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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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