Analysis Of Clincial Features And Prognostic Factors Of Cryptococcal Neoformans Meningitis Without Apparent Immune Dysfunction Diseases

Objective:To explore the clinical characteristics and prognostic factors of cryptococcal neoformans meningitis without apparent immune dysfunction diseases,which is helpful for diagnosis and treatment in the future.Methods:The essential data of 30 patients with definite etiological evidence in the First Affiliated Hospital of Chongqing Medical university were collected by the electronic medical record system.The data including gender,age of onset,course of admission,time of diagnosis,history of contact with pigeons,underlying disease,diagnosis and treatment,clinical symptoms,signs,cerebrospinal fluid routine,biochemical and pathogenic findings,treatment plan,prognosis and other information were statistically analyzed.Results:The average age of patients was 57.73±14.90 years?range:17-83 years?.19 were male and 11 were female.The most common manifestations were headache,vomiting and fever.93.3%patients had a headache usually with swelling quality.Vomiting was present in 63.3%?19/30?patients,and 3 patients of them had projectile vomiting.Half patients had fever,mainly with moderate fever?axillary temperature?.23%patients had varying degrees of conscious disorder from somnolence to coma.visual disturbance,mental and behavior disorder,various types of eye movement disorders,and seizure also happened during the disease.The incidence of meningeal irritation sign was 83.3%and the occurrence rate of pathological symptoms was 26.7%.In our study,60%of the patients had a cerebrospinal fluid pressure higher than 200 mmH₂O.The CSF leukocyte count was elevated(<8×10^{^6}/L)in 13.3%patients.The CSF glucose was decreased?<2.2 mmol/L?in 20?66.7%?cases.Indian Ink smear of CSF after first lumbar puncture was positive in 76.67%?23/30?patients,and cultures for cryptococcus was positive in 86.37%?19/22?patients.All of the included patients were paid a return visit by telephone.We assessed the outcome for all patients by using Modified Rankin Scale,14 patients?46.7%?had a poor outcome,10?33.3%?were dead in our study and all of them died within 3 months since discharge.Univariate analysis conducted to comparing the poor outcome group with the favorable group,duration of antifungal treatment?<2weeks P=0.001,<4weeks P=0.006?,conscious disorder?P=0.031?and respiratory failure?P=0.037?were associated with poor outcomes.Multiple logistic regression analysis confirmed that prognostic factors of poor outcome at CNM patients without immunosuppressive situations were independently associated with the induction phase of antifungal treatment less than 2 weeks?P=0.018?.Conclusion:The main clinical symptoms of cryptococcal neoformans meningitis without apparent immune disorders are headache,fever and vomiting,which are as nonspecific as CSF examination.Therefore,to make a diagnosis of it is often delayed or even misdiagnosed.Ink staining and fungal culture are very important for diagnosis,which should be detected as soon as possible and repeatedly if necessary.Impaired consciousness,respiratory failure and shorted treatment course were associated with the poor prognosis of cryptococcal meningitis,and less than 2 weeks of treatment was an independent predict factor of poor prognosis.