title: Cryptococcal meningitis in patients with or without human immunodeficiency virus: experience in a tertiary hospital.
abstract: OBJECTIVE
  Cryptococcal meningitis is a relatively common opportunistic infection in human immunodeficiency virus (HIV) patients and it can frequently occur in immunocompetent hosts without any apparent underlying disease. Nevertheless, little is known about cyptococcal meningitis in the Korean population. The purpose of this study was to evaluate the clinical features and initial laboratory findings of cryptococcal meningitis in patients with and without HIV at a tertiary care teaching hospital.
  
  
  METHODS
  We performed a retrospective study at a tertiary care teaching hospital from January 2001 to December 2009. Eleven HIV positive patients and nine HIV negative patients were included.
  
  
  RESULTS
  The most common symptoms were headache and fever in cryptococcal meningitis, and diabetic mellitus, end stage renal disease and liver cirrhosis were the main associated conditions in patients without HIV. Patients with HIV showed lower peripheral CD4+ cell counts (median: 9, range: 1-107) and a higher burden of cryptococcus than patients without HIV. There were no statistically significant differences in serum CRP level and other cerebrospinal fluid parameters between patients with HIV and without HIV. The in-hospital mortality was 10%, and recurrence of cyptococcal meningitis was observed in 3 patients with HIV and this occurred within 5 months of the first episode.
  
  
  CONCLUSIONS
  Cryptococcal meningitis is fatal without treatment, therefore, rapid recognition of symptoms such as fever and headache and diagnosis is required to decrease the mortality. Recurrence of meningitis after treatment should carefully be followed up, especially in advanced HIV patients.
authors.affiliation: Medical Research Institute, Department of Internal Medicine, Pusan National University College of Medicine, Yangsan, Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Lee
authors.forename: Hee Kyoung
authors.initials: HK
authors.lastname: Choi
authors.forename: Jungmin
authors.initials: J
authors.lastname: Son
authors.forename: Kye Hyung
authors.initials: KH
authors.lastname: Kim
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006761:Hospitals; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies