Prediction of unfavorable outcomes in cryptococcal meningitis: results of the multicenter Infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study

I N Hakyemez, H Erdem, G Beraud, M Lurdes, A Silva-Pinto, C Alexandru, B Bishop, F Mangani, X Argemi, M Poinot, R Hasbun, M Akcaer, S Alp, T Demirdal, K Angamuthu, F Amer, E Ragab, G A Shehata, D Ozturk-Engin, N OzgunesL Larsen, S Zimmerli, O R Sipahi, E Tukenmez Tigen, G Celebi, N Oztoprak, A C Yardimci, Y Cag

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Resumé

Cryptococcal meningitis (CM) is mostly seen in immunocompromised patients, particularly human immunodeficiency virus (HIV)-positive patients, but CM may also occur in apparently immunocompetent individuals. Outcome analyses have been performed in such patients but, due to the high prevalence of HIV infection worldwide, CM patients today may be admitted to hospitals with unknown HIV status, particularly in underdeveloped countries. The objective of this multicenter study was to analyze all types of CM cases in an aggregate cohort to disclose unfavorable outcomes. We retrospectively reviewed the hospitalized CM patients from 2000 to 2015 in 26 medical centers from 11 countries. Demographics, clinical, microbiological, radiological, therapeutic data, and outcomes were included. Death, neurological sequelae, or relapse were unfavorable outcomes. Seventy (43.8%) out of 160 study cases were identified as unfavorable and 104 (65%) were HIV infected. On multivariate analysis, the higher Glasgow Coma Scale (GCS) scores (p = 0.021), cerebrospinal fluid (CSF) leukocyte counts > 20 (p = 0.038), and higher CSF glucose levels (p = 0.048) were associated with favorable outcomes. On the other hand, malignancy (p = 0.026) was associated with poor outcomes. Although all CM patients require prompt and rational fungal management, those with significant risks for poor outcomes need to be closely monitored.

OriginalsprogEngelsk
TidsskriftEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
Vol/bind37
Udgave nummer7
Sider (fra-til)1231–1240
ISSN0934-9723
DOI
StatusUdgivet - jul. 2018

Fingeraftryk

Cryptococcal Meningitis
Research
HIV
Cerebrospinal Fluid
Glasgow Coma Scale
Virus Diseases
Multicenter Studies
Multivariate Analysis
Neoplasms

