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Prediction of unfavorable outcomes in cryptococcal meningitis: results of the multicenter Infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study

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A Correction to this article was published on 31 May 2018

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Abstract

Cryptococcal meningitis (CM) is mostly seen in immunocompromised patients, particularly human immunodeficiency virus (HIV)-positive patients, but CM may also occur in apparently immunocompetent individuals. Outcome analyses have been performed in such patients but, due to the high prevalence of HIV infection worldwide, CM patients today may be admitted to hospitals with unknown HIV status, particularly in underdeveloped countries. The objective of this multicenter study was to analyze all types of CM cases in an aggregate cohort to disclose unfavorable outcomes. We retrospectively reviewed the hospitalized CM patients from 2000 to 2015 in 26 medical centers from 11 countries. Demographics, clinical, microbiological, radiological, therapeutic data, and outcomes were included. Death, neurological sequelae, or relapse were unfavorable outcomes. Seventy (43.8%) out of 160 study cases were identified as unfavorable and 104 (65%) were HIV infected. On multivariate analysis, the higher Glasgow Coma Scale (GCS) scores (p = 0.021), cerebrospinal fluid (CSF) leukocyte counts > 20 (p = 0.038), and higher CSF glucose levels (p = 0.048) were associated with favorable outcomes. On the other hand, malignancy (p = 0.026) was associated with poor outcomes. Although all CM patients require prompt and rational fungal management, those with significant risks for poor outcomes need to be closely monitored.

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Change history

  • 31 May 2018

    In the original version of this article, Mustafa Sunbul was not included in the list of authors for this article. The name has been added accordingly.

References

  1. Maziarz EK, Perfect JR (2016) Cryptococcosis. Infect Dis Clin North Am 30(1):179–206. https://doi.org/10.1016/j.idc.2015.10.006

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bicanic T, Harrison TS (2004) Cryptococcal meningitis. Br Med Bull 72(1):99–118. https://doi.org/10.1093/bmb/ldh043

    Article  PubMed  Google Scholar 

  3. Chen CH, Sy HN, Lin LJ, Yen HC, Wang SH, Chen WL, Chen YM, Chang YJ (2015) Epidemiological characterization and prognostic factors in patients with confirmed cerebral cryptococcosis in central Taiwan. J Venom Anim Toxins Incl Trop Dis 21:12. https://doi.org/10.1186/s40409-015-0012-0

    Article  PubMed  PubMed Central  Google Scholar 

  4. Perfect JR (2015) Cryptococcosis (Cryptococcus neoformans and Cryptococcus gattii). In: Bennett JE, Dolin R, Blaser MJ (eds) Principles and practice of infectious diseases. Elsevier Saunders, Philadelphia, pp 2934–2948

    Google Scholar 

  5. Tenforde MW, Wake R, Leeme T, Jarvis JN (2016) HIV-associated cryptococcal meningitis: bridging the gap between developed and resource-limited settings. Curr Clin Microbiol Rep 3:92–102. https://doi.org/10.1007/s40588-016-0035-5

    Article  PubMed  PubMed Central  Google Scholar 

  6. Erdem H, Inan A, Guven E, Hargreaves S, Larsen L, Shehata G, Pernicova E, Khan E, Bastakova L, Namani S, Harxhi A, Roganovic T, Lakatos B, Uysal S, Sipahi OR, Crisan A, Miftode E, Stebel R, Jegorovic B, Fehér Z, Jekkel C, Pandak N, Moravveji A, Yilmaz H, Khalifa A, Musabak U, Yilmaz S, Jouhar A, Oztoprak N, Argemi X, Baldeyrou M, Bellaud G, Moroti RV, Hasbun R, Salazar L, Tekin R, Canestri A, Čalkić L, Praticò L, Yilmaz-Karadag F, Santos L, Pinto A, Kaptan F, Bossi P, Aron J, Duissenova A, Shopayeva G, Utaganov B, Grgic S, Ersoz G, Wu AKL, Lung KC, Bruzsa A, Radic LB, Kahraman H, Momen-Heravi M, Kulzhanova S, Rigo F, Konkayeva M, Smagulova Z, Tang T, Chan P, Ahmetagic S, Porobic-Jahic H, Moradi F, Kaya S, Cag Y, Bohr A, Artuk C, Celik I, Amsilli M, Gul HC, Cascio A, Lanzafame M, Nassar M (2017) The burden and epidemiology of community-acquired central nervous system infections: a multinational study. Eur J Clin Microbiol Infect Dis 36:1595–1611. https://doi.org/10.1007/s10096-017-2973-0

