title: Epidemiological characterization and prognostic factors in patients with confirmed cerebral cryptococcosis in central Taiwan.
abstract: BACKGROUND
  Cryptococcal meningitis is a deadly fungal infection. This study aimed to characterize the epidemiology of cerebral cryptococcosis and to define its prognostic factors.
  
  
  METHODS
  This cross-sectional study collected clinical information from cryptococcal meningitis patients with confirmed cerebral cryptococcosis from 2006 to 2012 at the Changhua Christian Healthcare System to access prognostic factors.
  
  
  RESULTS
  Fifty-nine adult cryptococcal meningitis patients were studied. The incidence at Changhua Christian Healthcare System was approximately 170 episodes per 100,000 patients within the studied period. Forty-one of 59 cryptococcal meningitis patients developed complications. Overall, 12 of 59 patients died, for a three-month mortality rate of 20.3 %. Prognostic factors positively associated with the three-month mortality included age (>55 years), patient delay, prolonged delay by the doctor in administering antifungal agent therapy, duration of intensive care unit stay, chronic lung disease, cryptococcemia, headache, altered mental status, positive blood cultures, and high cerebrospinal fluid opening pressure (≥250 mm H2O).
  
  
  CONCLUSIONS
  We strongly recommend early administration of an antifungal agent to each suspected cryptococcal meningitis patient to decrease both the delay by doctors in administering therapy and the mortality risk. Aggressive and supportive care for severe cryptococcal meningitis patients is critical to decrease overall mortality from this infection.
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, Changhua Christian Hospital, Changhua, 135 Nanhsiao Street, Changhua, Taiwan ; Infection Control Committee, Changhua Christian Hospital, Changhua, Taiwan ; Department of Nursing, College of Medicine & Nursing, Hung Kuang University, Taichung, Taiwan.
authors.forename: Chang-Hua
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Hiu-Ngar
authors.initials: HN
authors.lastname: Sy
authors.affiliation: Infection Control Committee, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Li-Jhen
authors.initials: LJ
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Hua-Cheg
authors.initials: HC
authors.lastname: Yen
authors.affiliation: Department of Microbiology, Immunology and Biopharmaceuticals, National Chiayi University, Chiayi City, Taiwan.
authors.forename: Shao-Hung
authors.initials: SH
authors.lastname: Wang
authors.affiliation: Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Wei-Liang
authors.initials: WL
authors.lastname: Chen
authors.affiliation: Department of Pharmacy, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yu-Min
authors.initials: YM
authors.lastname: Chen
authors.affiliation: Laboratory of Epidemiology and Biostatistics, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yu-Jun
authors.initials: YJ
authors.lastname: Chang
keywords: Cryptococcus gattii Cryptococcosis; Cryptococcus neoformans; Meningitis; Outcome; Risk Assessment