Clinical features of 55 patients with non-human immunodeficiency virus-associated cryptococcal meningitis

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Author: LIN Huizhen ¹ ZHANG Die ² LIU Zengjing ³ Huang Xiaoqun ⁴ LI Chunting ⁵ FANG Sheng ⁶ LI Ling ⁷ HUANG Meiyan ⁸ HUANG Cheng ⁹  HU Yanling ¹⁰

Affiliation: 1. Department of Microbiology, School of Basic Medical Sciences, Guangxi Medical University / Department of Clinical Laboratory, Wuming Hospital of Guangxi Medical University, Nanning 530199, China 2. Guangxi Collaborative Innovation Centre for Biomedicine, Guangxi Medical University, Nanning 530022, China 3. Department of Medical Quality Management, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545000, Guangxi Zhuang Autonomous Region, China 4. Department of Clinical Laboratory, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530011, China 5. Department of Clinical Laboratory, Pingnan People's Hospital, Guigang 537300, Guangxi Zhuang Autonomous Region, China 6. Department of Critical Care Medicine, Ningming People's Hospital, Chongzuo 532500, Guangxi Zhuang Autonomous Region, China 7. Department of Clinical Laboratory, Jingxi People's Hospital, Jingxi 533800, Guangxi Zhuang Autonomous Region, China 8. Department of Clinical Laboratory, The People's Hospital of Shanglin, Nanning 530500, China 9. Department of Clinical Laboratory, The People's Hospital of DuAn Yao Autonomous County, Hechi 530700, Guangxi Zhuang Autonomous Region, China 10. Life Sciences Institute, Guangxi Medical University, Nanning 530022, China

Keywords: Cryptococcal meningitis Non-human immunodeficiency virus Clinical features Laboratory examination Early diagnosis and treatment

DOI: 10.12173/j.issn.1004-4337.202402006

Reference: Lin HZ, Zhang D, Liu ZJ, Huang XQ, Li CT, Fang S, Li L, Huang MY, Huang C, Hu YL. Clinical features of 55 patients with non-human immunodeficiency virusassociated cryptococcal meningitis[J]. Journal of Mathematical Medicine, 2024, 37(6): 462-469. DOI: 10.12173/j.issn.1004-4337.202402006[Article in Chinese]  Copied

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Abstract

Objective The clinical characteristics of 55 patients with non-human immunodeficiency virus (HIV)-associated cryptococcal meningitis (CM) were analyzed to provide scientific basis for early clinical diagnosis of the disease.

Methods The electronic medical records of 55 patients with non-HIV-associated CM diagnosed in Wuming Hospital of Guangxi Medical University and 5 other primary hospitals from January 2004 to October 2023 were retrospectively studied, and their past medical history, first clinical features, laboratory examination and imaging examination were analyzed.

Results Among 55 patients with non-HIV-associated CM, 27 were males (49.1%), and the median age was 57 years (43, 67). 40 patients (72.73%) lived in rural areas, 32 patients (58.18%) had underlying diseases. Headache was the most typical initial clinical symptom (76.36%), followed by nausea and vomiting (50.91%), dizziness (45.45%), meningeal irritation (43.64%), and fever (41.82%). The percentage of intracranial pressure increase, cerebrospinal fluid (CSF) white blood cell count increase, CSF protein quantitative detection increase, CSF glucose quantitative detection decrease, and CSF chloride quantitative detection decrease were 73.33%, 94.34%, 86.00%, 68.52% and 64.81%, respectively. The percentage of white blood cells increase and neutrophils increase were 50.91% and 67.27%. Imaging abnormalities accounted for 50.91% , mainly included infarction, abnormal signal lesions and demyelinating lesions.

Conclusion Non-HIV-associated CM patients were mainly middle-aged and elderly patients, and the living environment was mainly rural. The first clinical features were headache, followed by nausea and vomiting, dizziness, positive meningeal irritation signs and fever. Most of the intracranial pressure and CSF related indicators were abnormal. Improving doctors' awareness of non-HIV-associated CM would benefit the early diagnosis and treatment of patients groups.

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1.中华医学会神经病学分会神经感染性疾病与脑脊液细胞学学组. 非人类免疫缺陷病毒相关隐球菌性脑膜炎诊断的中国专家共识[J]. 中华神经科杂志, 2023, 56(10): 1093-1102. [Chinese Society of Neuroinfectious Diseases and Cerebrospinal Fluid Cytology. Chinese expert consensus on the diagnosis of non-human immunodeficiency virus related cryptococcal meningitis[J]. Chinese Journal of Neurology, 2023, 56(10): 1093-1102.] DOI: 10.3760/cma.j.cn113694-20230505-00327.

2.Pinheiro SB, Sousa ES, Cortez ACA, et al. Cryptococcal meningitis in non-HIV patients in the State of Amazonas, Northern Brazil[J]. Braz J Microbiol, 2021, 52(1): 279-288. DOI: 10.1007/s42770-020-00383-1.

3.Dlamini K, Moetlhoa B, Turner A, et al. Mapping evidence on cryptococcal antigen infection among HIV-infected persons in sub-Saharan Africa- a scoping review protocol[J]. PLoS One, 2023, 18(6): e0281849. DOI: 10.1371/journal.pone.0281849.

