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A retrospective research of HIV-negative cryptococcal meningoencephalitis patients with acute/subacute onset

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Abstract

Cryptococcal meningoencephalitis (CM) may present as an acute, subacute, or chronic infection. It manifests as a chronic process in over 75 % of cases, but, sometimes, it presents with a more acute onset, mostly in HIV-associated patients. Until now, there has been no study performed on the clinical features of HIV-negative CM patients with acute/subacute onset. We collected 106 HIV-negative patients diagnosed with CM in our hospital during a 15-year period, analyzed their epidemiological and clinical features, as well as the outcomes, and explored the independent prognosis factors and the factors related to the survival time among them. We found that impaired consciousness (23.4 % vs. 3.4 %, p = 0.017) was more common in CM patients with acute/subacute onset, while decreased cerebrospinal fluid (CSF) glucose (51.9 % vs. 75.9 %, p = 0.026) was less common. The ratio of CSF glucose/blood glucose [odds ratio (OR) 0.04, 95 % confidence interval (CI) 0.004–0.262, p = 0.02], impaired consciousness (OR 5.09, 95 % CI 1.477–17.522, p = 0.01), and hospitalization length (OR 0.98, 95 % CI 0.977–0.999, p = 0.04) were indicated to be not only independent prognosis factors in HIV-negative CM patients with acute/subacute onset, but also factors significantly related to the survival time. The results of our study demonstrated that the contact history and potential history risk factors would not affect the onset process of HIV-negative CM patients, and the mortality, hospitalization length, and survival time has not been related to the onset process. However, the ratio of CSF glucose/blood glucose, consciousness level, and hospitalization length of the HIV-negative CM patients with acute/subacute onset should be of greater focus in the clinical work.

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Abbreviations

CM:

Cryptococcal meningoencephalitis

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

SLE:

Systemic lupus erythematosus

AmBd:

Amphotericin B deoxycholate

5-FC:

5-Fluorocytosine

FCZ:

Fluconazole

OR:

Odds ratio

CI:

Confidence interval

SD:

Standard deviation

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Acknowledgments

A very special thank you is given to Tejash Patel (University of North Carolina, USA) for the contribution to the language of this article.

Author contributions

LZ conceived the design for this study and HZ drafted the manuscript. LZ revised the manuscript in detail. HZ, QC, and ZSX collected the data. HZ and DMW performed the statistical analysis. MYL, YM, XMZ, JYL, and NFC made significant contributions to this work by providing assistance and helped in the data collection, data handling, and analysis. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People’s Republic of China

    H. Zheng, Q. Chen, Z. Xie, D. Wang, X. Zhang, Y. Man & L. Zhou

  2. Department of Neurology, The Central Hospital of Yongzhou, Yongzhou City, Hunan Province, People’s Republic of China

    M. Li

  3. Medical Records Room, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People’s Republic of China

    J. Lao & N. Chen

Authors
  1. H. Zheng
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  2. Q. Chen
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  3. Z. Xie
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  4. D. Wang
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  5. M. Li
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  6. X. Zhang
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  7. Y. Man
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  8. J. Lao
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  9. N. Chen
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  10. L. Zhou
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Correspondence to L. Zhou.

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The authors declare that they have no competing interests.

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Zheng, H., Chen, Q., Xie, Z. et al. A retrospective research of HIV-negative cryptococcal meningoencephalitis patients with acute/subacute onset. Eur J Clin Microbiol Infect Dis 35, 299–303 (2016). https://doi.org/10.1007/s10096-015-2545-0

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  • DOI: https://doi.org/10.1007/s10096-015-2545-0

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