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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.
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BMC Infectious Diseases

ISSN: 1471-2334

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