    Article  PubMed  CAS  Google Scholar 

  7. Abassi M, Boulware DR, Rhein J (2015) Cryptococcal meningitis: diagnosis and management update. Curr Trop Med Rep 2(2):90–99. https://doi.org/10.1007/s40475-015-0046-y

    Article  PubMed  PubMed Central  Google Scholar 

  8. Erdem H, Cag Y, Ozturk-Engin D, Defres S, Kaya S, Larsen L, Poljak M, Barsic B, Argemi X, Sørensen SM, Bohr AL, Tattevin P, Gunst JD, Baštáková L, Jereb M, Johansen IS, Karabay O, Pekok AU, Sipahi OR, Chehri M, Beraud G, Shehata G, Del Vecchio RF, Maresca M, Karsen H, Sengoz G, Sunbul M, Yilmaz G, Yilmaz H, Sharif-Yakan A, Kanj SS, Parlak E, Pehlivanoglu F, Korkmaz F, Komur S, Kose S, Ulug M, Bolukcu S, Coskuner SA, Ince N, Akkoyunlu Y, Halac G, Sahin-Horasan E, Tireli H, Kilicoglu G, Al-Mahdawi A, Nemli SA, Inan A, Senbayrak S, Stahl JP, Vahaboglu H (2015) Results of a multinational study suggest the need for rapid diagnosis and early antiviral treatment at the onset of herpetic meningoencephalitis. Antimicrob Agents Chemother 59(6):3084–3089. https://doi.org/10.1128/AAC.05016-14

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Liao CH, Chi CY, Wang YJ, Tseng SW, Chou CH, Ho CM, Lin PC, Ho MW, Wang JH (2012) Different presentations and outcomes between HIV-infected and HIV-uninfected patients with Cryptococcal meningitis. J Microbiol Immunol Infect 45(4):296–304. https://doi.org/10.1016/j.jmii.2011.12.005

    Article  PubMed  Google Scholar 

  10. McCabe WR, Jackson GG (1962) Gram-negative bacteremia: I. Etiology and ecology. Arch Intern Med 110(6):847–855

    Article  Google Scholar 

  11. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  PubMed  CAS  Google Scholar 

  12. Haddow LJ, Easterbrook PJ, Mosam A, Khanyile NG, Parboosing R, Moodley P, Moosa M-YS (2009) Defining immune reconstitution inflammatory syndrome: evaluation of expert opinion versus 2 case definitions in a South African cohort. Clin Infect Dis 49(9):1424–1432. https://doi.org/10.1086/630208

    Article  PubMed  Google Scholar 

  13. Schutte CM, van der Meyden CH (1998) A prospective study of Glasgow Coma Scale (GCS), age, CSF-neutrophil count, and CSF-protein and glucose levels as prognostic indicators in 100 adult patients with meningitis. J Inf Secur 37(2):112–115

    CAS  Google Scholar 

  14. Lu CH, Chang WN, Chang HW, Chuang YC (1999) The prognostic factors of cryptococcal meningitis in HIV-negative patients. J Hosp Infect 42(4):313–320. https://doi.org/10.1053/jhin.1998.0610

    Article  PubMed  CAS  Google Scholar 

  15. Majumder S, Mandal SK, Bandyopadhyay D (2011) Prognostic markers in AIDS-related cryptococcal meningitis. J Assoc Physicians India 59:152–154

    PubMed  CAS  Google Scholar 

  16. Chen SC, Slavin MA, Heath CH, Playford EG, Byth K, Marriott D, Kidd SE, Bak N, Currie B, Hajkowicz K, Korman TM, McBride WJ, Meyer W, Murray R, Sorrell TC; Australia and New Zealand Mycoses Interest Group (ANZMIG)-Cryptococcus Study (2012) Clinical manifestations of Cryptococcus gattii infection: determinants of neurological sequelae and death. Clin Infect Dis 55(6):789–798. https://doi.org/10.1093/cid/cis529

