Clinical Features of Cryptococcal Meningoencephalitis in HIV-Positive and -Negative Patients in a Resource-Limited Setting
Cryptococcal meningoencephalitis is a systemic fungal infection in immunocompromised and immunocompetent individuals. This study investigated the clinical characteristics and factors associated with mortality in HIV-associated and non-HIV-associated cryptococcal meningoencephalitis in a resource-lim...
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MDPI AG
2023-08-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/9/9/869 |
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| author | Rattagan Kajeekul Pawut Mekawichai Methee Chayakulkeeree |
| author_facet | Rattagan Kajeekul Pawut Mekawichai Methee Chayakulkeeree |
| author_sort | Rattagan Kajeekul |
| collection | DOAJ |
| description | Cryptococcal meningoencephalitis is a systemic fungal infection in immunocompromised and immunocompetent individuals. This study investigated the clinical characteristics and factors associated with mortality in HIV-associated and non-HIV-associated cryptococcal meningoencephalitis in a resource-limited setting. This was a retrospective cohort study of patients with cryptococcal meningoencephalitis between January 2009 and December 2019 at a tertiary teaching hospital in Thailand. Overall, 1019 patients with cryptococcal meningoencephalitis were enrolled, and 923 (90.6%) were HIV-positive. The patients with HIV-associated cryptococcal meningoencephalitis were younger than the HIV-negative patients (37 versus 56 years, <i>p</i> < 0.01). The HIV-negative patients were more likely to have underlying conditions (52.1% versus 7.5%; <i>p</i> < 0.01), had a longer median duration of headaches prior to admission (14 days versus 6 days, <i>p</i> < 0.01), and were more likely to have an altered mental status at presentation (36.5% versus 18.6%, <i>p</i> < 0.01) and pulmonary involvement (15.6% versus 0.8%, <i>p</i> < 0.01). The HIV-positive patients had lower cerebrospinal fluid (CSF) white blood cell counts (4 versus 94 cells/mm<sup>3</sup>; <i>p</i> < 0.01), lower CSF protein (69 versus 157 mg/dL; <i>p</i> < 0.01), higher CSF glucose (38.8 versus 21 mg/dL; <i>p</i> < 0.01), and more frequent cryptococcemia (44.1% versus 20.5%; <i>p</i> < 0.01). The mortality rate was high but not significantly different between the two groups (30.2% versus 33.2%; <i>p</i> = 0.53). The HIV-positive patients with comorbidities, fever, an altered mental status at presentation, a CSF white blood cell count below 20 cell/mm<sup>3</sup>, fungemia, and positive CSF India ink were independently associated with 30-day mortality. In comparison, an altered mental status at presentation and fungemia were associated with 30-day mortality in HIV-negative patients. In conclusion, HIV-negative patients with cryptococcal meningoencephalitis had more extensive central nervous system inflammation, although the two groups’ mortality rates were similar. Unfavorable prognostic factors included comorbidities, fever, an altered mental status at presentation, a low CSF white blood cell count, fungemia, and positive CSF India ink. |
| first_indexed | 2024-03-10T22:35:25Z |
| format | Article |
| id | doaj.art-b3016b715baf46d09eaaf7ee057b5008 |
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| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-10T22:35:25Z |
| publishDate | 2023-08-01 |
