Clinical Features And Prognostic Factors Of 47 Non-HIV Patients With Cryptococcal Meningititis

Objective:To improve the understanding of the disease and reduce the mortality of the disease,the data of 47 patients with Cryptococcal meningitis(CM)in our hospital were analyzed,and the prognostic factors were studied.Methods:Clinical data of 47 CM patients in the First Affiliated Hospital of Nanchang University from January 1,2012 to October 31,2018,including general conditions,clinical manifestations,laboratory examinations,head imaging results,treatments and prognosis were analyzed retrospectively.Results:1.General condition: The proportion of male and female patients was 1.24:1,with an average age of 48.83 years old.There were 7 cases(14.9%)with pigeon fecal exposure history,and 26 cases(55.3%)with underlying diseases.2.Clinical manifestations: Headache was the most common symptom in 45cases(95.7%),followed by fever in 35 cases(74.5%),nausea and vomiting in 21cases(44.7%),mental symptoms in 14 cases(29.8%),and positive meningeal stimulation was 24 cases(51.1%).3.Laboratory examinations and head imaging results: Cerebrospinal fluid(CSF)routine: 34 cases(72.3%)with elevated white blood cells;biochemistry: protein increased in 42 cases(89.4%),chlorine decreased in 26 cases(55.3%),and glucose decreased in 37 cases(78.7%).Positive CSF India ink staining in 35 cases(74.5%).Gold capsule test for CSF was performed in 25 cases,and 24 cases(96.0%)were positive.8 of the 10 cases(80.0%)were positive for CSF culture.The results of gold capsule test for peripheral blood in 17 cases were all positive.38 patients accepted head imaging examination,10 cases(26.3%)showed no obvious abnormality,and 17cases(44.7%)located in the brain.4.Treatment plan and prognosis: 4 patients received Amphotericin B(Am B)alone,15 patients received Am B+ Flucytosine(5-FC),16 patients received Am B+Fluconazole(FCZ),and 12 patients received Am B+ 5-FC + FCZ.There was no difference in efficacy between Am B+ 5-FC and Am B+ 5-FC + FCZ(P > 0.05),and the effect of Am B+ 5-FC + FCZ was better than that of Am B+ FCZ(P = 0.039).After treatment,there were 36 cases improved and 11 cases deteriorated,with an improvement rate of 76.6%.There were differences in mental symptoms and meningeal irritation between two groups.Conclusion:The clinical manifestations of CM have no specific,routine and biochemical of CSF are also poor in specificity.CSF ink stain and gold capsule test for CSF are important tests for diagnosis.Am B combined with 5-FC is the most economical and effective treatment.Mental symptoms and meningeal irritation during the disease indicated bad outcome.