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). 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.
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-infectedpatients (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). 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.
Authors: Elizabeth De Francesco Daher; Jarinne Camilo Landim Nasserala; Geraldo Bezerra da Silva Junior; Adriana Regina Vilarinho de Oliveira; José Urbano de Medeiros Neto; Anastácio Queiroz Sousa Journal: Rev Inst Med Trop Sao Paulo Date: 2015 Jul-Aug Impact factor: 1.846
Authors: I N Hakyemez; H Erdem; G Beraud; M Lurdes; A Silva-Pinto; C Alexandru; B Bishop; F Mangani; X Argemi; M Poinot; R Hasbun; M Sunbul; M Akcaer; S Alp; T Demirdal; K Angamuthu; F Amer; E Ragab; G A Shehata; D Ozturk-Engin; N Ozgunes; L Larsen; S Zimmerli; O R Sipahi; E Tukenmez Tigen; G Celebi; N Oztoprak; A C Yardimci; Y Cag Journal: Eur J Clin Microbiol Infect Dis Date: 2017-12-08 Impact factor: 3.267