The clinical characteristics of cryptococcal meningitis in apparently immunocompetent patients

Abstract

Abstract:

Objective To analyze the clinical features of cryptococcal meningitis (CM) in apparently immunocompetent patients.Methods Clinical data of 44 CM cases in immunocompetent patients were collected and analyzed in Shanghai Changzheng Hospital from 2000 to 2015.Results Headache, nausea, and fever were the most common leading symptoms of the patients whose mean age was 35.9 years old.The difference in the male-to-female gender ratio of immunocompetent patients was not significant in this survey.And the mean pressure of CSF was (339.3±75.0) mmH₂O.Cryptococcus neoformans was positively detected using Indian ink stain in 41 patients (97.6%, 41/42), followed by CSF cryptococcal antigen latex agglutination test 33 patients, CSF culture was positive in 11 patients.Six patients were given AmB and flucytosine, which was the most common induction therapy.The prognosis was somewhat optimistic of our study, resulting only one patient with mild paralysis.Conclusions Cryptococcal meningitis also can occur in immunocompetent hosts without any apparent underling disease, and the clinical manifestations may be not so typical at early stage, which can lead to misdiagnosis and missed diagnosis.To achieve higher survival and lower mortality rate, relevant CSF examinations are recommended for those suspected patients.

Key words: cryptococcal meningitis, immunocompetent hosts, clinical analysis

CLC Number:

R519.4

LIU Jia, FANG Wen-jie, HONG Nan, LI Juan, CHEN Min, PAN Wei-hua, LIAO Wan-qing. The clinical characteristics of cryptococcal meningitis in apparently immunocompetent patients[J]. Chinese Journal of Mycology, 2016, 11(2): 99-102.

References

[1] Liu Y,Jiang Y,Wu A,et al.Prognostic significance of serum antioxidant parameters in immunocompetent patients with cryptococcal meningitis[J].Eur J Clin Microbiol Infect Dis,2012,31(9):2359-2367.
[2] Park BJ,Wannemuehler KA,Marston BJ,et al.Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS[J].AIDS,2009,23(4):525-530.
[3] Chen JH,Varma A,Diaz MR,et al.Cryptococcus neoformans strains and infection in apparently immunocompetent patients,China[J].Emerg Infect Dis,2008,14(5):755-762.
[4] Chen M,Li XR,Wu SX,et al.Molecular epidemiology of Cryptococcus neoformans species complex isolates from HIV-positive and HIV-negative patients in southeast China[J].Frontiers of Medicine in China,2010,4(1):117-126.
[5] Chen YC,Fubin C,Chen.JH,et al.Cryptococcosis in China (1985-2010):review of cases from Chinese database[J].Mycopathologia,2012,173(5-6):329-335.
[6] Lee SJ,Choi HK,Son J,et al.Cryptococcal meningitis in patients with or without human immunodeficiency virus:experience in a tertiary hospital[J].Yonsei Med J,2011,52(3):482-487.
[7] Chau TT,Mai NH,Ph NH,et al.A prospective descriptive study of cryptococcal meningitis in HIV uninfected patients in Vietnam-high prevalence of Cryptococcus neoformans var grubii in the absence of underlying disease[J].BMC Infect Dis,2010,10:199.
[8] Suwatanapongched T,Sangsatra W,Boonsarngsuk V,et al.Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment[J].Diagn Interv Radiol,2013,19(6):438-446.
[9] Ye F,Xie JX,Zeng QS,et al.Retrospective analysis of 76 immunocompetent patients with primary pulmonary cryptococcosis[J].Lung,2012,190(3):339-346.
[10] 黄小萍,徐宁.免疫功能正常的肺隐球菌病19例临床分析[J].中国乡村医药杂志,2013,20(22):15-16.
[11] Zhu YJ,Chen JH,Nan X,et al.Cryptococcal meningitis in immunocompetent children[J].Mycoses,2012,55(2):168-171.
[12] 陈建能,俞如期,陈碧芬,等.89例新型隐球菌性脑膜炎的临床分析[J].中华实验和临床感染病杂志,2014,4(2):217-219.
[13] van Elden LJ,Walenkamp AM,Lipovsky MM,et al.Declining number of patients with cryptococcosis in the Netherlands in the era of highly active antiretroviral therapy[J].AIDS,2000,14(17):2787-2788.
[14] McNeil JI,Kan VL.Decline in the incidence of cryptococcosis among HIV-infected patients[J].J Acquir Immune Defic Syndr Hum Retrovirol,1995,9(2):206-208.
[15] Pappas PG,Perfect JR,Cloud GA,et al.Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy[J].Clin Infect Dis,2001,33(5):690-699.
[16] Shih CC,Chen YC,Chang SC,et al.Cryptococcal meningitis in non-HIV-infected patients[J].QJM,2000,93(4):245-251.
[17] Speed B,Dunt D.Clinical and host differences between infections with the two varieties of Cryptococcus neoformans[J].Clin Infect Dis,1995,21(1):28-34:discussion 35-36.
[18] Hoang LM,Maguire JA,Doyle P,et al.Cryptococcus neoformans infections at Vancouver Hospital and Health Sciences Centre (1997-2002):epidemiology,microbiology and histopathology[J].J Med Microbiol,2004,53(Pt 9):935-940.
[19] 吴琦,于洪志.国内肺隐球菌病临床资料汇总分析[J].西南军医,2009,11(4):606-608.
[20] SweHan KS,Bekker A,Greeff S,et al.Cryptococcus meningitis and skin lesions in an HIV negative child[J].J Clin Pathol,2008,61(10):1138-1139.
[21] Othman N,Abdullah NA,Wahab ZA.Cryptococcal meningitis in an immunocompetent child:a case report and literature review[J].Southeast Asian J Trop Med Public Health,2004,35(4):930-934.
[22] Huang KY,Huang YC,Hung IJ.et al.Cryptococcosis in nonhuman immunodeficiency virus-infected children[J].Pediatr Neurol,2010,42(4):267-270.
[23] Speed BR,Kaldor J.Rarity of cryptococcal infection in children[J].Pediatr Infect Dis J,1997,16(5):536-537.
[24] Lui G,Lee N,Ip M,et al.Cryptococcosis in apparently immunocompetent patients[J].QJM,2006,99(3):143-151.
[25] Jean SS,Fang CT,Shau WY,et al.Cryptococcaemia:clinical features and prognostic factors[J].QJM,2002,95(8):511-518.
[26] Perfect JR,Dismukes WE,Dromer F,et al.Clinical practice guidelines for the management of cryptococcal disease:2010 update by the infectious diseases society of america[J].Clin Infect Dis,2010,50(3):291-322.