
从 2000 年 1 月 1 日至 2009 年 12 月 31 日，回顾性分析了在国立台湾大学医院住院诊断为 cryptococcal 脑膜炎的所有年龄大于 18 岁的患者。
共确定了 88 例 cryptococcal 脑膜炎患者，其中 37 例（42%）为 HIV 感染。HIV 阳性组的 cryptococcal 脑膜炎患者更年轻（平均年龄 38 岁 vs. 60 岁；p<0.001）和男性（97% vs. 63%；p<0.001），Charlson 合并症评分更高（平均 7 分 vs. 4 分；p<0.001），初始咳嗽主诉更常见（36% vs. 16%；p=0.032），脑脊液（CSF）白细胞计数更低（平均 26 对 86；p=0.024），CSF 总蛋白含量更低（平均 88 对 149；p=0.012），血清乳胶凝集 cryptococcal 抗原滴度超过 1:512 的比例更高（77% vs. 50%；p=0.026），神经外部位点受累更常见（70% vs. 49%；p=0.046）， cryptococcemia 更多（68% vs. 35%；p=0.003），正常脑图像比例更高（44% vs. 13%；p=0.003）。第 30 天和第 90 天的全因死亡率分别为 23.9%和 31.8%。第 30 天死亡率的独立危险因素为精神状态改变、神经外部位点受累、淋巴细胞优势缺失和脑膜增强缺失（比值比：7.84、9.71、0.22 和 0.07；95%置信区间：2.03-30.27、2.01-46.94、0.06-0.80 和 0.01-0.49）。第 90 天死亡率的独立危险因素为血清白细胞计数超过 11000/μL、Charlson 合并症评分较高和正常脑图像缺失（比值比：5.39、1.40 和 0.09；95%置信区间：1.22-23.72、1.11-1.76 和 0.01-0.78）。
HIV 和非 HIV 患者 cryptococcal 脑膜炎的临床特征存在一些差异，包括年龄、性别、基础疾病、CSF 参数、神经外部位点受累、菌血症等。我们还确定了该疾病死亡的危险因素。然而，在第 30 天和第 90 天死亡率方面，HIV 阳性和 HIV 阴性患者的 cryptococcal 脑膜炎死亡率没有差异。
