Risk Factors for Cryptococcal Meningitis: A Single United States Center Experience

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• 作者：Andrés F. Henao-Martínez ; Lilyana Gross ; Bryan Mcnair ; Bruce McCollister…
• 关键词：Cryptococcal antigen ; Cryptococcal meningitis ; Cryptococcus neoformans ; Fungemia ; HIV ; Risk factors
• 刊名：Mycopathologia
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：181
• 期：11-12
• 页码：807-814
• 全文大小：
• 刊物类别：Biomedical and Life Sciences
• 刊物主题：Microbiology; Medical Microbiology; Eukaryotic Microbiology; Microbial Ecology; Plant Sciences;
• 出版者：Springer Netherlands
• ISSN：1573-0832
• 卷排序：181

文摘

Cryptococcal meningitis carries a high mortality. Further understanding of immune suppression factors associated with neuroinvasive infection will improve risk stratification and enhance early diagnosis and treatment with antifungal therapy. The aim of the study was to corroborate established or find novel clinical predictors for cryptococcal meningitis. We performed a matched case–control study of Cryptococcus infection in immunocompromised patients with or without cryptococcal meningitis. Data of all patients with a diagnosis of cryptococcal disease were collected at University of Colorado Hospital between 2000 and 2015 (n = 51). Thirty patients were diagnosed with cryptococcal meningitis. We built a logistic regression model for risk factors associated with cryptococcal meningitis. The single-predictor univariate model found that a positive blood culture, positive serum cryptococcal antigen, current malignancy, and headaches were significantly associated with cryptococcal meningitis (p = 0.02). In the adjusted multivariate model, central nervous system disease was significantly associated with a diagnosis of HIV infection (OR 24.45, 95 % CI 1.62–350.37; p = 0.022) and a positive serum cryptococcal antigen test (OR 42.92, 95 % CI 3.26–555.55; p = 0.0055). In patients with HIV infection or a positive serum cryptococcal antigen, the pretest probability of neuroinvasive Cryptococcus infection is increased and an aggressive diagnostic evaluation should be conducted to exclude infection and consider empiric therapy.