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| spelling | doaj.art-b3016b715baf46d09eaaf7ee057b50082023-11-19T11:28:26ZengMDPI AGJournal of Fungi2309-608X2023-08-019986910.3390/jof9090869Clinical Features of Cryptococcal Meningoencephalitis in HIV-Positive and -Negative Patients in a Resource-Limited SettingRattagan Kajeekul0Pawut Mekawichai1Methee Chayakulkeeree2Department of Internal Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima 30000, ThailandDepartment of Internal Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima 30000, ThailandDivision of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, ThailandCryptococcal meningoencephalitis is a systemic fungal infection in immunocompromised and immunocompetent individuals. This study investigated the clinical characteristics and factors associated with mortality in HIV-associated and non-HIV-associated cryptococcal meningoencephalitis in a resource-limited setting. This was a retrospective cohort study of patients with cryptococcal meningoencephalitis between January 2009 and December 2019 at a tertiary teaching hospital in Thailand. Overall, 1019 patients with cryptococcal meningoencephalitis were enrolled, and 923 (90.6%) were HIV-positive. The patients with HIV-associated cryptococcal meningoencephalitis were younger than the HIV-negative patients (37 versus 56 years, <i>p</i> < 0.01). The HIV-negative patients were more likely to have underlying conditions (52.1% versus 7.5%; <i>p</i> < 0.01), had a longer median duration of headaches prior to admission (14 days versus 6 days, <i>p</i> < 0.01), and were more likely to have an altered mental status at presentation (36.5% versus 18.6%, <i>p</i> < 0.01) and pulmonary involvement (15.6% versus 0.8%, <i>p</i> < 0.01). The HIV-positive patients had lower cerebrospinal fluid (CSF) white blood cell counts (4 versus 94 cells/mm<sup>3</sup>; <i>p</i> < 0.01), lower CSF protein (69 versus 157 mg/dL; <i>p</i> < 0.01), higher CSF glucose (38.8 versus 21 mg/dL; <i>p</i> < 0.01), and more frequent cryptococcemia (44.1% versus 20.5%; <i>p</i> < 0.01). The mortality rate was high but not significantly different between the two groups (30.2% versus 33.2%; <i>p</i> = 0.53). The HIV-positive patients with comorbidities, fever, an altered mental status at presentation, a CSF white blood cell count below 20 cell/mm<sup>3</sup>, fungemia, and positive CSF India ink were independently associated with 30-day mortality. In comparison, an altered mental status at presentation and fungemia were associated with 30-day mortality in HIV-negative patients. In conclusion, HIV-negative patients with cryptococcal meningoencephalitis had more extensive central nervous system inflammation, although the two groups’ mortality rates were similar. Unfavorable prognostic factors included comorbidities, fever, an altered mental status at presentation, a low CSF white blood cell count, fungemia, and positive CSF India ink.https://www.mdpi.com/2309-608X/9/9/869<i>Cryptococcus</i>cryptococcosiscryptococcal meningitiscryptococcal meningoencephalitisfungal infectionHIV |
| spellingShingle | Rattagan Kajeekul Pawut Mekawichai Methee Chayakulkeeree Clinical Features of Cryptococcal Meningoencephalitis in HIV-Positive and -Negative Patients in a Resource-Limited Setting Journal of Fungi <i>Cryptococcus</i> cryptococcosis cryptococcal meningitis cryptococcal meningoencephalitis fungal infection HIV |
| title | Clinical Features of Cryptococcal Meningoencephalitis in HIV-Positive and -Negative Patients in a Resource-Limited Setting |
| title_full | Clinical Features of Cryptococcal Meningoencephalitis in HIV-Positive and -Negative Patients in a Resource-Limited Setting |
| title_fullStr | Clinical Features of Cryptococcal Meningoencephalitis in HIV-Positive and -Negative Patients in a Resource-Limited Setting |
| title_full_unstemmed | Clinical Features of Cryptococcal Meningoencephalitis in HIV-Positive and -Negative Patients in a Resource-Limited Setting |
| title_short | Clinical Features of Cryptococcal Meningoencephalitis in HIV-Positive and -Negative Patients in a Resource-Limited Setting |
| title_sort | clinical features of cryptococcal meningoencephalitis in hiv positive and negative patients in a resource limited setting |
| topic | <i>Cryptococcus</i> cryptococcosis cryptococcal meningitis cryptococcal meningoencephalitis fungal infection HIV |
| url | https://www.mdpi.com/2309-608X/9/9/869 |
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