Cryptococcal Meningitis: Differences between Patients with and without HIV-Infection.

Background

Cryptococcal meningitis is one of the most devastating infections, particularly in HIV-infected individuals. The increased use of immunosuppressants led to an increase in the incidence of cryptococcosis in HIV-uninfected individuals. This study aimed to compare the characteristics between groups.

Methods

This retrospective cohort study was conducted from 2011 to 2021 in northern Thailand. Individuals diagnosed with cryptococcal meningitis aged ≥15 years were enrolled onto the study.

Results

Out of 147 patients, 101 were individuals infected with HIV and 46 were non-infected. Factors associated with being infected with HIV included age < 45 years (OR 8.70, 95% CI 1.78-42.62), white blood cells < 5000 cells/cu.mm. (OR 7.18, 95% CI 1.45-35.61), and presence of fungemia (OR 5.86, 95% CI 1.17-42.62). Overall, the mortality rate was 24% (18% in HIV-infected vs. 37% in HIV-uninfected individuals, p-value = 0.020). Factors associated with mortality included concurrent pneumocystis pneumonia (HR 5.44, 95% CI 1.55-19.15), presence of alteration of consciousness (HR 2.94, 95% CI 1.42-6.10), infection caused by members of C. gattii species complex (HR 4.19, 95% CI 1.39-12.62), and anemia (HR 3.17, 95% CI 1.17-8.59).

Conclusions

Clinical manifestations of cryptococcal meningitis differed between patients with and without HIV-infection in some aspects. Increasing awareness in physicians of this disease in HIV-uninfected individuals may prompt earlier diagnosis and timely treatment.