Citer dette

Hakyemez, I N ; Erdem, H ; Beraud, G ; Lurdes, M ; Silva-Pinto, A ; Alexandru, C ; Bishop, B ; Mangani, F ; Argemi, X ; Poinot, M ; Hasbun, R ; Akcaer, M ; Alp, S ; Demirdal, T ; Angamuthu, K ; Amer, F ; Ragab, E ; Shehata, G A ; Ozturk-Engin, D ; Ozgunes, N ; Larsen, L ; Zimmerli, S ; Sipahi, O R ; Tukenmez Tigen, E ; Celebi, G ; Oztoprak, N ; Yardimci, A C ; Cag, Y. / Prediction of unfavorable outcomes in cryptococcal meningitis : results of the multicenter Infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study. I: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2018 ; Bind 37, Nr. 7. s. 1231–1240.
@article{322360169be9484685f415e6a546eec0,
title = "Prediction of unfavorable outcomes in cryptococcal meningitis: results of the multicenter Infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study",
abstract = "Cryptococcal meningitis (CM) is mostly seen in immunocompromised patients, particularly human immunodeficiency virus (HIV)-positive patients, but CM may also occur in apparently immunocompetent individuals. Outcome analyses have been performed in such patients but, due to the high prevalence of HIV infection worldwide, CM patients today may be admitted to hospitals with unknown HIV status, particularly in underdeveloped countries. The objective of this multicenter study was to analyze all types of CM cases in an aggregate cohort to disclose unfavorable outcomes. We retrospectively reviewed the hospitalized CM patients from 2000 to 2015 in 26 medical centers from 11 countries. Demographics, clinical, microbiological, radiological, therapeutic data, and outcomes were included. Death, neurological sequelae, or relapse were unfavorable outcomes. Seventy (43.8{\%}) out of 160 study cases were identified as unfavorable and 104 (65{\%}) were HIV infected. On multivariate analysis, the higher Glasgow Coma Scale (GCS) scores (p = 0.021), cerebrospinal fluid (CSF) leukocyte counts > 20 (p = 0.038), and higher CSF glucose levels (p = 0.048) were associated with favorable outcomes. On the other hand, malignancy (p = 0.026) was associated with poor outcomes. Although all CM patients require prompt and rational fungal management, those with significant risks for poor outcomes need to be closely monitored.",
keywords = "Adult, Antifungal Agents/therapeutic use, Cerebrospinal Fluid/microbiology, Comorbidity, Cryptococcus/classification, Female, HIV Infections/complications, Humans, Immunocompromised Host, Male, Meningitis, Cryptococcal/diagnosis, Middle Aged, Retrospective Studies, Surveys and Questionnaires, Treatment Outcome",
author = "Hakyemez, {I N} and H Erdem and G Beraud and M Lurdes and A Silva-Pinto and C Alexandru and B Bishop and F Mangani and X Argemi and M Poinot and R Hasbun and M Akcaer and S Alp and T Demirdal and K Angamuthu and F Amer and E Ragab and Shehata, {G A} and D Ozturk-Engin and N Ozgunes and L Larsen and S Zimmerli and Sipahi, {O R} and {Tukenmez Tigen}, E and G Celebi and N Oztoprak and Yardimci, {A C} and Y Cag",
year = "2018",
month = "7",
doi = "10.1007/s10096-017-3142-1",
language = "English",
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pages = "1231–1240",
journal = "European Journal of Clinical Microbiology & Infectious Diseases",
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Hakyemez, IN, Erdem, H, Beraud, G, Lurdes, M, Silva-Pinto, A, Alexandru, C, Bishop, B, Mangani, F, Argemi, X, Poinot, M, Hasbun, R, Akcaer, M, Alp, S, Demirdal, T, Angamuthu, K, Amer, F, Ragab, E, Shehata, GA, Ozturk-Engin, D, Ozgunes, N, Larsen, L, Zimmerli, S, Sipahi, OR, Tukenmez Tigen, E, Celebi, G, Oztoprak, N, Yardimci, AC & Cag, Y 2018, 'Prediction of unfavorable outcomes in cryptococcal meningitis: results of the multicenter Infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study', European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, bind 37, nr. 7, s. 1231–1240. https://doi.org/10.1007/s10096-017-3142-1

Prediction of unfavorable outcomes in cryptococcal meningitis : results of the multicenter Infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study. / Hakyemez, I N; Erdem, H; Beraud, G; Lurdes, M; Silva-Pinto, A; Alexandru, C; Bishop, B; Mangani, F; Argemi, X; Poinot, M; Hasbun, R; Akcaer, M; Alp, S; Demirdal, T; Angamuthu, K; Amer, F; Ragab, E; Shehata, G A; Ozturk-Engin, D; Ozgunes, N; Larsen, L; Zimmerli, S; Sipahi, O R; Tukenmez Tigen, E; Celebi, G; Oztoprak, N; Yardimci, A C; Cag, Y.

