Studies on predictors in patients with cryptococcal meningitis / 中华全科医师杂志

ABSTRACT

Objective To investigate the factors that might influence the effectiveness of treatment for cryptococcal meningitis. Methods Retrospective analysis was conducted for 11 patients with cryptococcal meningitis admitted to Peking Union Medical College (PUMC) Hospital during 1980-1995. Results Seven of 11 patients with cryptococcal meningitis were successfully cured with combination of amphotericin B and flucytosine for 14 to 31 weeks (five months in average), paraventriculostomy was performed in five of them with hydrocephalus complicated with deteriorated mental status and one of them was administered with additional fluconazole for 15 days during its early stage of therapy. Four of the 11 patients died from cryptococcosis during the course of antifungal therapy. The duration of illness varied from three weeks to four and a half months (two months in average) . And four of them had underlying illness with steroids / cytotoxic therapy and another one had AIDS. Factors associated with unfavorable outcomes included more rapidly progress of the illness (2/11), delay in diagnosis and antifungal therapy, severe impairment of host defense mechanisms against infection, underlying illness involving central nervous system, and significantly abnormal cerebrospinal fluid for a sustained period. Conclusions Cryptococcal meningitis could hardly be diagnosed earlier. Combination of antifungal therapy with paraventriculoatomy at adequate time, if necessary, was effective in treatment for it.