Prediction of unfavorable outcomes in cryptococcal meningitis: results of the multicenter Infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study.

Hakyemez, I N; Erdem, H; Beraud, G; Lurdes, M; Silva-Pinto, A; Alexandru, C; Bishop, B; Mangani, F; Argemi, X; Poinot, M; Hasbun, R; Akcaer, M; Alp, S; Demirdal, T; Angamuthu, K; Amer, F; Ragab, E; Shehata, G A; Ozturk-Engin, D; Ozgunes, N; ... (2018). Prediction of unfavorable outcomes in cryptococcal meningitis: results of the multicenter Infectious Diseases International Research Initiative (ID-IRI) cryptococcal meningitis study. European journal of clinical microbiology & infectious diseases, 37(7), pp. 1231-1240. Springer 10.1007/s10096-017-3142-1

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Cryptococcal meningitis (CM) is mostly seen in immunocompromised patients, particularly human immunodeficiency virus (HIV)-positive patients, but CM may also occur in apparently immunocompetent individuals. Outcome analyses have been performed in such patients but, due to the high prevalence of HIV infection worldwide, CM patients today may be admitted to hospitals with unknown HIV status, particularly in underdeveloped countries. The objective of this multicenter study was to analyze all types of CM cases in an aggregate cohort to disclose unfavorable outcomes. We retrospectively reviewed the hospitalized CM patients from 2000 to 2015 in 26 medical centers from 11 countries. Demographics, clinical, microbiological, radiological, therapeutic data, and outcomes were included. Death, neurological sequelae, or relapse were unfavorable outcomes. Seventy (43.8%) out of 160 study cases were identified as unfavorable and 104 (65%) were HIV infected. On multivariate analysis, the higher Glasgow Coma Scale (GCS) scores (p = 0.021), cerebrospinal fluid (CSF) leukocyte counts > 20 (p = 0.038), and higher CSF glucose levels (p = 0.048) were associated with favorable outcomes. On the other hand, malignancy (p = 0.026) was associated with poor outcomes. Although all CM patients require prompt and rational fungal management, those with significant risks for poor outcomes need to be closely monitored.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Zimmerli, Stefan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0934-9723

Publisher:

Springer

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

30 Jan 2018 10:37

Last Modified:

19 Jul 2018 14:06

Publisher DOI:

10.1007/s10096-017-3142-1

Related URLs:

PubMed ID:

29218468

BORIS DOI:

10.7892/boris.107914

URI:

https://boris.unibe.ch/id/eprint/107914

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