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

Research output: Contribution to journalJournal articleResearchpeer-review

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.

Original languageEnglish
JournalEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
Volume37
Issue number7
Pages (from-to)1231–1240
ISSN0934-9723
DOIs
Publication statusPublished - Jul 2018

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

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