Epidemiological characterization and prognostic factors in patients with confirmed cerebral cryptococcosis in central Taiwan

• Published in: Journal of Venomous Animals and Toxins including Tropical Diseases
• Main Authors: Chang-Hua Chen, Hiu-Ngar Sy, Li-Jhen Lin, Hua-Cheg Yen, Shao-Hung Wang, Wei-Liang Chen, Yu-Min Chen, Yu-Jun Chang
• Format: Article in Journal/Newspaper
• Language: English
• Published: SciELO 2015
• Subjects: Cryptococcus neoformans; Cryptococcus gattii Cryptococcosis; Meningitis; Outcome; Risk Assessment; Arctic medicine. Tropical medicine; RC955-962; Toxicology. Poisons; RA1190-1270; Zoology; QL1-991; Arctic
• Online Access: https://doi.org/10.1186/s40409-015-0012-0; https://doaj.org/article/87940d38f1de43f1844d8a169f75baa5

Abstract Background Cryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors. Methods This cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors. Results Fifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (>250 mm H 2 O). Conclusions We strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.