Document Detail


The prognostic factors of cryptococcal meningitis in HIV-negative patients.
MedLine Citation:
PMID:  10467545     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Seventy-one patients with cryptococcal meningitis, 46 males and 25 females, aged 15-83 years, were included in this study. Their initial clinical manifestations, cerebrospinal fluid (CSF) features, and therapeutic results were analysed. Patients were treated with three different regimens: amphotericin B, fluconazole, and combination therapy. Based on the therapeutic results, the 71 patients were also divided into cured, improved, and failed groups. For statistical comparison, the clinical manifestations and CSF features, were compared according to therapeutic outcome. There was no statistical difference in outcome among the three different antifungal regimens. However, patients treated with fluconazole required 36% fewer days of hospitalization compared with those receiving amphotericin B. Significant prognostic factors, included low CSF glucose, high CSF lactate, high CSF cryptococcal antigen titre (> or = 1:1024), initial level of consciousness, the presence of seizure, hydrocephalus, and central nervous system vasculitis. Multiple logistic regression analysis showed that only initial level of consciousness, and CSF antigen titre were strongly associated with therapeutic failure after other potentially confounding factors were adjusted for. Because some of the prognostic factors in cryptococcal meningitis can be corrected, early diagnosis, early use of appropriate antifungal treatment, and the correction of the underlying metabolic derangements are important in management.
Authors:
C H Lu; W N Chang; H W Chang; Y C Chuang
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of hospital infection     Volume:  42     ISSN:  0195-6701     ISO Abbreviation:  J. Hosp. Infect.     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-10-07     Completed Date:  1999-10-07     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  8007166     Medline TA:  J Hosp Infect     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  313-20     Citation Subset:  IM; X    
Affiliation:
Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Amphotericin B / administration & dosage
Antifungal Agents / administration & dosage
Drug Therapy, Combination
Female
Fluconazole / administration & dosage
Flucytosine / administration & dosage
HIV Seronegativity*
Humans
Male
Meningitis, Cryptococcal / diagnosis*,  drug therapy
Middle Aged
Prognosis
Taiwan
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antifungal Agents; 1397-89-3/Amphotericin B; 2022-85-7/Flucytosine; 86386-73-4/Fluconazole

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