Predictors of outcome in Cryptococcus neoformans var. gattii meningitis |
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Authors: | Seaton RA; Naraqi S; Wembri JP; Warrell DA |
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Affiliation: | Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, UK; Department of Clinical Sciences, Medical Faculty, University of Papua New Guinea, Papua New Guinea; Correspondence to Dr RA Seaton, Infection and Immunodeficiency Unit, King's Cross Hospital, Clepington Road, Dundee DD3 8EA, UK |
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Abstract: | In Papua New Guinea, <it>Cryptococcus neoformans</it> var.
<it>gattii</it> meningitis has a high fatality rate even in
immunocompetent patients. Our retrospective study attempted to identify
marker of poor prognosis. Of 88 immunocompetent patients, 30 (34.1%) died,
usually soon after admission, and mortality was higher in men
(<it>p</it> = 0.025) and older patients (<it>p</it>
= 0.039). Death was associated with altered consciousness
(<it>p</it><0.001), a history of convulsions prior to
treatment (<it>p</it> = 0.002) and a maximum systolic blood
pressure of >150 mmHg (<it>p</it> = 0.017). These data
suggest that death results from raised intracranial pressure and subsequent
tentorial herniation. However, CSF opening pressure measured on admission
was raised in 29/36 (81%) patients and did not predict outcome. In
survivors, relapse was uncommon and was not predicted by discharge serum
cryptococcal antigen titres, which were frequently raised on completion of
therapy in asymptomatic patients. Mortality may be reduced if efforts are
made to lower intracranial pressure in those patients who present with
markers of poor prognosis.
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