4.朱利平, 翁心华. 非艾滋病相关隐球菌性脑膜炎的再认识[J]. 中华传染病杂志, 2021, 39(10) : 583-587. [Zhu LP, Weng XH. Spotlight on the management of human immunodeficiency virus-uninfected cryptococcal meningitis[J]. Chinese Journal of Infectious Diseases, 2021, 39(10): 583-587. DOI: 10.3760/cma.j.cn311365-20210607-00201.

5.Huang Y, Jin X, Wu F, et al. Cryptococcal meningitis in HIV-negative patients: a 12-year single-center experience in China[J]. J Clin Med, 2023, 12(2): 515. DOI: 10.3390/jcm12020515.

6.陈东科, 孙长贵. 实用临床微生物学检验与图谱[M]. 北京: 人民卫生出版社, 2011: 594. [Chen DK, Sun CG. Practical clinical microbiology test and atlas[M]. Beijing: People's Medical Publishing House, 2011: 594.]

7.王芙蓉, 梁奇明. 隐球菌性脑膜炎[J]. 中华神经科杂志, 2022, 55(8): 886-892. [Wang FR, Liang QM. Cryptococcal neoformans meningoencephalitis[J]. Chinese Journal of Neurology, 2022, 55(8): 886-892.] DOI: 10.3760/cma.j.cn113694-20220406-00271.

8.Teekaput C, Yasri S, Chaiwarith R. Cryptococcal meningitis: differences between patients with and without HIV-infection[J]. Pathogens, 2023, 12(3): 427. DOI: 10.3390/pathogens12030427.

9.Beardsley J, Sorrell TC, Chen SC. Central nervous system cryptococcal infections in non-HIV infected patients[J]. J Fungi (Basel), 2019, 5(3): 71. DOI: 10.3390/jof5030071.

10.Zhao Y, Ye L, Zhao F, et al. Cryptococcus neoformans, a global threat to human health[J]. Infect Dis Poverty, 2023, 12(1): 20. DOI: 10.1186/s40249-023-01073-4.

11.Del Poeta M, Ward BJ, Greenberg B, et al. Cryptococcal meningitis reported with fingolimod treatment: case series[J]. Neurol Neuroimmunol Neuroinflamm, 2022, 9(3): e1156. DOI: 10.1212/NXI.0000000000001156.

12.Stack M, Hiles J, Valinetz E, et al. Cryptococcal meningitis in young, immunocompetent patients: a single-center retrospective case series and review of the literature[J]. Open Forum Infect Dis, 2023, 10(8): ofad420. DOI: 10.1093/ofid/ofad420.

13.高红林, 陈慧敏, 凌勇, 等. 隐球菌性脑膜炎51例临床特点分析[J]. 脑与神经疾病杂志, 2021, 29(5): 284-287. [Gao HL, Chen HM, Ling Y, et al. Clinical analysis of 51 cases with cryptococcal meningitis[J]. Journal of Brain and Nervous Diseases, 2021, 29(5): 284-287.] https://d.wanfangdata.com.cn/periodical/ChlQZXJpb2RpY2FsQ0hJTmV3UzIwMjMxMjI2EhFueXNqamJ6ejIwMjEwNTAwNRoIMWN6czQ1eWE%3D.

14.Lan J, Lv L, Ye L, et al. Post-infectious inflammatory response syndrome in an HIV-negative patient after cryptococcus gattii meningoencephalitis: a case report and review of the literature[J]. J Med Case Rep, 2023, 17(1): 332. DOI: 10.1186/s13256-023-04066-x.

15.Kajeekul R, Mekawichai P, Chayakulkeeree M. Clinical features of cryptococcal meningoencephalitis in HIV-positive and -negative patients in a resource-limited setting[J]. J Fungi (Basel), 2023, 9(9): 869. DOI: 10.3390/jof9090869.

16.Erturk Sengel B, Tukenmez Tigen E, Can Sarinoglu R, et al. Cryptococcus meningitis presented with multiple cerebral infarcts in an immunocompetent patient[J]. IDCases, 2021, 24: e01154. DOI: 10.1016/j.idcr.2021.e01154.

17.Jjunju S, Nuwagira E, Meya DB, et al. Persistently elevated intracranial pressure in cryptococcal meningitis-76 therapeutic lumbar punctures[J]. Med Mycol Case Rep, 2023, 40: 50-53. DOI: 10.1016/j.mmcr.2023.04.001.

18.Coussement J, Heath CH, Roberts MB, et al. Current epidemiology and clinical features of cryptococcus infection in patients without human immunodeficiency virus: a multicenter study in 46 hospitals in Australia and New Zealand[J]. Clin Infect Dis, 2023, 77(7): 976-986. DOI: 10.1093/cid/ciad321.

19.Dantas KC, de Freitas-Xavier RS, Spina Lombardi SCF, et al. Comparative analysis of diagnostic methods for the detection of cryptococcus neoformans meningitis[J]. PLoS Negl Trop Dis, 2023, 17(3): e0011140. DOI: 10.1371/journal.pntd.0011140.

20.Nanfuka V, Mkhoi ML, Gakuru J, et al. Symptomatic cryptococcal meningitis with negative serum and cerebrospinal fluid cryptococcal antigen tests[J]. HIV AIDS (Auckl), 2021, 13: 861-865. DOI: 10.2147/HIV.S328084.