    Article  PubMed  Google Scholar 

  17. Hung CW, Chang WN, Kung CT, Tsai NW, Wang HC, Lin WC, Huang CR, Huang CC, Tsai WC, Chang HW, Su YJ, Lin YJ, Cheng BC, Chang YT, Su CM, Lu CH (2014) Predictors and long-term outcome of seizures in human immuno-deficiency virus (HIV)-negative cryptococcal meningitis. BMC Neurol 14:208. https://doi.org/10.1186/s12883-014-0208-x

    Article  PubMed  PubMed Central  Google Scholar 

  18. Cabello Úbeda A, Fortes Alen J, Gadea I, Mahillo I, Górgolas M, Fernández Guerrero ML (2016) Cryptococcal meningoencephalitis. Epidemiology and mortality risk factors in pre- and post-HAART era. Med Clin (Barc) 146(9):397–401. https://doi.org/10.1016/j.medcli.2015.11.045

    Article  Google Scholar 

  19. Henao-Martínez AF, Gross L, McNair B, McCollister B, DeSanto K, Montoya JG, Shapiro L, Beckham JD (2016) Risk factors for Cryptococcal meningitis: a single United States center experience. Mycopathologia 181(11–12):807–814. https://doi.org/10.1007/s11046-016-0048-x

    Article  PubMed  PubMed Central  Google Scholar 

  20. Diamond RD, Bennett JE (1974) Prognostic factors in cryptococcal meningitis. A study in 111 cases. Ann Intern Med 80(2):176–181

    Article  PubMed  CAS  Google Scholar 

  21. Darras-Joly C, Chevret S, Wolff M, Matheron S, Longuet P, Casalino E, Joly V, Chochillon C, Bédos JP (1996) Cryptococcus neoformans infection in France: epidemiologic features of and early prognostic parameters for 76 patients who were infected with human immunodeficiency virus. Clin Infect Dis 23(2):369–376

    Article  PubMed  CAS  Google Scholar 

  22. Jarvis JN, Bicanic T, Loyse A, Namarika D, Jackson A, Nussbaum JC, Longley N, Muzoora C, Phulusa J, Taseera K, Kanyembe C, Wilson D, Hosseinipour MC, Brouwer AE, Limmathurotsakul D, White N, van der Horst C, Wood R, Meintjes G, Bradley J, Jaffar S, Harrison T (2014) Determinants of mortality in a combined cohort of 501 patients with HIV-associated cryptococcal meningitis: implications for improving outcomes. Clin Infect Dis 58(5):736–745. https://doi.org/10.1093/cid/cit794

    Article  PubMed  Google Scholar 

  23. Chen YF, Wang DN, Chen ZT, Zhao ZH, Lin Y, Wang HY, Wang N (2016) Risk factors associated with acute/subacute cerebral infarction in HIV-negative patients with cryptococcal meningitis. J Neurol Sci 364:19–23. https://doi.org/10.1016/j.jns.2016.02.062

    Article  PubMed  Google Scholar 

  24. Wu JQ, Xu B, Ou XT, Zhu LP, Weng XH (2010) Factors associated with mortality in cryptococcal meningitis. Zhonghua Yi Xue Za Zhi 90(1):33–37

    PubMed  Google Scholar 

  25. Pappas PG, Perfect JR, Cloud GA, Larsen RA, Pankey GA, Lancaster DJ, Henderson H, Kauffman CA, Haas DW, Saccente M, Hamill RJ, Holloway MS, Warren RM, Dismukes WE (2001) Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy. Clin Infect Dis 33(5):690–699. https://doi.org/10.1086/322597

    Article  PubMed  CAS  Google Scholar 

  26. Schmalzle SA, Buchwald UK, Gilliam BL, Riedel DJ (2016) Cryptococcus neoformans infection in malignancy. Mycoses 59(9):542–552. https://doi.org/10.1111/myc.12496

    Article  PubMed  Google Scholar 

  27. White M, Cirrincione C, Blevins A, Armstrong D (1992) Cryptococcal meningitis: outcome in patients with AIDS and patients with neoplastic disease. J Infect Dis 165(5):960–963

