Clinical characteristics and outcomes of patients with cryptococcal meningoencephalitis in a resource-limited setting

Background: Cryptococcosis is a potentially lethal opportunistic infection among human immunodeficiency virus (HIV)- infected individuals. The mortality rate of patient with cryptococcal meningoencephalitis (CM) in Thailand is high. Studying the factors associated with treatment failure is important to improve outcome. Material and Method: A retrospective study of patients with cryptococcosis in Siriraj Hospital, Thailand, during 2005-2008 was conducted. Treatment options, outcomes, survival and factors associated with outcomes and mortality were analyzed. Results: A total of 143 patients with cryptococcosis were enrolled. Mean age was 39 years old and 58.7% were male. There were 124 HIV-infected patients (86.7%) and 116 of those had CM. Favorable clinical response in HIV-associated CM was 55.2% and 6-month survival was 67.2%. Relapse was found in 21 patients (18.1%). Factors associated with favorable clinical response included lower opening and closing pressures and a higher white blood cell in cerebrospinal fluid (CSF). Favorable mycological response was 56.8% and factors associated with favorable mycological response were a lower CD₄ ⁺ T-lymphocyte count and a longer amphotericin B treatment. The median time to achieve CSF sterilization was 30 days. Factors associated with survival were a longer course of amphotericin B, a lower CSF opening pressure and a higher white blood cell in CSF. Conclusion: High mortality rate of HIV-associated CM was demonstrated and most likely linked to inadequate induction antifungal therapy resulting in inability to sterilize CSF. New strategies and/or guidelines are suggested to improve survival.