title: A retrospective research of HIV-negative cryptococcal meningoencephalitis patients with acute/subacute onset.
abstract: Cryptococcal meningoencephalitis (CM) may present as an acute, subacute, or chronic infection. It manifests as a chronic process in over 75 % of cases, but, sometimes, it presents with a more acute onset, mostly in HIV-associated patients. Until now, there has been no study performed on the clinical features of HIV-negative CM patients with acute/subacute onset. We collected 106 HIV-negative patients diagnosed with CM in our hospital during a 15-year period, analyzed their epidemiological and clinical features, as well as the outcomes, and explored the independent prognosis factors and the factors related to the survival time among them. We found that impaired consciousness (23.4 % vs. 3.4 %, p = 0.017) was more common in CM patients with acute/subacute onset, while decreased cerebrospinal fluid (CSF) glucose (51.9 % vs. 75.9 %, p = 0.026) was less common. The ratio of CSF glucose/blood glucose [odds ratio (OR) 0.04, 95 % confidence interval (CI) 0.004-0.262, p = 0.02], impaired consciousness (OR 5.09, 95 % CI 1.477-17.522, p = 0.01), and hospitalization length (OR 0.98, 95 % CI 0.977-0.999, p = 0.04) were indicated to be not only independent prognosis factors in HIV-negative CM patients with acute/subacute onset, but also factors significantly related to the survival time. The results of our study demonstrated that the contact history and potential history risk factors would not affect the onset process of HIV-negative CM patients, and the mortality, hospitalization length, and survival time has not been related to the onset process. However, the ratio of CSF glucose/blood glucose, consciousness level, and hospitalization length of the HIV-negative CM patients with acute/subacute onset should be of greater focus in the clinical work.
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China.
authors.forename: H
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China.
authors.forename: Q
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China.
authors.forename: Z
authors.initials: Z
authors.lastname: Xie
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China.
authors.forename: D
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Neurology, The Central Hospital of Yongzhou, Yongzhou City, Hunan Province, People's Republic of China.
authors.forename: M
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China.
authors.forename: X
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: Man
authors.affiliation: Medical Records Room, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China.
authors.forename: J
authors.initials: J
authors.lastname: Lao
authors.affiliation: Medical Records Room, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, People's Republic of China.
authors.forename: N
authors.initials: N
authors.lastname: Chen
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, No.1838 North Guangzhou Avenue, Guangzhou City, Guangdong Province, People's Republic of China. zhouliang_1963@126.com.
authors.forename: L
authors.initials: L
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003244:Consciousness Disorders / Q000382:microbiology; D003454:Cryptococcus / Q000302:isolation & purification; D003840:Deoxycholic Acid / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid*; D015658:HIV Infections; D006760:Hospitalization; D006801:Humans; D007223:Infant; D000069544:Infectious Encephalitis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D008590:Meningoencephalitis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D001786:Blood Glucose; D004338:Drug Combinations; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D005947:Glucose