A Comparison of the Clinical Characteristics and Outcomes of Cryptococcal Meningitis in HIV-negative Individuals With and Without Immunosuppression

Abstract

Cryptococcal meningitis (CM) is found to occur in immunosuppressed patients and those who are immunocompetent. This study aimed to compare the presentation and outcome of CM in patients who are human immunodeficiency virus (HIV) negative with and without immunosuppression. We reviewed 255 clinical records from patients with CM who are HIV negative. The demographic and clinical characteristics, cerebrospinal fluid profiles, brain magnetic resonance imaging, treatment, and outcomes of these individuals were retrospectively analyzed. Among the 255 patients with CM, 91 (35.7%) appeared immunocompetent. CM was present in a younger population in the immunocompetent group (above 50 y, 19.8% vs. 32.3%, P=0.026), with higher initial complaints of visual and auditory symptoms (45.1% vs. 27.4%, P=0.004; 19.8% vs. 9.1%, P=0.016; respectively) and higher cerebrospinal fluid white blood cell counts (30.8% vs. 45.1%, P=0.009) compared with the immunocompromised patients. In addition, the immunocompetent patients had a higher proportion of normal brain images than did the immunocompromised patients (10% vs. 2%, P=0.028). There were no differences in hospital mortality and satisfactory outcomes between the groups (mortality: 10.9% vs. 7.0%, P=0.416; satisfactory outcomes: 76.4% vs. 80.2%, P=0.585). We found significant differences between the immunocompetent and HIV-negative immunocompromised patients; however, there were fewer differences between the groups than expected. Further studies assessing the immune responses in both groups should be performed.

Central Nervous System Cryptococcal Infections in Non-HIV Infected Patients

“…An increasing number of studies have focused on the clinical epidemiology and outcomes of cryptococcosis in persons without HIV. The main patient groups are SOT recipients, those with other immunodeficiency disorders, rheumatic disorders, malignancy, diabetes mellitus, cirrhosis and hepatitis B virus infection [3,6,7,12,13,14,15,16]. The results of several published cohorts with more than 20 cases are presented in Table 2.…”

The utility of cerebrospinal fluid white cell count during the prognostic assessment for cryptococcal meningitis patients: a retrospective study

“…The incidence of CM in HIV-infected patients has decreased in the era of antiretroviral therapy. However, in recent years, CM has been on the rise in HIV-negative hosts with organ transplants, autoimmune disease, immune deficiencies, hematological malignancies, prolonged immunosuppressants treatment, and even in apparently immunocompetent individuals [3]. Recent advances in the care for CM patients and CM prevention, including some new agents and adjunctive immunomodulatory therapies, have the potential to reduce mortality from the disease [4,5].…”

Comparisons of cryptococcal meningitis caused by Cryptococcus neoformans between HIV-negative patients with and without lung infection in two Chinese university hospitals

“…The clinical characteristics and outcomes in CM have been shown to vary depending on the underlying condition [8][9][10][11][12][13][14]. The HBV-positive CM patients presented with lower initial complaints of visual symptoms, lower cerebrospinal fluid (CSF) white blood cell (WBC) counts, lower percentages of the total protein in the CSF exceeding 0.45 g/L, higher glucose levels in the CSF, higher percentage of positive results for Cryptococcus culture in the CSF, more extraneural involvement sites, and a higher proportion of normal brain images compared with the HBV-negative CM patients [14].…”

“…The HBV-positive CM patients presented with lower initial complaints of visual symptoms, lower cerebrospinal fluid (CSF) white blood cell (WBC) counts, lower percentages of the total protein in the CSF exceeding 0.45 g/L, higher glucose levels in the CSF, higher percentage of positive results for Cryptococcus culture in the CSF, more extraneural involvement sites, and a higher proportion of normal brain images compared with the HBV-negative CM patients [14]. Compared with the immunocompromised patients, CM was present in a younger population, with higher initial complaints of visual and auditory symptoms, higher CSF WBC counts, higher proportion of normal brain images in the immunocompetent patients [11]. In addition, the elderly patients (≥65 years) were more vulnerable to CM than adults aged <65 years, and had female predominance, higher rates of altered consciousness and recent cerebral infarction [15].…”

“…Sex, age, length of hospital stay, CSF profiles, brain images, underlying diseases, initial presentation, drug resistance of Cryptococcus neoformans, antifungal therapy and outcomes were recorded. The outcomes were classified as "cured", "improved", "other", "untreated", "invalid", and "death" at discharge and further classified into satisfactory (cured or improved) and unsatisfactory (the others) outcomes in accordance with previous studies [11,16]. 1…”