Impaired consciousness and decreased glucose concentration of CSF as prognostic factors in immunocompetent patients with cryptococcal meningitis

Zhang, Chen; Tan, Zheren; Tian, Fafa

doi:10.1186/s12879-020-4794-5

Cited by 20 publications

(20 citation statements)

References 34 publications

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“…Moreover, in the present study, the most common symptoms included headache, fever, weakness, lethargy, cough, and sputum. This was partially in line with the results of a research conducted by Zhang et al [ 15 ] who reported headache, fever, and emesis as the most common symptoms. Besides, this is consistent with the findings of the study carried out by Lee et al who mentioned headache, fever, and altered state of consciousness as the most common symptoms [ 12 ].…”

Section: Discussionsupporting

confidence: 91%

“…However, the glucose level of CFS was not associated with the increase in the mortality rate. On the other hand, Zhang et al reported decreased glucose concentration of CSF as an effective factor on the increase of mortality [ 15 ]. Generally, it was not possible to compare the findings of this research with those of other studies due to the small population of the present study.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical features and para-clinical findings of cryptococcal meningitis in the North of Iran during 2011-19

Babamahmoodi¹,

Firozjaii²,

Bayani³

et al. 2021

CMM

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Background and Purpose:Cryptococcalmeningitis (CM) is a serious fungal infection that especially affectspatients with human immunodeficiency virus (HIV). In this regard,the present retrospective study aimed to analyze the clinical and laboratory features and therapeutic outcomes of patients with CM admitted to two teaching referral centersin the north of Iran during 2011-19. Materials and Methods:This study was performed onall the hospitalized patients diagnosed with CM in two therapeutic centers of infectious diseases in the north of Iran. The required data,such as demographic characteristics and clinical and paraclinical features of patients, were extracted and entered in the information forms. Finally, the collected data were analyzed inSPSSsoftware(version16). Results:For the purpose of the study, records of 12confirmed CM patients were evaluatedin this research. Based on the results,75% of the patients were male. Moreover,the average age of the subjects was 40.33± 8.93 years old and 66.6%ofthem(n=8) were HIV-positive. Other underlying diseases among HIV-positive patients included infection with hepatitis C virus (25%) and a history of tuberculosis (25%). In total, threeHIV-negative patients suffered from Hodgkin lymphoma (25%), sarcoidosis (25%),and asthma (25%) and one patient (25%) had no underlying disease. Headache (75%), weakness,and fatigue (75%) were the most common symptoms among the participants. The cluster of differentiation 4count in all HIV-positive patients was less than 100 cells/μl. There was no significant difference between symptoms in HIV-positive and HIV-negative patients. Besides, no significant difference was observed between the groups of HIV-positive and HIV-negative patients regarding the period between the onset of symptoms and diagnosis of CM,the length of hospital stay,and the duration of antifungal medication consumption. In total,three patients (25%) expired,and six patients recovered. The CM recurred in two HIV-negative and oneHIV-positive subjects;the two HIV-negative patients were treated,whilethe HIV-positive patient expired due to this recurrence. Conclusion:Clinical features and cerebrospinal fluid parameters were not different in HIV-positive and HIV-negative participants. Despite the fact thatCM is not common in Iran, due to the increasing number of immunosuppressive patients, the differential diagnosis of CM should be considered for patients with signs and symptoms of infection in the central nervous system.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Clinical features and para-clinical findings of cryptococcal meningitis in the North of Iran during 2011-19

Babamahmoodi¹,

Firozjaii²,

Bayani³

et al. 2021

CMM

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“…Interestingly, our data indicated that altered consciousness was strongly associated with cryptococcemia outcome in patients with and without HIV infection. It was previously noted that severe fungemia and cryptococcal meningitis both resulted in altered consciousness, 39,40 and altered consciousness is recognised as a predictor associated with unfavourable outcomes in patients with cryptococcosis 41,42 . In our study, all patients exhibited fungemia, and 71.5% patients exhibited cryptococcal meningitis.…”

Section: Discussionsupporting

confidence: 49%

“…It was previously noted that severe fungemia and cryptococcal meningitis both resulted in altered consciousness, 39,40 and altered consciousness is recognised as a predictor associated with unfavourable outcomes in patients with cryptococcosis. 41,42 In our study, all patients exhibited fungemia, and 71.5% patients exhibited cryptococcal meningitis. Therefore, it is conceivable that altered consciousness could serve as an indicator of cryptococcemia prognosis.…”

Section: It Has Long Been Noted That Hiv Infection Is Associated Withsupporting

confidence: 50%

Clinical features and Outcomes of Cryptococcemia patients with and without HIV infection

Zhao

Zhou

Zheng

et al. 2021

Mycoses

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Background The effects of cryptococcemia on patient outcomes in those with or without HIV remain unclear. Methods One hundred and seventy‐nine cryptococcemia patients were enrolled in this retrospective study. Demographic characteristics, blood test results and outcome were compared between the two groups. Results The diagnosis time of Cryptococcus infection was 2.0(0‐6.0) days for HIV‐infected patients, 5.0 (1.5‐8.0) days for HIV‐uninfected patients (p = .008), 2.0 (1.0‐6.0) days for cryptococcal meningitis (CM) patients and 6.0 (5.0‐8.0) days for non‐CM patients (p < .001). HIV infection [adjusted odds ratio (AOR) (95% confidence interval): 6.0(2.3‐15.9)], CRP < 15 mg/L [AOR:3.7(1.7‐8.1)) and haemoglobin > 110 g/L [AOR:2.5(1.2‐5.4)] were risk factors for CM development. Forty‐six (25.7%) patients died within 90 days. ICU stay [AOR:2.8(1.1‐7.1)], hypoalbuminemia [AOR:2.7(1.4‐5.3)], no anti‐cryptococcal treatment [AOR:4.7(1.9‐11.7)] and altered consciousness [AOR:2.4(1.0‐5.5)] were independent risk factors for 90‐day mortality in all patients. HIV infection did not increase the 90‐day mortality of cryptococcemia patients when anti‐Cryptococcus treatment was available. Non‐Amphotericin B treatment [AOR:3.4(1.0‐11.2)] was associated with 90‐day mortality in HIV‐infected patients, but age ≥ 50.0 years old [AOR:2.7(1.0‐2.9)], predisposing disease [AOR:4.1(1.2‐14.2)] and altered consciousness [AOR:3.7(1.1‐12.9)] were associated with 90‐day mortality in HIV‐uninfected patients who accepted anti‐Cryptococcus treatment. Conclusion HIV infection increased the incidence of CM rather than mortality in cryptococcemia patients. The predictive model was completely divergent in HIV‐infected and HIV‐uninfected patients, suggesting that novel strategies for diagnosis and treatment algorithms are urgently needed.

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“…Son levaduras encapsuladas que se reproducen por gemación y que pueden ocasionar enfermedad tanto en personas inmunocompetentes como inmunocomprometidas. Frecuentemente estas levaduras afectan al Sistema Nervioso Central (13,14).…”

Section: Introductionunclassified

Estudio epidemiológico de histoplasmosis, paracoccidioidomicosis y criptococosis en una zona urbana de Ciudad Guayana, estado Bolívar, Venezuela

Alayo¹,

Cermeño

Calzadilla³

et al. 2021

Invest Clin

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Se realizó un estudio prospectivo con el objetivo de determinar la prevalencia de infecciones por Histoplasma capsulatum, Complejo Paracoccidioides spp. y Complejo Cryptoccocus en individuos que viven o trabajan en la Plaza de las Ciencias del Sur, Puerto Ordaz, en el estado Bolívar, Venezuela, donde se refugian aves migratorias. Se aplicó una encuesta clínico-epidemiológica y se administraron pruebas intradérmicas de histoplasmina y paracoccidiodina, a todos los sujetos participantes en el estudio. A aquellos individuos sintomáticos respiratorios crónicos, se les realizó una evaluación clínica, radiológica, cultivo micológico y estudio serológico (anticuerpos específicos para Histoplasma capsulatum, Complejo Paracoccidioides spp. y del antígeno capsular del Complejo Cryptococcus spp.). Se aplicaron 632 pruebas intradérmicas a 316 individuos. De estos, sólo 296 (93,7%) acudieron a la lectura de las pruebas. Los sujetos tenían una media de edad de 40,3 años (rango: 7-76 años). Las manifestaciones clínicas más frecuentes fueron: tos (n=49; 16,5%), expectoración (n=17; 5,7%) y fiebre (n=8; 2,7%). La prueba para la histoplasmina fue positiva en el 47,3% (n=140) y a la paracoccidioidina, en el 32,4% (n=96). Los factores de riesgos fueron: contacto con palomas 30,4% (n=90) y visitas a fincas con gallineros 29,1% (n=86). Se identificaron dos casos de paracoccidioidomicosis pulmonar (0,7%) y un caso (0,3%) de criptococosis pulmonar. La elevada prevalencia de infección por Histoplasma capsulatum (47,3%) y Paracoccidioides spp. (32,4%) en ambientes urbanos del estado Bolívar, demuestra la necesidad de promover la búsqueda activa de estos hongos patógenos en quienes tienen síntomas respiratorios crónicos, que no mejoran con terapia antibacteriana y que habitan en zonas con características ambientales y geográficas, propicias para el desarrollo de estos hongos.

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Impaired consciousness and decreased glucose concentration of CSF as prognostic factors in immunocompetent patients with cryptococcal meningitis

Cited by 20 publications

References 34 publications

Clinical features and para-clinical findings of cryptococcal meningitis in the North of Iran during 2011-19

Clinical features and para-clinical findings of cryptococcal meningitis in the North of Iran during 2011-19

Clinical features and Outcomes of Cryptococcemia patients with and without HIV infection

Estudio epidemiológico de histoplasmosis, paracoccidioidomicosis y criptococosis en una zona urbana de Ciudad Guayana, estado Bolívar, Venezuela

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