Cryptococcal Meningitis - HIV-Negative Patients

2/10/2003

Question: Are there unique diagnostic or therapeutic considerations in HIV-negative cryptococcal meningitis?

Link Directly to Fulltext Article at Publisher

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Unique Identifier:11477526

Authors: Pappas PG. Perfect JR. Cloud GA. Larsen RA. Pankey GA. Lancaster DJ. Henderson H. Kauffman CA. Haas DW. Saccente M. Hamill RJ. Holloway MS. Warren RM. Dismukes WE.

Institution: University of Alabama at Birmingham Medical Center, Birmingham, AL 35294-0006, USA. ppappas@uabid.dom.uab.edu

Title: Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy.

Source: Clinical Infectious Diseases. 33(5):690-9, 2001 Sep 1.

Abstract: We conducted a case study of human immunodeficiency virus (HIV)-negative patients with cryptococcosis at 15 United States medical centers from 1990 through 1996 to understand the demographics, therapeutic approach, and factors associated with poor prognosis in this population. Of 306 patients with cryptococcosis, there were 109 with pulmonary involvement, 157 with central nervous system (CNS) involvement, and 40 with involvement at other sites. Seventy-nine percent had a significant underlying condition. Patients with pulmonary disease were usually treated initially with fluconazole (63%); patients with CNS disease generally received amphotericin B (92%). Fluconazole was administered to approximately two-thirds of patients with CNS disease for consolidation therapy. Therapy was successful for 74% of patients. Significant predictors of mortality in multivariate analysis included age > or =60 years, hematologic malignancy, and organ failure. Overall mortality was 30%, and mortality attributable to cryptococcosis was 12%. Cryptococcosis continues to be an important infection in HIV-negative patients and is associated with substantial overall and cause-specific mortality. CAS Registry/EC Number 0 (Antifungal Agents). 0 (Azoles). 86386-73-4 (Fluconazole).

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Unique Identifier:10787453

Authors: Shih CC. Chen YC. Chang SC. Luh KT. Hsieh WC.

Institution: Departments of Internal Medicine and. Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Title: Cryptococcal meningitis in non-HIV-infected patients.

Source: QJM. 93(4):245-51, 2000 Apr.

Abstract: There are few reports on cryptococcal meningitis in non-HIV-infected patients in subtropical areas. We reviewed 94 non-HIV-infected patients microbiologically diagnosed with cryptococcal meningitis and hospitalized at National Taiwan University Hospital, 1977-1996. Forty-two patients (44.7%) had underlying diseases. The main initial manifestations were headache (86.2%), vomiting (72.3%) and fever (69. 1%). The 30 patients with T-cell suppression had more acute illnesses (median duration of symptoms: 14 days vs. 29 days), less typical presentations of meningitis, and reduced inflammatory responses compared with the 64 without T cell suppression. There was no statistical difference between patients who received amphotericin B treatment for 10 weeks and those received amphotericin B with subsequent fluconazole treatment, in terms of mortality rate and recurrence rate. Seventy-five patients (79.8%) had satisfactory clinical responses, and two relapsed. Eighteen patients died (19.1%) and 10 of these died within 2 weeks of hospitalization. Patients in this series had outcomes comparable with those from temperate and even tropical countries with high percentages of immunocompetent hosts. Factors significantly associated with death were lymphoma, semicoma, leukocytosis, and initial high titres of cryptococcal antigen in cerebral spinal fluid (especially >/=1 : 512). On multivariate analysis, lymphoma and initial high cryptococcal antigen titres were independent predictors of mortality. CAS Registry/EC Number 0 (Antibiotics, Antifungal). 1397-89-3 (Amphotericin B). 86386-73-4 (Fluconazole).

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Unique Identifier:9545144

Authors: Peachey PR. Gubbins PO. Martin RE.

Institution: Arkansas Poison Control/Drug Information Center, Little Rock, USA.

Title: The association between cryptococcal variety and immunocompetent and immunocompromised hosts. [Review] [29 refs]

Source: Pharmacotherapy. 18(2):255-64, 1998 Mar-Apr.

Abstract: The varieties of Cryptococcus neoformans serotypes are neoformans and gattii. Data suggest an association between cryptococcal variety and host immune status. In addition, the two varieties differ in their epidemiology and pathogenicity. Furthermore, symptoms, outcome, and response of cryptococcosis to antifungal therapy may vary. The two varieties also differ in immune-modulating effects. Sparse clinical data suggest var. gattii is more virulent and may be more recalcitrant to antifungal therapy. Also, its infections produce more sequelae. A better understanding of how cryptococcal variety influences the clinical course and response to the treatment of cryptococcosis is needed. Clinicians should be aware of the association, especially in patients with refractory disease. It may be useful to type the isolate to the variety level and administer prolonged antifungal therapy. [References: 29]

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Unique Identifier:7756484

Authors: Mitchell DH. Sorrell TC. Allworth AM. Heath CH. McGregor AR. Papanaoum K. Richards MJ. Gottlieb T.

Institution: Westmead Hospital, New South Wales, Australia.

Title: Cryptococcal disease of the CNS in immunocompetent hosts: influence of cryptococcal variety on clinical manifestations and outcome. [Review] [26 refs]

Source: Clinical Infectious Diseases. 20(3):611-6, 1995 Mar.

Abstract: We performed a retrospective review of cases of cerebral cryptococcosis among patients admitted to 12 Australian teaching hospitals between 1985 and 1992. Of 118 cases identified, 35 occurred in immunocompetent hosts. When cases due to Cryptococcus neoformans variety neoformans were compared with those due to Cryptococcus neoformans variety gattii, we found that the latter tended to occur in healthy hosts whose residence or job was located in a rural area, and cerebral mass lesions and/or hydrocephalus and pulmonary mass lesions were more common. For a subgroup of patients with infection due to C. neoformans variety gattii, multiple enhancing lesions were observed on cerebral computed tomograms, and papilledema, high CSF and serum cryptococcal antigen titers, and a worse prognosis (despite prolonged amphotericin B therapy and intraventricular shunt insertion) were also noted. No significant difference in clinical course or outcome in terms of variety of C. neoformans was noted for patients with cryptococcal meningitis whose computed tomographic scans appeared normal on presentation. [References: 26] CAS Registry/EC Number 0 (Antigens, Fungal). 1397-89-3 (Amphotericin B). 2022-85-7 (Flucytosine).