Table 2.
Demographic characteristics, laboratory results, and treatment modalities of patients with cryptococcal meningitis (n = 46) at two-week evaluation
| Variables | Cured (%) (n = 26) | Not cured#(%) (n = 20) | p value |
|---|---|---|---|
|
Demographics | |||
|
Male sex |
19 (73.1) |
13 (65) |
0.75 |
|
Age >60 years |
6 (23.1) |
11 (55) |
0.04 |
|
Coexisting conditions | |||
|
AIDS |
2 (8.3)a |
4 (22.2)b |
0.38 |
|
Solid tumor malignancy |
2 (7.7) |
4 (20) |
0.38 |
|
Hematologic malignancy |
3 (11.5) |
1 (5) |
0.62 |
|
Steroid usage |
3 (11.5) |
5 (25) |
0.27 |
|
Liver cirrhosis |
1 (3.8) |
4 (20) |
0.37 |
|
Chronic renal failure |
2 (7.6) |
1 (5) |
1 |
|
Diabetic mellitus |
8 (30.8) |
4 (20) |
0.51 |
|
COPD |
4 (15.4) |
0 |
0.12 |
|
Organ transplantation |
1 (3.8) |
0 |
1 |
|
No known predisposing factorc |
6 (23.1) |
2 (10) |
0.44 |
|
Previous anti-fungal therapyd |
3 (11.5) |
4 (20) |
0.68 |
|
Severity status | |||
|
APACHE-II score |
8.2 ± 2.4 |
10.4 ± 3.7 |
0.19 |
|
APACHE-II score ≥ 15 |
5 (19.2) |
5 (25) |
0.73 |
|
Shock |
1 (3.8) |
0 |
1 |
|
IICP |
23 (88.5) |
18 (90) |
1 |
|
ICU admission |
14 (53.8) |
8 (40) |
0.39 |
|
Initial laboratory data | |||
|
India ink smear positive |
12 (46.2) |
11 (55) |
0.77 |
|
CSF opening pressure (mmH20) |
248 ± 132 |
252 ± 136 |
0.58 |
|
CSF WBC count (/μL) |
32.2 ± 40.6 |
28.8 ± 38.6 |
0.28 |
|
CSF CAT ≥ 1:1024 |
13 (50) |
14 (70) |
0.23 |
|
Serum CAT ≥ 1:1024 |
9 (34.6) |
9 (45) |
0.55 |
|
Concurrent cryptococcemia |
6 (23.1) |
6 (30) |
0.74 |
|
Serotype B Cryptococcus neoformans isolate |
4 (15.4) |
1 (5) |
0.37 |
|
Isolate resistant to fluconazole (MIC >8 μg/ml) |
4 (15.4) |
8 (40) |
0.09 |
|
Isolate resistant to amphotericin B (MIC >1 μg/ml) |
3 (11.5) |
5 (25) |
0.27 |
|
Treatment modality in induction therapy | |||
|
Amphotericin B plus flucytosine |
0 |
1 (5) |
0.44 |
|
Amphotericin B plus fluconazole |
10 (38.5) |
13 (65) |
0.14 |
|
Amphotericin B alone |
12 (46.2) |
5 (25) |
0.22 |
| Fluconazole alone | 4 (15.4) | 1 (5) | 0.37 |
Abbreviations: AIDS acquired immuno-deficiency syndrome, CAT cryptococcal-antigen titer, COPD chronic obstructive pulmonary disease, CSF cerebro-spinal fluid, ICU intensive care unit, IICP increasing intra-cranial pressure.
# Non-cured patients included 15 patients who failed to respond to cryptococcal meningitis treatment by the end of two weeks of initial anti-fungal therapy, and five who died from cryptococcal infection before the end of two weeks of initial anti-fungal therapy.
aNumber of patients available for analysis, n = 24.
bNumber of patients available for analysis, n = 18.
cAll 8 patients without known predisposing factor were tested for HIV and none was infected.
dReceived systemic anti-fungal agents one month prior to first positive cryptococcal cerebro-spinal fluid culture.
*Multivariate logistic regression analysis indicated that age >60 years (OR = 4.1; 95% CI: 1.1-14.5; p = 0.03) was an independent predictive factor for poor clinical outcome (failure and death) of cryptococcal meningitis at 2-week evaluation.