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Table 2 Demographic characteristics, laboratory results, and treatment modalities of patients with cryptococcal meningitis (n = 46) at two-week evaluation

From: Correlation of anti-fungal susceptibility with clinical outcomes in patients with cryptococcal meningitis

Variables

Cured (%) (n = 26)

Not cured # (%) (n = 20)

p value

Demographics

Male sex

19 (73.1)

13 (65)

0.75

Age >60 years

6 (23.1)

11 (55)

0.04

Coexisting conditions

AIDS

2 (8.3) a

4 (22.2) b

0.38

Solid tumor malignancy

2 (7.7)

4 (20)

0.38

Hematologic malignancy

3 (11.5)

1 (5)

0.62

Steroid usage

3 (11.5)

5 (25)

0.27

Liver cirrhosis

1 (3.8)

4 (20)

0.37

Chronic renal failure

2 (7.6)

1 (5)

1

Diabetic mellitus

8 (30.8)

4 (20)

0.51

COPD

4 (15.4)

0

0.12

Organ transplantation

1 (3.8)

0

1

No known predisposing factor c

6 (23.1)

2 (10)

0.44

Previous anti-fungal therapy d

3 (11.5)

4 (20)

0.68

Severity status

APACHE-II score

8.2 ± 2.4

10.4 ± 3.7

0.19

APACHE-II score ≥ 15

5 (19.2)

5 (25)

0.73

Shock

1 (3.8)

0

1

IICP

23 (88.5)

18 (90)

1

ICU admission

14 (53.8)

8 (40)

0.39

Initial laboratory data

India ink smear positive

12 (46.2)

11 (55)

0.77

CSF opening pressure (mmH 2 0)

248 ± 132

252 ± 136

0.58

CSF WBC count (/μL)

32.2 ± 40.6

28.8 ± 38.6

0.28

CSF CAT ≥ 1:1024

13 (50)

14 (70)

0.23

Serum CAT ≥ 1:1024

9 (34.6)

9 (45)

0.55

Concurrent cryptococcemia

6 (23.1)

6 (30)

0.74

Serotype B Cryptococcus neoformans isolate

4 (15.4)

1 (5)

0.37

Isolate resistant to fluconazole (MIC >8 μg/ml)

4 (15.4)

8 (40)

0.09

Isolate resistant to amphotericin B (MIC >1 μg/ml)

3 (11.5)

5 (25)

0.27

Treatment modality in induction therapy

Amphotericin B plus flucytosine

0

1 (5)

0.44

Amphotericin B plus fluconazole

10 (38.5)

13 (65)

0.14

Amphotericin B alone

12 (46.2)

5 (25)

0.22

Fluconazole alone

4 (15.4)

1 (5)

0.37

  1. Abbreviations: AIDS acquired immuno-deficiency syndrome, CAT cryptococcal-antigen titer, COPD chronic obstructive pulmonary disease, CSF cerebro-spinal fluid, ICU intensive care unit, IICP increasing intra-cranial pressure.
  2. # Non-cured patients included 15 patients who failed to respond to cryptococcal meningitis treatment by the end of two weeks of initial anti-fungal therapy, and five who died from cryptococcal infection before the end of two weeks of initial anti-fungal therapy.
  3. aNumber of patients available for analysis, n = 24.
  4. bNumber of patients available for analysis, n = 18.
  5. cAll 8 patients without known predisposing factor were tested for HIV and none was infected.
  6. dReceived systemic anti-fungal agents one month prior to first positive cryptococcal cerebro-spinal fluid culture.
  7. *Multivariate logistic regression analysis indicated that age >60 years (OR = 4.1; 95% CI: 1.1-14.5; p = 0.03) was an independent predictive factor for poor clinical outcome (failure and death) of cryptococcal meningitis at 2-week evaluation.