Clinical Features of Cryptococcal Meningoencephalitis in HIV-Positive and -Negative Patients in a Resource-Limited Setting
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Population and Data Collection
2.3. Statistical Analysis
3. Results
3.1. Demographics and Clinical Characteristics
3.2. Outcomes and Mortality
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | HIV-Positive n = 923 (%) | HIV-Negative n = 96 (%) | p-Value |
---|---|---|---|
Mean age, years ± SD | 37.4 ± 10.0 | 56.0 ± 15.2 | <0.01 |
Female sex, n (%) | 289 (31.3) | 33 (34.4) | 0.54 |
Comorbid disease, n (%) * | 69 (7.5) | 50 (52.1) | <0.01 |
Hypertension | 23 (2.5) | 18 (18.8) | <0.01 |
Diabetes mellitus | 8 (0.9) | 10 (10.4) | <0.01 |
Systemic lupus erythematosus | 2 (0.2) | 12 (12.5) | <0.01 |
Others | 42 (4.6) | 46 (16.7) | <0.01 |
Extra-central nervous system involvement, n (%) | |||
Pulmonary involvement | 7 (0.8) | 15 (15.6) | <0.01 |
Lymphadenitis | 6 (0.7) | 2 (2.1) | 0.43 |
Fungemia | 369 (44.1) | 18 (20.5) | <0.01 |
Median duration of headache before admission, days (range) | 6.0 (0–180) | 14.0 (0–120) | <0.01 |
Alteration of consciousness at presentation, n (%) | 172 (18.6) | 35 (36.5) | <0.01 |
Clinical manifestations, n (%) | |||
Fever | 618 (67) | 68 (70.8) | 0.44 |
Seizure | 125 (13.5) | 15 (15.6) | 0.57 |
Visual disturbance | 22 (2.4) | 2 (2.1) | 0.85 |
Cranial nerve palsy | 37 (4) | 5 (5.2) | 0.57 |
Cough | 23 (2.5) | 5 (5.2) | 0.12 |
Dyspnea | 17 (1.8) | 4 (4.2) | 0.13 |
Stiffness of neck | 419 (45.4) | 46 (47.9) | 0.64 |
Pupil edema | 15 (1.6) | 2 (2.1) | 0.74 |
Weakness | 22 (2.4) | 5 (5.2) | 0.10 |
Mortality rate at 30 days, n (%) | 279 (30.2) | 32 (33.2) | 0.53 |
Characteristics | HIV-Positive n = 923 | HIV-Negative n = 96 | p-Value |
---|---|---|---|
Median open pressure, mmH2O (range) | 27.0 (10–75) | 25.0 (6–60) | 0.54 |
Median CSF white blood cell counts, cells/mm3 (range) | 4.0 (0–2050) | 94.0 (0–650) | <0.01 |
Median CSF glucose, mg/dL (range) | 38.8 (0–169) | 21.0 (1–122) | <0.01 |
Mean CSF/blood glucose ratio ± SD | 0.33 ± 0.17 | 0.24 ± 0.19 | <0.01 |
Median CSF protein, mg/dL (range) | 69.0 (1.4–2240) | 157.0 (30–787) | <0.01 |
Positive CSF India ink, n (%) | 609 (66.1) | 48 (50.5) | 0.03 |
Positive CSF cryptococcal antigen, n (%) | 857 (97.7) | 89 (97.8) | 0.90 |
Positive CSF culture for Cryptococcus spp., n (%) | 654 (71.0) | 58 (60.4) | 0.34 |
Characteristics | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|
Odds Ratio | 95% CI | p-Value | Odds Ratio | 95% CI | p-Value | |
Age > 50 years | 1.63 | 1.12–2.33 | 0.008 | 2.09 | 1.40–3.11 | <0.001 |
Female sex | 1.23 | 0.93–1.63 | 0.16 | |||
HIV infection | 0.87 | 0.55–1.36 | 0.53 | |||
Comorbidities | 1.90 | 1.33–2.73 | <0.001 | 1.64 | 1.09–2.47 | 0.017 |
Duration of headache > 14 days | 0.69 | 0.47–1.01 | 0.56 | |||
Fever | 1.37 | 1.02–1.84 | 0.034 | |||
Seizure | 1.69 | 1.17–2.44 | 0.005 | |||
Altered mental status at presentation | 3.27 | 2.39–4.45 | <0.001 | 2.96 | 2.10–4.18 | <0.001 |
Stiffness of neck | 1.09 | 0.84–1.43 | 0.514 | |||
Open pressure > 18 mm H2O | 1.30 | 0.95–1.78 | 0.98 | |||
CSF WBC < 20 cells/mm3 | 1.64 | 1.25–2.15 | <0.001 | 1.70 | 1.28–2.26 | <0.001 |
CSF glucose < 40 cells/mm3 | 1.16 | 0.88–1.52 | 0.30 | |||
CSF protein > 45 cells/mm3 | 1.39 | 1.04–1.87 | 0.026 | |||
Fungemia | 1.86 | 1.42–2.44 | <0.001 | 1.80 | 1.10–2.93 | 0.018 |
Positive CSF culture for Cryptococcus spp. | 1.06 | 0.79–1.42 | 0.69 | |||
Positive CSF India ink | 1.66 | 1.24–2.22 | 0.001 | 1.42 | 1.03–1.94 | 0.032 |
Characteristics | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|
Odds Ratio | 95% CI | p-Value | Odds Ratio | 95% CI | p-Value | |
