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Table 3 Demographic characteristics, laboratory results, and initial treatment modalities of patients with cryptococcal meningitis (n = 46) at 10-week evaluation

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

Variables

Cured (%) (n = 21)

Not cured # (%) (n = 25)

p-value

Demographics

   

Male sex

15 (71.4)

17 (68)

1

Age >60 years

6 (28.6)

11 (44)

0.36

Co-existing conditions

AIDS

1 (5.3) a

5 (21.7) b

0.19

Solid tumor malignancy

2 (9.5)

4 (16)

0.67

Hematologic malignancy

3 (14.3)

1 (4)

0.32

Steroid usage

2 (9.5)

6 (24)

0.26

Liver cirrhosis

1 (4.8)

4 (16)

0.36

Chronic renal failure

1 (4.8)

2 (8)

1

Diabetic mellitus

7 (33.3)

5 (20)

0.34

COPD

3 (14.3)

1 (4)

0.32

Organ transplantation

1 (4.8)

0

0.46

No known predisposing factor c

5 (23.8)

3 (12)

0.44

Previous anti-fungal therapy d

2 (9.5)

5 (20)

0.43

Severity status

APACHE-II score

7.2 ±3.4

10 ± 2.2

0.39

APACHE-II score ≥ 15

4 (19.1)

6 (24)

0.74

Shock

1 (4.8)

0

0.46

IICP

19 (90.5)

22 (88)

1

ICU admission

12 (57.1)

10 (40)

0.38

Initial laboratory data

India ink smear positive

9 (42.9)

14 (56)

0.55

CSF opening pressure (mmH 2 0)

254 ± 116

246 ± 122

0.68

CSF WBC count (/μL)

30.4 ± 42.8

28.6 ± 32.4

0.26

CSF CAT ≥ 1:1024

11 (52.4)

16 (64)

0.55

Serum CAT ≥ 1:1024

8 (38.1)

10 (40)

1

Concurrent cryptococcemia

4 (19.1)

8 (32)

0.50

Serotype B Cryptococcus neoformans isolate

4 (19.1)

1 (4)

0.16

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

1 (4.8)

11 (44)

<0.01*

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

2 (9.5)

6 (24)

0.26

Treatment modality in induction therapy

Amphotericin B plus flucytosine

0

1 (4)

1

Amphotericin B plus fluconazole

7 (33.3)

16 (64)

0.08

Amphotericin B alone

11 (52.4)

6 (24)

0.07

Fluconazole alone

3 (14.3)

2 (8)

0.65

  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 17 patients who failed to respond to cryptococcal meningitis treatment by the end of 10 weeks of anti-fungal therapy and eight who died from cryptococcal infection before the end of 10-week anti-fungal therapy.
  3. aNumber of patients available for analysis, n = 19.
  4. bNumber of patients available for analysis, n = 23.
  5. cAll 8 patients without known predisposing factor were tested for HIV and none was infected.
  6. dReceived systemic antifungal agents one month prior to first positive cryptococcal cerebro-spinal fluid culture.
  7. *Multivariate logistic regression analysis indicated that the presence of Cryptococcus neoformans isolates resistant to fluconazole (OR = 15.7; 95% CI: 1.8-135.9; p = 0.01) was an independent predictive factor for poor clinical outcome (failure and death) of cryptococcal meningitis at 10-week evaluation.
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BMC Infectious Diseases

ISSN: 1471-2334

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