title: Comparison of clinical features and prognostic factors in HIV-negative adults with cryptococcal meningitis and tuberculous meningitis: a retrospective study.
abstract: The incidence of cryptococcal meningitis (CM) and tuberculous meningitis (TBM) have gradually increased in recent years. These two types of meningitis are easily misdiagnosed which leads to a poor prognosis. In this study we compared differences of clinical features and prognostic factors in non-HIV adults with CM and TBM.
  
  
  
  We retrospectively reviewed the medical records of CM and TBM patients from January 2008 to December 2015 in our university hospital in China. The data included demographic characteristics, laboratory results, imaging findings, clinical outcomes.
  
  
  
  A total of 126 CM and 105 TBM patients were included. CM patients were more likely to present with headache, abnormal vision and hearing, and they might be less prone to fever and cough than TBM patients (P < 0.05). Higher percentage of CM patients presented with cerebral ischemia/infarction and demyelination in brain MRI than TBM patients (P < 0.05). CM patients had lower counts of WBC in CSF, lower total protein in CSF and serum CD4/CD8 ratio than TBM patients (P < 0.05). After three months of treatment, CM group have worse outcome than TBM group (P < 0.05). Multivariate analysis showed that age more than 60y (OR = 4.981, 95% CI: 1.955-12.692, P = 0.001), altered mentation (OR = 5.054, 95% CI: 1.592-16.046, P = 0.006), CD4/CD8 ratios < 1 (OR = 8.782, 95% CI: 2.436-31.661, P = 0.001) and CSF CrAg ≥ 1:1024 (OR = 4.853, 95% CI: 1.377-17.098, P = 0.014) were independent risk factors for poor prognosis for CM patients. For TBM patients, hydrocephalus (OR = 7.290, 95% CI: 1.630-32.606, P = 0.009) and no less than three underlying diseases (OR = 6.899, 95% CI: 1.766-26.949, P = 0.005) were independent risk factors, headache was a protective factor of prognosis.
  
  
  
  Our study provided some helpful clues in the differential diagnosis of non-HIV patients with CM or TBM and identified some risk factors for the poor prognosis of these two meningitis which could help to improve the treatment outcome. Further studies are worth to be done.
authors.affiliation: Center of Infectious Disease, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, China.
authors.forename: Junyan
authors.initials: J
authors.lastname: Qu
authors.affiliation: Center of Infectious Disease, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, China.
authors.forename: Taoyou
authors.initials: T
authors.lastname: Zhou
authors.affiliation: Center of Infectious Disease, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, China.
authors.forename: Cejun
authors.initials: C
authors.lastname: Zhong
authors.affiliation: Center of Infectious Disease, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Deng
authors.affiliation: Center of Infectious Disease, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, China. lvxj33966@126.com.
authors.forename: Xiaoju
authors.initials: X
authors.lastname: Lü
mesh_terms: D000328:Adult; D000946:Antigens, Fungal / Q000134:cerebrospinal fluid; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology; D002681:China; D015897:Comorbidity; D003371:Cough / Q000209:etiology; D003711:Demyelinating Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006261:Headache / Q000209:etiology; D006785:Hospitals, University; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D016919:Meningitis, Cryptococcal / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014390:Tuberculosis, Meningeal / Q000150:complications / Q000175:diagnosis* / Q000628:therapy
chemical_list: D000946:Antigens, Fungal
keywords: Clinical features; Cryptococcal meningitis; HIV negative; Prognostic factors; Tuberculous meningitis