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Cryptococcal meningitis in HIV-infected patients at Chiang Mai University Hospital: a retrospective study
Abstract:
Cryptococcal meningitis (CM) is a common central nervous system infection in HIV-infected patients. This study aimed to determine treatment outcomes among HIV-infected patients who had cryptococcal meningitis and to determine predictors of death. We conducted a retrospective cohort study among HIV-infected patients receiving care at Chiang Mai University Hospital from January 1, 2005 to December 31, 2010. We studied 79 patients; 45 (57.0%) were male and the mean age was 35.1 +/- 7.2 years. Eleven patients (13.9%) had previous opportunistic infection. The most common presenting symptoms were headache (63 patients, 79.8%), fever (49 patients, 62.0%), and altered consciousness (21 patients, 26.6%). The median CD4+ cell count was 20 cells/mm3 [Interquartile range (IQR) 10, 53]. The in-hospital, 90-day, and 1-year mortality rates were 24.1%, 32.4%, and 52.2%, respectively. The CM attributable in-hospital, 90-day and 1-year mortality rates were 13.9%, 20.3%, and 23.2%, respectively. Predictors associated with a 1-year mortality were a high cerebrospinal (CSF) cryptococcal antigen titer (> 1:10,000) [Odds Ratio (OR) =7.08, 95% confidence interval (CI): 1.62-31.00, p = 0.009], and altered consciousness at presentation (OR = 5.27; 95% CI: 1.16-24.05; p = 0.032). Cryptococcal meningitis is an important cause of death in HIV-infected patients. HIV-infected patients with a low CD4+ cell count, a headache, fever and altered consciousness should be investigated for CM and those with a high CSF cryptococcal antigen titer are at high risk for mortality.
Insights
Cryptococcal meningitis (CM) is a significant cause of death in HIV patients. High cerebrospinal fluid cryptococcal antigen titers and altered consciousness predict mortality, necessitating prompt investigation and treatment.
Area of Science:
- Infectious Diseases
- Neurology
- Immunology
Background:
- Cryptococcal meningitis (CM) is a leading cause of mortality in human immunodeficiency virus (HIV)-infected individuals.
- Central nervous system infections in immunocompromised patients require effective diagnostic and prognostic markers.
Purpose of the Study:
- To evaluate treatment outcomes for cryptococcal meningitis (CM) in HIV-infected patients.
- To identify predictors of mortality in HIV-infected patients diagnosed with CM.
Main Methods:
- Retrospective cohort study conducted at Chiang Mai University Hospital from 2005 to 2010.
- Analysis of clinical data, CD4+ cell counts, and cerebrospinal fluid (CSF) cryptococcal antigen titers from 79 HIV-infected patients.
- Statistical analysis to determine predictors of 1-year mortality.
Main Results:
- The 1-year mortality rate for cryptococcal meningitis (CM) was 52.2%.
- Predictors of 1-year mortality included high CSF cryptococcal antigen titer (> 1:10,000) and altered consciousness at presentation.
- Patients with low CD4+ cell counts (< 20 cells/mm3) and common CM symptoms like headache and fever were identified.
Conclusions:
- Cryptococcal meningitis (CM) remains a critical cause of death in the HIV-infected population.
- Early detection and management are crucial, especially for patients presenting with altered consciousness and high CSF cryptococcal antigen titers.
- Prompt investigation for CM is recommended in HIV-infected patients with symptoms such as headache, fever, and altered consciousness.