A prospective descriptive study of cryptococcal meningitis in HIV uninfected patients in Vietnam - high prevalence of Cryptococcus neoformans var grubii in the absence of underlying disease

Chau, Tran TH; Mai, Nguyen H; Phu, Nguyen H; Nghia, Ho D; Chuong, Ly V; Sinh, Dinh X; Duong, Van A; Diep, Pham T; Campbell, James I; Baker, Stephen; Hien, Tran T; Lalloo, David G; Farrar, Jeremy J; Day, Jeremy N

doi:10.1186/1471-2334-10-199

Table 1 Features of 35 cryptococcal meningitis cases according to infecting species.

From: A prospective descriptive study of cryptococcal meningitis in HIV uninfected patients in Vietnam - high prevalence of Cryptococcus neoformans var grubii in the absence of underlying disease

		C. neoformansvar grubii	C. neoformansvar gattii
		(n = 25)	(n = 10)
Variable		Value	Value	Odds ratio	P Value
		(Range or %)	(range or %)	(95% CI)
Median Age (range)		31 (15 - 74)	41 (18 - 53)		0.47
Male Sex		10 (40)	5 (50)	1.48 (0.26 - 8.4)	0.71
Underlying Disease		7 (28)	1 (10)	0.29 (0.01 - 2.9)	0.39
Symptoms
Fever		20 (80)	9 (90)	2.2 (0.2 - 117)	0.64
Headache		19 (90)	8 (89)	0.85 (0.04 - 55.8)	1.0
Vomiting		9 (36)	5 (50)	1.75 (0.31 - 10.1)	0.47
Blurred vision		12 (52)	4 (40)	0.62 (0.10 - 3.47)	0.71
Diplopia		4 (20)	2 (20)	1.0 (0.95 - 10.9)	1.0
Convulsions		4 (16)	1 (10)	0.59 (0.01 - 7.2)	0.59
Signs
GCS < 11/15		7 (28)	1 (10)	0.29 (0.01 - 2.9)	0.39
Neck Stiffness		22 (88)	8 (80)	0.56 (0.05 - 7.8)	0.61
Focal Neurological Signs		7 (28)	5 (50)	2.5 (0.4 - 15.0)	0.26
Papilloedema		5 (21)	5 (50)	3.63 (0.6 - 24.3)	0.11
Investigations
Abnormal Chest X-ray		8 (32)	2 (20)	0.54 (0.05 - 3.7)	0.69
Abnormal Brain Imaging^a		7 (58)	7(100)	-	0.13
Haematocrit		37.8 (25.3 - 51.4)	38.8 (31.1 - 46)		0.65
Blood White Cell Count (×10^9/ml)		11.5(3.3 - 26.6)	13.6 (7.1 - 26.1)		0.37
Platelet count (×10^9/L)		256 (56.9 - 356)	305 (140 - 487)
CSF opening pressure (cmCSF)^b		34.2 (2 - > 40)	30.5 (15 - > 40)		0.44
CSF White Cell Count/ml		287 (2 - 1080)	279 (12 - 480)		0.18
CSF Lymphocyte %^c		53 (12 - 97)	56 (19 - 93)		0.74
CSF Protein (g/L)		1.28 (0.35 - 2.63)	1.25 (0.4 - 1.94)		0.9
Log2 CSF Cryptococcal antigen titre⁵		7.4 (3 - 15)	8.6 (2 - 14)		0.5
Lactate (mmol/L)		6.2 (1.6 - 22.5)	4.2 (2 - 8.4)		0.052
Antifungal MICs (mg/L)
Amphotericin	GM(95%CI)	0.71 (0.62 - 0.83)	0.45 (0.34 - 0.60)		0.01
	MIC90	1.0	0.5
Flucytosine	GM(95%CI)	8.23 (7.22 - 9.37)	1.85 (1.18 - 2.90)		< 0.001
	MIC90	16/0	4.0
Fluconazole	GM(95%CI)	6.96 (5.11 - 9.49)	4.54 (2.44 - 8.42)		0.19
	MIC90	16.0	16.0
Itraconazole	GM(95%CI)	0.11 (0.08 - 0.14)	0.9 (0.05 - 0.14)		0.48
	MIC90	0.26	0.26
Voriconazole	GM(95%CI)	0.07 (0.05 - 0.09)	0.06 (0.04 - 0.51)		0.85
	MIC90	0.13	0.26
Posaconazole	GM(95%CI)	0.13 (0.10 - 0.17)	0.10 (0.06 - 0.17)		0.336
	MIC90	0.26	0.26

^aN = 26, ^bN = 33, ^cN = 32, ^dN = 31
GM = Geometric Mean
MIC90 = minimum inhibitory concentration 90

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