I: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, Bind 37, Nr. 7, 07.2018, s. 1231–1240.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Prediction of unfavorable outcomes in cryptococcal meningitis

T2 - results of the multicenter Infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study

AU - Hakyemez, I N

AU - Erdem, H

AU - Beraud, G

AU - Lurdes, M

AU - Silva-Pinto, A

AU - Alexandru, C

AU - Bishop, B

AU - Mangani, F

AU - Argemi, X

AU - Poinot, M

AU - Hasbun, R

AU - Akcaer, M

AU - Alp, S

AU - Demirdal, T

AU - Angamuthu, K

AU - Amer, F

AU - Ragab, E

AU - Shehata, G A

AU - Ozturk-Engin, D

AU - Ozgunes, N

AU - Larsen, L

AU - Zimmerli, S

AU - Sipahi, O R

AU - Tukenmez Tigen, E

AU - Celebi, G

AU - Oztoprak, N

AU - Yardimci, A C

AU - Cag, Y

PY - 2018/7

Y1 - 2018/7

N2 - Cryptococcal meningitis (CM) is mostly seen in immunocompromised patients, particularly human immunodeficiency virus (HIV)-positive patients, but CM may also occur in apparently immunocompetent individuals. Outcome analyses have been performed in such patients but, due to the high prevalence of HIV infection worldwide, CM patients today may be admitted to hospitals with unknown HIV status, particularly in underdeveloped countries. The objective of this multicenter study was to analyze all types of CM cases in an aggregate cohort to disclose unfavorable outcomes. We retrospectively reviewed the hospitalized CM patients from 2000 to 2015 in 26 medical centers from 11 countries. Demographics, clinical, microbiological, radiological, therapeutic data, and outcomes were included. Death, neurological sequelae, or relapse were unfavorable outcomes. Seventy (43.8%) out of 160 study cases were identified as unfavorable and 104 (65%) were HIV infected. On multivariate analysis, the higher Glasgow Coma Scale (GCS) scores (p = 0.021), cerebrospinal fluid (CSF) leukocyte counts > 20 (p = 0.038), and higher CSF glucose levels (p = 0.048) were associated with favorable outcomes. On the other hand, malignancy (p = 0.026) was associated with poor outcomes. Although all CM patients require prompt and rational fungal management, those with significant risks for poor outcomes need to be closely monitored.

AB - Cryptococcal meningitis (CM) is mostly seen in immunocompromised patients, particularly human immunodeficiency virus (HIV)-positive patients, but CM may also occur in apparently immunocompetent individuals. Outcome analyses have been performed in such patients but, due to the high prevalence of HIV infection worldwide, CM patients today may be admitted to hospitals with unknown HIV status, particularly in underdeveloped countries. The objective of this multicenter study was to analyze all types of CM cases in an aggregate cohort to disclose unfavorable outcomes. We retrospectively reviewed the hospitalized CM patients from 2000 to 2015 in 26 medical centers from 11 countries. Demographics, clinical, microbiological, radiological, therapeutic data, and outcomes were included. Death, neurological sequelae, or relapse were unfavorable outcomes. Seventy (43.8%) out of 160 study cases were identified as unfavorable and 104 (65%) were HIV infected. On multivariate analysis, the higher Glasgow Coma Scale (GCS) scores (p = 0.021), cerebrospinal fluid (CSF) leukocyte counts > 20 (p = 0.038), and higher CSF glucose levels (p = 0.048) were associated with favorable outcomes. On the other hand, malignancy (p = 0.026) was associated with poor outcomes. Although all CM patients require prompt and rational fungal management, those with significant risks for poor outcomes need to be closely monitored.

KW - Adult

KW - Antifungal Agents/therapeutic use

KW - Cerebrospinal Fluid/microbiology

KW - Comorbidity

KW - Cryptococcus/classification

KW - Female

KW - HIV Infections/complications

KW - Humans

KW - Immunocompromised Host

KW - Male

KW - Meningitis, Cryptococcal/diagnosis

KW - Middle Aged

KW - Retrospective Studies

KW - Surveys and Questionnaires

KW - Treatment Outcome

U2 - 10.1007/s10096-017-3142-1

DO - 10.1007/s10096-017-3142-1

M3 - Journal article

C2 - 29218468

VL - 37

SP - 1231

EP - 1240

JO - European Journal of Clinical Microbiology & Infectious Diseases

JF - European Journal of Clinical Microbiology & Infectious Diseases

SN - 0934-9723

IS - 7

ER -