pISSN 2093-2340   eISSN 2092-6448
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    Infect Chemother. 2010 Oct;42(5):285-290. Korean.
    Published online Oct 31, 2010.
    https://doi.org/10.3947/ic.2010.42.5.285
    Copyright © 2010 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy
    Original Article

    Cryptococcal Meningitis : 12 Years Experience in a Single Tertiary Health Care Center

    Su Jin Jeong,1,2 Yun Tae Chae,1,2 Sung Joon Jin,1,2 Ji-hyeon Baek,1,2 Bum Sik Chin,1,2 Sang Hoon Han,1,2 Chang Oh Kim,1,2 Jun Yong Choi,1,2 Young Goo Song,1,2 and June Myung Kim1,2
      • 1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
      • 2AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
    • Correspondence to June Myung Kim, M.D. Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-2-2228-1946, Fax: +82-2-393-6884, Email: jmkim@yuhs.ac
    Received May 03, 2010; Revised September 24, 2010; Accepted September 27, 2010.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Background

    Cryptococcal infections are frequent in human immunodeficiency virus (HIV)-infected patients. This infection may occur in other immunocompromised patients, and the diagnosis is often delayed in these cases. There are a few reports on cryptococcal meningitis in non-HIV-infected patients in Korea. We reviewed the clinical features and efficacy of antifungal therapy in 33 patients who were treated at a single tertiary health care center of Korea.

    Materials and Methods

    The medical records of 33 consecutive patients who were admitted to one tertiary hospital for cryptococcal meningitis between 1995 and 2008 were reviewed retrospectively. Cryptococcal meningitis was confirmed by positive cerebral spinal fluid (CSF) cultures or compatible clinical features plus a positive cryptococcal antigen test of CSF.

    Results

    Of the 33 patients analyzed, 30 cases were non-HIV patients. The outcomes were complete cure in 23 cases, relapse after initial treatment in four cases, and death due to treatment failure in six cases. The main initial manifestations were headache (84.8%), fever (54.5%), and seizure (33.3%). Factors significantly associated with unfavorable outcomes, including mortality and relapse, were afebrile condition, mental change, hearing impairment, initial high opening pressure of CSF (>250 mmH2O), and low initial absolute neutrophil count. On multivariate analysis, afebrile condition was an independent predictor of an unfavorable outcome (odds ratio 17.3; 95% confidence interval 1.0-28.3; P=0.045).

    Conclusions

    It is necessary to observe closely cryptococcal meningitis patients without fever on admission.

    Keywords
    Cryptococcal infection; Cryptococcal meningitis; Fever

    Tables

    Table 1
    General Characteristics of the Patients with Cryptococcal meningitis

    Table 2
    Cerebrospinal Fluid findings in the Patients of Cryptococcal meningitis

    Table 3
    Clinical Features of the Patients of Cryptococcal meningitis

    Table 4
    Treatment Outcome of Cryptococcal meningitis

    Table 5
    Risk Factors for Poor Prognosis of Cryptococcal meningitis in Patients; Univariate analysis

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    MeSH Terms
    Delivery of Health Care
    Fever
    HIV
    Headache
    Hearing Loss
    Humans
    Immunocompromised Host
    Korea
    Medical Records
    Meningitis, Cryptococcal
    Multivariate Analysis
    Neutrophils
    Recurrence
    Retrospective Studies
    Seizures
    Tertiary Care Centers
    Treatment Failure
    Metrics
    Share
    Tables
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