title: [Cryptococcal meningoencephalitis. Epidemiology and mortality risk factors in pre- and post-HAART era].
abstract: OBJECTIVE
  Cryptococcal meningoencephalitis (CM) is an uncommon entity, but remains a major cause of morbidity and mortality in patients with AIDS.
  
  
  METHODS
  Review of CM cases in a university hospital. The diagnosis was determined by isolation of Cryptococcus neoformans in cerebrospinal fluid. Morbidity and mortality was assessed at 12 weeks (early mortality) and between 3 and 18 months after diagnosis (late mortality).
  
  
  RESULTS
  We analyzed 32 patients from 2,269 AIDS cases (1.41%). 10 patients between 1990-1996 and 22 between 1997-2014. Cryptococcal antigen in CSF was positive in all cases, with titers>1,024 in 19 patients (63%); this group had lower CD4+ counts (40 ± 33 vs. 139 ± 78 cel/μL) and greater disseminated involvement. After a first CM episode the relapse rate was 34%. Global mortality rate was 28% (9/32), much higher in the pre-HAART era.
  
  
  CONCLUSIONS
  CM morbidity and mortality is related to severe immunodeficiency, disseminated disease, high titers of antigen in CSF and delayed initiation of HAART.
authors.affiliation: División de Enfermedades Infecciosas, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España. Electronic address: acabello@fjd.es.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Cabello Úbeda
authors.affiliation: Servicio de Anatomía Patológica, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España.
authors.forename: José
authors.initials: J
authors.lastname: Fortes Alen
authors.affiliation: Servicio de Microbiología, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Gadea
authors.affiliation: Servicio de Epidemiología, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Mahillo
authors.affiliation: División de Enfermedades Infecciosas, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España.
authors.forename: Miguel
authors.initials: M
authors.lastname: Górgolas
authors.affiliation: División de Enfermedades Infecciosas, Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España.
authors.forename: Manuel L
authors.initials: ML
authors.lastname: Fernández Guerrero
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003453:Cryptococcosis / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D008297:Male; D008590:Meningoencephalitis / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
keywords: AIDS; Criptococosis meníngea; Cryptococcal meningitis; Cryptococcal meningoencephalitis; Meningoencefalitis criptocócica; Sida