Comparisons of presentations and outcomes of cryptococcal meningitis between patients with and without hepatitis B virus infection.
OBJECTIVE
The clinical characteristics and outcomes in cryptococcal meningitis (CM) have been shown to vary depending on the underlying condition. The purpose of this study was to investigate these differences in patients with and without hepatitis B virus (HBV) infection.


METHODS
We performed a retrospective study at the Third Affiliated Hospital of Sun Yat-Sen University from January 2006 to June 2012. Thirty-two HBV-positive patients and 58 HBV-negative patients were included.


RESULTS
Among the 90 patients with CM, 32 (35.6%) were HBV-infected. CM occurred in a younger population in the HBV-positive group, with a higher Charlson comorbidity score than the HBV-negative group. The HBV-positive group presented with lower initial complaints of visual symptoms, lower cerebrospinal fluid (CSF) white blood cell counts, lower percentages of the total protein in the CSF exceeding 0.45 g/l, higher glucose levels in the CSF, a higher percentage of positive results for Cryptococcus culture in the CSF, more extraneural involvement sites, and a higher proportion of normal brain images than the HBV-negative group. Factors for a poor prognosis in the HBV-positive group included liver cirrhosis and HBV DNA >10³ copies/ml. In the HBV-uninfected group, lower glucose in the CSF and hydrocephalus were the indicators of an unsatisfactory outcome.


CONCLUSIONS
Certain clinical features of CM were found to be significantly different between HBV-infected and HBV-uninfected patients, including age and initial laboratory findings, as well as the indicators of an unsatisfactory outcome. Host defense defects in the HBV-infected group may lead to a lower intensity of inflammation in the pathogenesis of CM compared with the HBV-uninfected patients and may account for these divergences between the two groups.
Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, China.
Yu-Hua
YH
Zhong
Department of Neurology, Foshan Chinese Medicine Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Foshan, Guangdong Province, China.
Feng
F
Tan
Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, China.
Min
M
Li
Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, China.
Jia
J
Liu
Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, China.
Xuan
X
Wang
Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, China.
Yuan
Y
Yuan
Wilmer Eye Institute, Johns Hopkins University School of Medicine, 400 N. Broadway, Baltimore, MD 21093, USA. Electronic address: xzhong13@jhmi.edu.
Xiu-Feng
XF
Zhong
Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, China. Electronic address: pfh93@163.com.
Fu-Hua
FH
Peng
D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D003454:Cryptococcus / Q000302:isolation & purification; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D005437:Flucytosine / Q000627:therapeutic use; D006509:Hepatitis B / Q000150:complications*; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy; D016919:Meningitis, Cryptococcal / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000890:Anti-Infective Agents; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine
China; Cryptococcal meningitis; HBV; Infection