Clinical Characteristics and Outcomes of Patients with Cryptococcal Meningoencephalitis in a Resource-Limited Setting
Methee Chayakulkeeree MD, PhD*, Pattaraporn Wangchinda MD*
Affiliation : The authors contribute equally to this manuscript * Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Cryptococcosis is a potentially lethal opportunistic infection among human immunodeficiency virus (HIV)-
infected individuals. The mortality rate of patient with cryptococcal meningoencephalitis (CM) in Thailand is high. Studying
the factors associated with treatment failure is important to improve outcome.
Material and Method: A retrospective study of patients with cryptococcosis in Siriraj Hospital, Thailand, during 2005-2008
was conducted. Treatment options, outcomes, survival and factors associated with outcomes and mortality were analyzed.
Results : A total of 143 patients with cryptococcosis were enrolled. Mean age was 39 years old and 58.7% were male. There
were 124 HIV-infected patients (86.7%) and 116 of those had CM. Favorable clinical response in HIV-associated CM was
55.2% and 6-month survival was 67.2%. Relapse was found in 21 patients (18.1%). Factors associated with favorable
clinical response included lower opening and closing pressures and a higher white blood cell in cerebrospinal fluid (CSF).
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Favorable mycological response was 56.8% and factors associated with favorable mycological response were a lower CD4
T-lymphocyte count and a longer amphotericin B treatment. The median time to achieve CSF sterilization was 30 days.
Factors associated with survival were a longer course of amphotericin B, a lower CSF opening pressure and a higher white
blood cell in CSF.
Conclusion : High mortality rate of HIV-associated CM was demonstrated and most likely linked to inadequate induction
antifungal therapy resulting in inability to sterilize CSF. New strategies and/or guidelines are suggested to improve survival.
Keywords : Cryptococcus neoformans, Cryptococcosis, Cryptococcal meningoencephalitis, Predicting factors, Cryptococcal infection
