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Risk Factors for Cryptococcal Meningitis: A Single United States Center Experience

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Abstract

Cryptococcal meningitis carries a high mortality. Further understanding of immune suppression factors associated with neuroinvasive infection will improve risk stratification and enhance early diagnosis and treatment with antifungal therapy. The aim of the study was to corroborate established or find novel clinical predictors for cryptococcal meningitis. We performed a matched case–control study of Cryptococcus infection in immunocompromised patients with or without cryptococcal meningitis. Data of all patients with a diagnosis of cryptococcal disease were collected at University of Colorado Hospital between 2000 and 2015 (n = 51). Thirty patients were diagnosed with cryptococcal meningitis. We built a logistic regression model for risk factors associated with cryptococcal meningitis. The single-predictor univariate model found that a positive blood culture, positive serum cryptococcal antigen, current malignancy, and headaches were significantly associated with cryptococcal meningitis (p = 0.02). In the adjusted multivariate model, central nervous system disease was significantly associated with a diagnosis of HIV infection (OR 24.45, 95 % CI 1.62–350.37; p = 0.022) and a positive serum cryptococcal antigen test (OR 42.92, 95 % CI 3.26–555.55; p = 0.0055). In patients with HIV infection or a positive serum cryptococcal antigen, the pretest probability of neuroinvasive Cryptococcus infection is increased and an aggressive diagnostic evaluation should be conducted to exclude infection and consider empiric therapy.

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Acknowledgments

No funding agencies had any role in the preparation, review, or approval of this manuscript. We thank Daniela Garcia for her help in reviewing the manuscript. The views expressed in this article are those of the authors and do not necessarily represent the views of the University of Colorado Denver or Stanford University Medical Center. J.D.B receives research support from the University of Colorado Neurosciences Institute and NINDS 1R01NS097729.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, University of Colorado Denver, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA

    Andrés F. Henao-Martínez, Bruce McCollister & J. David Beckham

  2. Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA

    Lilyana Gross & Bryan Mcnair

  3. Health Sciences Library, University of Colorado Denver, Aurora, Colorado, USA

    Kristen DeSanto

  4. Division of Infectious Diseases and Geographic Medicine, Stanford University Medical Center, Stanford, Palo Alto, CA, USA

    Jose G. Montoya

  5. Division of Infectious Diseases, Department of Medicine, Denver Veterans Affairs Medical Center, 1055 Clermont Street, Box 111L, Denver, CO, 80220, USA

    Leland Shapiro

Authors
  1. Andrés F. Henao-Martínez
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  2. Lilyana Gross
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Correspondence to Andrés F. Henao-Martínez.

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Henao-Martínez, A.F., Gross, L., Mcnair, B. et al. Risk Factors for Cryptococcal Meningitis: A Single United States Center Experience. Mycopathologia 181, 807–814 (2016). https://doi.org/10.1007/s11046-016-0048-x

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  • DOI: https://doi.org/10.1007/s11046-016-0048-x

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