Age > 50 years | 2.11 | 1.48–2.99 | <0.001 | 2.09 | 1.40–3.11 | <0.001 |
Female sex | 1.21 | 0.93–1.59 | 0.153 | |||
HIV infection | 0.90 | 0.59–1.37 | 0.62 | |||
Comorbidities | 2.12 | 1.48–3.03 | <0.001 | 1.64 | 1.09–2.47 | 0.017 |
Duration of headache > 14 days | 0.67 | 0.48–0.96 | 0.026 | |||
Fever | 1.51 | 1.15–1.98 | 0.003 | |||
Seizure | 1.75 | 1.22–2.50 | 0.002 | |||
Altered mental status at presentation | 3 | 2.19–4.13 | <0.001 | 2.96 | 2.10–4.18 | <0.001 |
Stiffness of neck | 1.13 | 0.88–1.45 | 0.35 | |||
Open pressure > 18 mm H2O | 1.25 | 0.94–1.66 | 0.130 | |||
CSF WBC < 20 cells/mm3 | 1.55 | 1.21–1.99 | 0.001 | 1.70 | 1.28–2.26 | <0.001 |
CSF glucose < 40 cells/mm3 | 1.18 | 0.92–1.52 | 0.198 | |||
CSF protein > 45 cells/mm3 | 1.26 | 0.96–1.67 | 0.102 | |||
Fungemia | 1.80 | 1.39–2.31 | <0.001 | 1.80 | 1.10–2.93 | 0.018 |
Positive CSF culture for Cryptococcus spp. | 0.98 | 0.75–1.29 | 0.91 | |||
Positive CSF India ink | 1.48 | 1.14–1.92 | 0.004 | 1.42 | 1.03–1.94 | 0.032 |
Factor | HIV-Positive | HIV-Negative | ||||
---|---|---|---|---|---|---|
Odds Ratio | 95% CI | p-Value | Odds Ratio | 95% CI | p-Value | |
Age > 50 years | 1.74 | 1.10–2.76 | 0.02 | 1.80 | 0.70–4.64 | 0.22 |
Female sex | 1.23 | 0.91–1.65 | 0.18 | 1.23 | 0.51–2.98 | 0.65 |
Comorbidities | 2.18 | 1.39–3.41 | <0.01 | 1.71 | 0.70–4.19 | 0.24 |
Duration of headache > 14 days | 0.70 | 0.46–1.07 | 0.09 | 0.56 | 0.22–1.43 | 0.22 |
Fever | 1.40 | 1.03–1.91 | 0.03 | 1.08 | 0.42–2.76 | 0.87 |
Seizure | 1.72 | 1.17–2.54 | <0.01 | 1.41 | 0.45–4.38 | 0.55 |
Altered mental status at presentation | 3.26 | 2.32–4.59 | <0.01 | 3.56 | 1.46–8.67 | <0.01 |
Stiffness of neck | 1.10 | 0.83–1.45 | 0.53 | 1.07 | 0.46–2.49 | 0.89 |
Pulmonary involvement | 0.92 | 0.18–4.79 | 0.92 | 0.69 | 0.20–2.36 | 0.55 |
Open pressure > 18 cm H2O | 1.45 | 1.04–2.02 | 0.03 | 0.49 | 0.18–1.29 | 0.14 |
CSF WBC < 20 cells/mm3 | 1.75 | 1.31–2.34 | <0.01 | 1.31 | 0.48–3.57 | 0.60 |
CSF glucose < 40 cells/mm3 | 1.10 | 0.82–1.45 | 0.55 | 2.12 | 0.76–5.93 | 0.15 |
CSF protein > 45 cells/mm3 | 1.48 | 1.09–2.00 | 0.01 | 0.38 | 0.43–3.40 | 0.37 |
Fungemia | 1.76 | 1.32–2.33 | <0.01 | 5.57 | 1.94–16.0 | <0.01 |
Positive CSF culture for Cryptococcus spp. | 1.09 | 0.80–1.48 | 0.60 | 0.94 | 0.39–2.23 | 0.88 |
Positive CSF India ink | 1.81 | 1.33–2.48 | <0.01 | 0.97 | 0.41–2.27 | 0.94 |
Factor | HIV-Positive | HIV-Negative | ||
---|---|---|---|---|
Adjusted Odds Ratio (95% CI) | p-Value | Adjusted Odds Ratio (95% CI) | p-Value | |
Comorbidities | 1.85 (1.12–3.06) | 0.02 | ||
Fever | 1.42 (1.02–1.98) | 0.04 | ||
Altered mental status at presentation | 3.53 (2.42–5.17) | <0.01 | 3.30 (1.28–8.47) | 0.01 |
CSF WBC < 20 cells/mm3 | 1.59 (1.13–2.24) | <0.01 | ||
Fungemia | 1.44 (1.04–1.97) | 0.03 | 5.17 (1.73–15.50) | <0.01 |
Positive CSF India ink | 1.55 (1.08–2.22) | 0.02 |
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Kajeekul, R.; Mekawichai, P.; Chayakulkeeree, M. Clinical Features of Cryptococcal Meningoencephalitis in HIV-Positive and -Negative Patients in a Resource-Limited Setting. J. Fungi 2023, 9, 869. https://doi.org/10.3390/jof9090869
Kajeekul R, Mekawichai P, Chayakulkeeree M. Clinical Features of Cryptococcal Meningoencephalitis in HIV-Positive and -Negative Patients in a Resource-Limited Setting. Journal of Fungi. 2023; 9(9):869. https://doi.org/10.3390/jof9090869
Chicago/Turabian StyleKajeekul, Rattagan, Pawut Mekawichai, and Methee Chayakulkeeree. 2023. "Clinical Features of Cryptococcal Meningoencephalitis in HIV-Positive and -Negative Patients in a Resource-Limited Setting" Journal of Fungi 9, no. 9: 869. https://doi.org/10.3390/jof9090869