Clinical Analysis Of 23 Patients With Cryptococcal Meningitis

Objectives To investigate the clinical data of patients with cryptococcal meningitis.Methods Totally 23 patients with cryptococcal meningitis who were hospitalized in the 2nd Afiliated Hospital of Zhejiang University from January 2003 to December 2007 were enrolled in this study.The clinical data including diagnosis and misdiagnosis,experimental and etiology tests,treatments from all the patients were analyzed retrospectively.Results Among the 23 patients enrolled in the study,13 patients(56.5%)had concomitant diseases.The misdiagnosis rate of all patients was 78.2%(18/23).The positive rate of cerebrospinal fluid(CSF)India ink smear was 60.8% (10/23),while 43.4%(10/23)cases of cryptococcus neoformans culture in CSF was positive.The treatments were as follows:single therapy of Amphotericin B(AmpB)or with flucytosine(5-FC)(3 cases);single therapy of Fluconazole or with 5-FC(5 cases); combination of AmB with 5-FC or FCZ initally,single therapy of FCZ in later stage(15 cases);AmB intrathecal injection(13 cases).There were 4 patients cured,11 improved,8 gave up treatment.Conclusions High misdiagnosis rate is common in patients with cryptococcal meningitis.Immunodeficiency is the major risk factor for cryptococcal meningitis.Combination of AmpB with 5-FC antifungal therapy,AmB intrathecal injection and control of acute intracranial hypertension are the keys to improve prognosis of cryptococcal meningitis.