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Epidemiological characterization and prognostic factors in patients with confirmed cerebral cryptococcosis in central
Chang-Hua Chen1, Hiu-Ngar Sy2, Li-Jhen Lin3
1Division of Infectious Disease, Department of Internal Medicine, Changhua Christian Hospital, Changhua, 135 Nanhsiao Street, Changhua, Taiwan ; Infection Control Committee, Changhua Christian Hospital, Changhua, Taiwan ; Department of Nursing, College of Medicine & Nursing, Hung Kuang University, Taichung, Taiwan.
Background:
Cryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors.
Methods:
This cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors.
Results:
Fifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (≥250 mm H2O).
Conclusions:
We strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.
