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Size Matters: Measurement of Capsule Diameter in Cryptococcus neoformans
Published on: February 27, 2018
[Factors associated with mortality in cryptococcal meningitis]
Ji-qin Wu1, Bin Xu, Xue-ting Ou
1Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China.
Objective:
To investigate factors associated with mortality in non-AIDS patients with cryptococcal meningitis.
Methods:
We retrospectively reviewed 154 cases of non-HIV cryptococcal meningitis in a tertiary care hospital in China, from 1997 through 2007.
Results:
The 1-year attributable mortality was 19.6% (28/143), and overall mortality was 28.7% (41/143). Advanced age (> or = 60 years), delay in diagnosis (> 4 months), hematologic malignancy, solid malignancy, altered mental status (coma, seizure, herniation), and CSF drainage or shunting were factors associated with increased death; factors associated with increased survival were amphotericin B based initial therapy and flucytosine containing therapy. In multivariate analysis, age > or = 60 years, the time from symptom onset to diagnosis > 4 months, coma, cerebral herniation, and non-amphotericin B based initial therapy were independently associated with increased overall mortality; factors independently associated with cause-specific mortality were time from symptom onset to diagnosis > 4 months, cerebral herniation and non-amphotericin B based initial therapy.
Conclusion:
A variety of factors were associated with mortality in non-AIDS cryptococcal meningitis. Amphotericin B based initial treatment was independently correlated to improved 1-year survival.
Insights
Mortality in non-AIDS cryptococcal meningitis is linked to older age, delayed diagnosis, and severe symptoms. Initial treatment with amphotericin B significantly improves survival rates in these patients.
Area of Science:
- Infectious Diseases
- Neurology
- Critical Care Medicine
Context:
- Cryptococcal meningitis (CM) is a serious fungal infection, particularly in non-AIDS patients.
- Mortality rates for non-AIDS CM remain significant, necessitating identification of key prognostic factors.
- Understanding these factors is crucial for improving patient outcomes in this vulnerable population.
Purpose:
- To identify clinical and demographic factors associated with mortality in non-AIDS patients diagnosed with cryptococcal meningitis.
- To evaluate the impact of diagnostic delays and specific therapeutic interventions on survival.
- To determine independent predictors of both overall and cause-specific mortality.
Summary:
- A retrospective review of 154 non-HIV CM cases identified advanced age (≥60 years), delayed diagnosis (>4 months), hematologic/solid malignancies, altered mental status (coma, herniation), and CSF drainage as mortality predictors.
- Amphotericin B-based initial therapy and flucytosine-containing regimens were associated with increased survival.
- Multivariate analysis confirmed age, diagnostic delay, coma, cerebral herniation, and non-amphotericin B therapy as independent predictors of mortality.
Impact:
- Findings highlight the importance of timely diagnosis and aggressive management, including amphotericin B-based therapy, for non-AIDS CM patients.
- Identifies high-risk patient groups (elderly, those with malignancies or neurological deficits) requiring closer monitoring.
- Contributes to evidence-based guidelines for managing cryptococcal meningitis in immunocompetent individuals.
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