    Article  PubMed  CAS  Google Scholar 

  28. Erdem H, Ozturk-Engin D, Tireli H, Kilicoglu G, Defres S, Gulsun S, Sengoz G, Crisan A, Johansen IS, Inan A, Nechifor M, Al-Mahdawi A, Civljak R, Ozguler M, Savic B, Ceran N, Cacopardo B, Inal AS, Namiduru M, Dayan S, Kayabas U, Parlak E, Khalifa A, Kursun E, Sipahi OR, Yemisen M, Akbulut A, Bitirgen M, Popovic N, Kandemir B, Luca C, Parlak M, Stahl JP, Pehlivanoglu F, Simeon S, Ulu-Kilic A, Yasar K, Yilmaz G, Yilmaz E, Beovic B, Catroux M, Lakatos B, Sunbul M, Oncul O, Alabay S, Sahin-Horasan E, Kose S, Shehata G, Andre K, Dragovac G, Gul HC, Karakas A, Chadapaud S, Hansmann Y, Harxhi A, Kirova V, Masse-Chabredier I, Oncu S, Sener A, Tekin R, Elaldi N, Deveci O, Ozkaya HD, Karabay O, Senbayrak S, Agalar C, Vahaboglu H (2015) Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis: results of Haydarpasa-II study. J Neurol 262(4):890–898. https://doi.org/10.1007/s00415-015-7651-5

    Article  PubMed  Google Scholar 

  29. Erdem H, Elaldi N, Öztoprak N, Sengoz G, Ak O, Kaya S, Inan A, Nayman-Alpat S, Ulu-Kilic A, Pekok AU, Gunduz A, Gozel MG, Pehlivanoglu F, Yasar K, Yılmaz H, Hatipoglu M, Cicek-Senturk G, Akcam FZ, Inkaya AC, Kazak E, Sagmak-Tartar A, Tekin R, Ozturk-Engin D, Ersoy Y, Sipahi OR, Guven T, Tuncer-Ertem G, Alabay S, Akbulut A, Balkan II, Oncul O, Cetin B, Dayan S, Ersoz G, Karakas A, Ozgunes N, Sener A, Yesilkaya A, Erturk A, Gundes S, Karabay O, Sirmatel F, Tosun S, Turhan V, Yalci A, Akkoyunlu Y, Aydın E, Diktas H, Kose S, Ulcay A, Seyman D, Savasci U, Leblebicioglu H, Vahaboglu H (2014) Mortality indicators in pneumococcal meningitis: therapeutic implications. Int J Infect Dis 19:13–19. https://doi.org/10.1016/j.ijid.2013.09.012

    Article  PubMed  Google Scholar 

  30. Satishchandra P, Mathew T, Gadre G, Nagarathna S, Chandramukhi A, Mahadevan A, Shankar SK (2007) Cryptococcal meningitis: clinical, diagnostic and therapeutic overviews. Neurol India 55(3):226–232. https://doi.org/10.4103/0028-3886.35683

    Article  PubMed  CAS  Google Scholar 

  31. Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, Harrison TS, Larsen RA, Lortholary O, Nguyen MH, Pappas PG, Powderly WG, Singh N, Sobel JD, Sorrell TC (2010) Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 50(3):291–322. https://doi.org/10.1086/649858

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lee YC, Wang JT, Sun HY, Chen YC (2011) Comparisons of clinical features and mortality of cryptococcal meningitis between patients with and without human immunodeficiency virus infection. J Microbiol Immunol Infect 44(5):338–345. https://doi.org/10.1016/j.jmii.2010.08.011

    Article  PubMed  CAS  Google Scholar 

  33. Brizendine KD, Baddley JW, Pappas PG (2013) Predictors of mortality and differences in clinical features among patients with Cryptococcosis according to immune status. PLoS One 8(3):e60431. https://doi.org/10.1371/journal.pone.0060431

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Hiesgen J, Schutte C, Olorunju S, Retief J (2017) Cryptococcal meningitis in a tertiary hospital in Pretoria, mortality and risk factors—a retrospective cohort study. Int J STD AIDS 28(5):480–485. https://doi.org/10.1177/0956462416653559

