Table 3.
Demographic characteristics, laboratory results, and initial treatment modalities of patients with cryptococcal meningitis (n = 46) at 10-week evaluation
| Variables | Cured (%) (n = 21) | Not cured#(%) (n = 25) | p-value |
|---|---|---|---|
|
Demographics |
|
|
|
|
Male sex |
15 (71.4) |
17 (68) |
1 |
|
Age >60 years |
6 (28.6) |
11 (44) |
0.36 |
|
Co-existing conditions | |||
|
AIDS |
1 (5.3)a |
5 (21.7)b |
0.19 |
|
Solid tumor malignancy |
2 (9.5) |
4 (16) |
0.67 |
|
Hematologic malignancy |
3 (14.3) |
1 (4) |
0.32 |
|
Steroid usage |
2 (9.5) |
6 (24) |
0.26 |
|
Liver cirrhosis |
1 (4.8) |
4 (16) |
0.36 |
|
Chronic renal failure |
1 (4.8) |
2 (8) |
1 |
|
Diabetic mellitus |
7 (33.3) |
5 (20) |
0.34 |
|
COPD |
3 (14.3) |
1 (4) |
0.32 |
|
Organ transplantation |
1 (4.8) |
0 |
0.46 |
|
No known predisposing factorc |
5 (23.8) |
3 (12) |
0.44 |
|
Previous anti-fungal therapyd |
2 (9.5) |
5 (20) |
0.43 |
|
Severity status | |||
|
APACHE-II score |
7.2 ±3.4 |
10 ± 2.2 |
0.39 |
|
APACHE-II score ≥ 15 |
4 (19.1) |
6 (24) |
0.74 |
|
Shock |
1 (4.8) |
0 |
0.46 |
|
IICP |
19 (90.5) |
22 (88) |
1 |
|
ICU admission |
12 (57.1) |
10 (40) |
0.38 |
|
Initial laboratory data | |||
|
India ink smear positive |
9 (42.9) |
14 (56) |
0.55 |
|
CSF opening pressure (mmH20) |
254 ± 116 |
246 ± 122 |
0.68 |
|
CSF WBC count (/μL) |
30.4 ± 42.8 |
28.6 ± 32.4 |
0.26 |
|
CSF CAT ≥ 1:1024 |
11 (52.4) |
16 (64) |
0.55 |
|
Serum CAT ≥ 1:1024 |
8 (38.1) |
10 (40) |
1 |
|
Concurrent cryptococcemia |
4 (19.1) |
8 (32) |
0.50 |
|
Serotype B Cryptococcus neoformans isolate |
4 (19.1) |
1 (4) |
0.16 |
|
Isolate resistant to fluconazole (MIC >8 μg/ml) |
1 (4.8) |
11 (44) |
<0.01* |
|
Isolate resistant to amphotericin B (MIC >1 μg/ml) |
2 (9.5) |
6 (24) |
0.26 |
|
Treatment modality in induction therapy | |||
|
Amphotericin B plus flucytosine |
0 |
1 (4) |
1 |
|
Amphotericin B plus fluconazole |
7 (33.3) |
16 (64) |
0.08 |
|
Amphotericin B alone |
11 (52.4) |
6 (24) |
0.07 |
| Fluconazole alone | 3 (14.3) | 2 (8) | 0.65 |
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 17 patients who failed to respond to cryptococcal meningitis treatment by the end of 10 weeks of anti-fungal therapy and eight who died from cryptococcal infection before the end of 10-week anti-fungal therapy.
aNumber of patients available for analysis, n = 19.
bNumber of patients available for analysis, n = 23.
cAll 8 patients without known predisposing factor were tested for HIV and none was infected.
dReceived systemic antifungal agents one month prior to first positive cryptococcal cerebro-spinal fluid culture.
*Multivariate logistic regression analysis indicated that the presence of Cryptococcus neoformans isolates resistant to fluconazole (OR = 15.7; 95% CI: 1.8-135.9; p = 0.01) was an independent predictive factor for poor clinical outcome (failure and death) of cryptococcal meningitis at 10-week evaluation.