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Updated: Jul 14, 2025
Size Matters: Measurement of Capsule Diameter in Cryptococcus neoformans
Published on: February 27, 2018
The prognostic factors for cryptococcal meningitis in non-human immunodeficiency virus patients: An observational
Hotaka Namie1, Takahiro Takazono1,2, Yusuke Hidaka3
1Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Background:
Cryptococcal meningitis (CM) is an invasive fungal infection with a poor prognosis that often occurs in both healthy individuals and compromised hosts, such as patients infected with human immunodeficiency virus (HIV). Unlike CM in HIV patients, evidence regarding CM in non-HIV patients is limited to small retrospective studies.
Objective:
To identify the pretreatment prognostic factors for CM in non-HIV patients.
Methods:
We conducted a large retrospective analysis of CM in non-HIV patients using data from a nationwide Japanese database. The study included hospitalized patients diagnosed with CM between 1 April 2010 and 31 March 2017. All-cause mortality was compared between patients with CM with and without HIV infection. Poor diagnostic factors were analysed in the non-HIV CM group.
Results:
Overall, 533 (64 HIV and 469 non-HIV) patients met the criteria. The mortality rate at 90 days was significantly lower in the HIV group (6.3% vs. 25.4% p = .0002). In a logistic regression analysis of the non-HIV group, age ≥ 65 y (odds ratio [OR] 2.37, 95% CI 1.17-4.78), impaired consciousness (Japan Coma Scale ≥1) (OR 2.25, 95% CI 1.29-3.93), haemodialysis (OR 3.53, 95% CI 1.12-11.20) and previous corticosteroid usage (OR 2.40, 95% CI 1.37-4.19) were associated with poor prognosis at 30 days after diagnosis.
Conclusion:
More caution is suggested when treating non-HIV with CM in older patients with impaired consciousness, previous corticosteroid usage and haemodialysis.
Insights
Cryptococcal meningitis (CM) in non-HIV patients has a higher mortality rate. Older age, impaired consciousness, hemodialysis, and corticosteroid use are key predictors of poor prognosis in these patients.
Area of Science:
- Infectious Diseases
- Mycology
- Epidemiology
Background:
- Cryptococcal meningitis (CM) is a severe fungal infection with high mortality, particularly in immunocompromised individuals like those with HIV.
- Limited data exists on CM prognosis in non-HIV patients, necessitating further research.
Purpose of the Study:
- To identify pretreatment prognostic factors for cryptococcal meningitis (CM) in patients without HIV infection.
- To compare mortality rates between HIV-positive and HIV-negative CM patients.
Main Methods:
- A large-scale retrospective analysis of nationwide Japanese data from 2010-2017.
- Inclusion of hospitalized patients diagnosed with CM.
- Comparison of all-cause mortality and logistic regression analysis for prognostic factors in non-HIV CM patients.
Main Results:
- The study analyzed 533 patients (64 HIV, 469 non-HIV).
- Non-HIV CM patients had a significantly higher 90-day mortality rate (25.4% vs. 6.3%).
- In non-HIV patients, advanced age (≥65 years), impaired consciousness, hemodialysis, and prior corticosteroid use were associated with poor 30-day prognosis.
Conclusions:
- Non-HIV CM patients face a poorer prognosis compared to HIV-positive patients.
- Older age, impaired consciousness, hemodialysis, and corticosteroid use are critical factors to consider for improved management of non-HIV CM.
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