    Article  PubMed  CAS  Google Scholar 

  35. Anekthananon T, Manosuthi W, Chetchotisakd P, Kiertiburanakul S, Supparatpinyo K, Ratanasuwan W, Pappas PG, Filler SG, Kopetskie HA, Nolen TL, Kendrick AS, Larsen RA; BAMSG 3-01 Study Team (2011) Predictors of poor clinical outcome of cryptococcal meningitis in HIV-infected patients. Int J STD AIDS 22(11):665–670. https://doi.org/10.1258/ijsa.2011.010538

    Article  PubMed  CAS  Google Scholar 

  36. Cachay ER, Caperna J, Sitapati AM, Jafari H, Kandel S, Mathews WC (2010) Utility of clinical assessment, imaging, and cryptococcal antigen titer to predict AIDS-related complicated forms of cryptococcal meningitis. AIDS Res Ther 7:29. https://doi.org/10.1186/1742-6405-7-29

    Article  PubMed  PubMed Central  Google Scholar 

  37. Chayakulkeeree M, Wangchinda P (2014) Clinical characteristics and outcomes of patients with cryptococcal meningoencephalitis in a resource-limited setting. J Med Assoc Thai 97(Suppl 3):S26–S34

    PubMed  Google Scholar 

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Funding

The study was not funded.

Author information

Authors and Affiliations

  1. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey

    I. N. Hakyemez

  2. Infectious Diseases International Research Initiative (ID-IRI), Ankara, Turkey

    H. Erdem

  3. Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, Ankara, Turkey

    H. Erdem & M. Akcaer

  4. Department of Infectious Diseases, Poitiers University Hospital, Poitiers, France

    G. Beraud

  5. Department of Infectious Diseases, Centro Hospitalar S. João and Faculty of Medicine of University of Porto, Porto, Portugal

    M. Lurdes & A. Silva-Pinto

  6. Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania

    C. Alexandru

  7. Department of Internal Medicine B, Rambam Medical Center, Haifa, Israel

    B. Bishop

  8. Department of Infectious and Tropical Diseases, “G. B. Rossi” University Hospital, Verona, Italy

    F. Mangani

  9. Department of Infectious Diseases, Nouvel Hôpital Civil, Strasbourg, France

    X. Argemi

  10. Department of Infectious and Tropical Diseases, University Hospital of Pontchaillou, Rennes, France

    M. Poinot

  11. Department of Infectious Diseases, The University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA

    R. Hasbun

  12. Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey

    M. Sunbul

  13. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    S. Alp

  14. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey

    T. Demirdal

  15. Department of Clinical Microbiology, Almana General Hospital, Dammam, Saudi Arabia

    K. Angamuthu

  16. Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    F. Amer

  17. Diagnostic Microbiology Lab of Alexandria University Hospital, Alexandria, Egypt

    E. Ragab

  18. Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt

    G. A. Shehata

  19. Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey

    D. Ozturk-Engin

  20. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Okan University, Istanbul, Turkey

    N. Ozgunes

  21. Department of Infectious Diseases, Odense University Hospital, Odense, Denmark

    L. Larsen

  22. Department of Infectious Diseases, Bern University Hospital and Institute for Infectious Diseases, University of Bern, Bern, Switzerland

    S. Zimmerli

  23. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey

    O. R. Sipahi

  24. Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Marmara University, Istanbul, Turkey

    E. Tukenmez Tigen

  25. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey

    G. Celebi

  26. Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey

    N. Oztoprak

  27. Department of Infectious Diseases and Clinical Microbiology, Istanbul Training and Research Hospital, Istanbul, Turkey

    A. C. Yardimci

  28. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey

    Y. Cag

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  1. I. N. Hakyemez
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  2. H. Erdem
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  29. Y. Cag
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Corresponding author

Correspondence to H. Erdem.

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The authors declare that they have no conflict interest.

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The study obtained approval by the review board of the Fatih Sultan Mehmet Education and Research Hospital in Istanbul.

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Not applicable for this study as data were retrospectively collected.

Additional information

The original version of this article was revised: In the originally published version, Mustafa Sunbul was not included in the list of authors for this article. The name has been added accordingly.

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Hakyemez, I.N., Erdem, H., Beraud, G. et al. Prediction of unfavorable outcomes in cryptococcal meningitis: results of the multicenter Infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study. Eur J Clin Microbiol Infect Dis 37, 1231–1240 (2018). https://doi.org/10.1007/s10096-017-3142-1

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