Cryptococcal meningitis in human immunodeficiency virus (HIV)-positive and HIV-negative patients.
This study compared clinical manifestations, blood biochemistry and cerebrospinal fluid (CSF) results of HIV-positive and HIV-negative patients with cryptococcal meningitis. We collected 57 cases of cryptococcal meningitis from cytological specimens submitted to the Department of Tropical Pathology, Faculty of Tropical Medicine. Pertinent clinical data were analyzed retrospectively in 47 cases for clinical manifestations, laboratory features and outcomes of 38 HIV-positive and 9 HIV-negative patients. Headache was the most common symptom seen in all cases, of which 70.2% occurred with fever. CSF examination of both groups revealed elevated opening pressure. Increased CSF protein and depressed CSF glucose levels were seen in HIV-negative cases, which differed from HIV-positive cases, where a slight change was noted. CSF pleocytosis in HIV-positive patients was variable. Forty-eight percent of HIV-positive patients had CSF leukocyte counts below 20 cells/ mm3. None was found in the HIV-negative patients. Specific treatments with amphotericin B and fluconazole were given. Five fatal cases of cryptococcal meningitis were noted, all of which were HIV-positive. There were statistically significant differences in blood neutrophils, blood eosinophils, CSF leukocyte counts, CSF neutrophils, CSF lymphocytes, CSF glucose, and CSF total protein, in HIV-positive and HIV-negative patients (p = 0.050, p = 0.022, p = 0.002, p = 0.016, p = 0.047, p = 0.031, p = 0.009, respectively).
Viriyavejakul
P
P
Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. P.Viriyavejakul@liverpool.ac.uk
Tangwanicharoen
T
T
Punpoowong
B
B
Chaisri
U
U
Wilainam
P
P
Nuntakomon
D
D
Yimsamran
S
S
Maneerat
Y
Y
Pongponratn
E
E
Wilairatana
P
P
Riganti
M
M
D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000453:epidemiology*; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013785:Thailand / Q000453:epidemiology