Cryptococcal meningitis in systemic lupus erythematosus patients: pooled analysis and systematic review.
Cryptococcal meningitis is an important fungal infection among systemic lupus erythematosus patients. We conducted a pooled analysis and systematic review to describe the epidemiological and clinical profile of cryptococcal meningitis in systemic lupus erythematosus patients. From two hospitals in China and nine literature databases, cases and prevalence data were collected for pooled analysis and meta-analysis, respectively. Categorical variables of cases were compared using a χ(2)-test on the statistical program of SAS. A multiple regression analysis was performed to ascertain independent predictors significantly correlated with prognosis. Meta-analysis was conducted by the statistical program of R. The prevalence of cryptococcal meningitis in systemic lupus erythematosus patients was 0.5%. Patients were predominantly females and adults. A prednisone equivalent of more than 30 mg/day before infection was associated with higher mortality (odds ratio (OR)=9.69 (1.54, 60.73)). In all, 36.8-38.9% patients showed low lupus activity when they developed the crytococcal infection. Moreover, 38.2% of the patients were misdiagnosed. The estimated case-fatality rate was 23.6%. Our results suggest that more emphasis should be placed to further understand lupus-related cryptococcal meningitis and to develop better prophylaxis and management strategies to combat this condition.
Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.|Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Wenjie
W
Fang
Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.|Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.|CBS-KNAW Fungal Biodiversity Centre, Utrecht 3584, The Netherlands.
Min
M
Chen
Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.|Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Jia
J
Liu
Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen 6532, The Netherlands.
Ferry
http://orcid.org/0000-0002-5622-1916
F
Hagen
Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Abdullah
A
Ms
Directorate General of Health Services, Ministry of Health, Ibri Hospital, Ibri 515, Oman.
Al-Hatmi
Department of Dermatology and Rheumatology, The Second Afflicted Hospital of Kunming Medical University, Kunming, Yunnan Province 650504, China.
Peilian
P
Zhang
Department of Dermatology and Rheumatology, The Second Afflicted Hospital of Kunming Medical University, Kunming, Yunnan Province 650504, China.
Yun
Y
Guo
Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.|Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.|CBS-KNAW Fungal Biodiversity Centre, Utrecht 3584, The Netherlands.
Teun
T
Boekhout
Department of Dermatology and Rheumatology, The Second Afflicted Hospital of Kunming Medical University, Kunming, Yunnan Province 650504, China.
Danqi
D
Deng
Department of Biology, McMaster University, Hamilton L8S 4K1, Canada.
Jianping
J
Xu
Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.|Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Weihua
W
Pan
Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.|Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Wanqing
W
Liao
D000367:Age Factors; D002681:China; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000382:microbiology; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications / Q000382:microbiology* / Q000401:mortality / Q000473:pathology*; D009026:Mortality; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D015995:Prevalence; D012737:Sex Factors; D016019:Survival Analysis
D007166:Immunosuppressive Agents; D011241:Prednisone