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Conference Paper: Cryptococcal meningitis: a hospital-based study

TitleCryptococcal meningitis: a hospital-based study
Authors
Issue Date2012
PublisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org.hk
Citation
The 17th Medical Research Conference (MRC 2012), Hong Kong, China, 14 January 2012. In Hong Kong Medical Journal, 2012, v. 18 n. 1, suppl. 1, p. 35, abstract no. 47 How to Cite?
AbstractOBJECTIVE: Cryptococcus meningitis (CM) is an uncommon CNS infection. This study aimed to find out the clinical and radiological characteristics of CM patients. METHODS: Records of CM patients diagnosed and treated in Queen Mary Hospital during the period 1995-2008 were retrospectively studied. Cryptococcus meningitis was diagnosed by raised cryptococcal antigen titer in CSF with exclusion of other causes of meningitis. Patients who died from CM or who had modified Barthel Index (mBI) <12 at 6 months after initiation of anti-fugal therapy was classified as having poor clinical outcome. RESULTS: Twenty-one CM patients were identified, 11 were male. Fourteen (67%) patients had medical comorbidities at presentation and were immunocompromised: six (29%) had autoimmune diseases such as SLE on immunosuppressants, four (19%) were HIV carriers, two (10%) had chronic rheumatic heart disease, and two had renal transplant on immunosuppressants. The mean age of onset was 48 years (SD, 15). The mean duration of presenting symptoms was 33 days (SD, 37 days). Presenting symptoms included headache (76%), fever (71%), neurological deficits (43%, including incoordination, limb weakness, diplopia, blurring of vision), confusion (33%), lethargy/dizziness (28%), nausea/vomiting (28%), neck pain (24%), decreased GC (5%), personality change (5%) and incontinence (5%). The most common clinical signs at presentation were neck stiffness (33%) and cranial nerves palsy (24%). The mean opening pressure on LP was 21 cm water (range, 3-55; SD, 13), mean CSF cell count 61/μL (range, 2-290/μL; SD, 99/μL), mean CSF glucose 2.2 mmol/L (range, 0.9-3.8; SD, 0.9) and mean CSF protein 1.4 g/L (range, 0.5-6; SD, 1.4). Initial neuroimaging revealed abnormalities in seven (33%) patients, including leptomeningeal enhancement (1), calcification from previous inflammation (1), hydrocephalus (1), cerebral oedema (1), and cerebral infarctions (3). Standard anti-fungal medications was started immediately once CM was diagnosed. Five (24%) patients succumbed from CM despite active treatment, including three HIV carriers, one ESRF patient post-renal transplantation on immunosuppressants, and an 83-year-old man with good past health. Ten (48%) patients had good recovery with mBI at 6 months >90, and only one of the 16 survivors had poor outcome with mBI at 6 months <12. CONCLUSION: Cryptococcus meningitis is a serious CNS infection predominantly affecting immunocompromised patients with a mortality rate of 24%. HIV infection, immunosuppression for organ transplantation and advanced age might be risk factors for mortality from CM. Most survivors had satisfactory functional recovery with only mild or minimal neurological disability.
Persistent Identifierhttp://hdl.handle.net/10722/160302
ISSN
2015 Impact Factor: 0.887
2015 SCImago Journal Rankings: 0.279

 

DC FieldValueLanguage
dc.contributor.authorLeung, GKKen_US
dc.contributor.authorPang, KKWen_US
dc.contributor.authorTsang, KLen_US
dc.contributor.authorTse, CTAen_US
dc.contributor.authorPang, SYYen_US
dc.contributor.authorCheung, RTFen_US
dc.contributor.authorHo, SLen_US
dc.contributor.authorLau, GKKen_US
dc.contributor.authorTeo, KCen_US
dc.contributor.authorChan, KHen_US
dc.date.accessioned2012-08-16T06:07:54Z-
dc.date.available2012-08-16T06:07:54Z-
dc.date.issued2012en_US
dc.identifier.citationThe 17th Medical Research Conference (MRC 2012), Hong Kong, China, 14 January 2012. In Hong Kong Medical Journal, 2012, v. 18 n. 1, suppl. 1, p. 35, abstract no. 47en_US
dc.identifier.issn1024-2708-
dc.identifier.urihttp://hdl.handle.net/10722/160302-
dc.description.abstractOBJECTIVE: Cryptococcus meningitis (CM) is an uncommon CNS infection. This study aimed to find out the clinical and radiological characteristics of CM patients. METHODS: Records of CM patients diagnosed and treated in Queen Mary Hospital during the period 1995-2008 were retrospectively studied. Cryptococcus meningitis was diagnosed by raised cryptococcal antigen titer in CSF with exclusion of other causes of meningitis. Patients who died from CM or who had modified Barthel Index (mBI) <12 at 6 months after initiation of anti-fugal therapy was classified as having poor clinical outcome. RESULTS: Twenty-one CM patients were identified, 11 were male. Fourteen (67%) patients had medical comorbidities at presentation and were immunocompromised: six (29%) had autoimmune diseases such as SLE on immunosuppressants, four (19%) were HIV carriers, two (10%) had chronic rheumatic heart disease, and two had renal transplant on immunosuppressants. The mean age of onset was 48 years (SD, 15). The mean duration of presenting symptoms was 33 days (SD, 37 days). Presenting symptoms included headache (76%), fever (71%), neurological deficits (43%, including incoordination, limb weakness, diplopia, blurring of vision), confusion (33%), lethargy/dizziness (28%), nausea/vomiting (28%), neck pain (24%), decreased GC (5%), personality change (5%) and incontinence (5%). The most common clinical signs at presentation were neck stiffness (33%) and cranial nerves palsy (24%). The mean opening pressure on LP was 21 cm water (range, 3-55; SD, 13), mean CSF cell count 61/μL (range, 2-290/μL; SD, 99/μL), mean CSF glucose 2.2 mmol/L (range, 0.9-3.8; SD, 0.9) and mean CSF protein 1.4 g/L (range, 0.5-6; SD, 1.4). Initial neuroimaging revealed abnormalities in seven (33%) patients, including leptomeningeal enhancement (1), calcification from previous inflammation (1), hydrocephalus (1), cerebral oedema (1), and cerebral infarctions (3). Standard anti-fungal medications was started immediately once CM was diagnosed. Five (24%) patients succumbed from CM despite active treatment, including three HIV carriers, one ESRF patient post-renal transplantation on immunosuppressants, and an 83-year-old man with good past health. Ten (48%) patients had good recovery with mBI at 6 months >90, and only one of the 16 survivors had poor outcome with mBI at 6 months <12. CONCLUSION: Cryptococcus meningitis is a serious CNS infection predominantly affecting immunocompromised patients with a mortality rate of 24%. HIV infection, immunosuppression for organ transplantation and advanced age might be risk factors for mortality from CM. Most survivors had satisfactory functional recovery with only mild or minimal neurological disability.-
dc.languageengen_US
dc.publisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org.hk-
dc.relation.ispartofHong Kong Medical Journalen_US
dc.rightsHong Kong Medical Journal. Copyright © Hong Kong Academy of Medicine Press.-
dc.titleCryptococcal meningitis: a hospital-based studyen_US
dc.typeConference_Paperen_US
dc.identifier.emailLeung, GKK: gilberto@hkucc.hku.hken_US
dc.identifier.emailTse, CTA: acttse@hotmail.comen_US
dc.identifier.emailCheung, RTF: rtcheung@hku.hken_US
dc.identifier.emailHo, SL: slho@hku.hken_US
dc.identifier.emailLau, GKK: gkklau@hku.hken_US
dc.identifier.emailChan, KH: koonho@hku.hken_US
dc.identifier.authorityLeung, GKK=rp00522en_US
dc.identifier.authorityCheung, RTF=rp00434en_US
dc.identifier.authorityHo, SL=rp00240en_US
dc.identifier.authorityLau, GKK=rp01499en_US
dc.identifier.authorityChan, KH=rp00537en_US
dc.identifier.hkuros202330en_US
dc.identifier.volume18-
dc.identifier.issue1, suppl. 1-
dc.identifier.spage35, abstract no. 47en_US
dc.identifier.epage35, abstract no. 47en_US
dc.publisher.placeHong Kong-

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