OBJECTIVES

This study aims to describe the demographic factors, clinical and laboratory features and outcomes of adult cryptococcal meningitis and possibly to identify demographic as well as CSF parameters affecting mortality in adult Filipinos with cryptococcal meningitis.

STUDY DESIGN

Retrospective case review

RESULTS

A total of 61 patients were admitted with a diagnosis of cryptococcal meningitis from 1993 to 2005, 60% of which were males (male to female ratio 1.5:1). Ages ranged from 18 to 73 years, with 11 (18%) patients having underlying co-morbidities. The most common presenting complaint was headache (76%) followed by nausea and vomiting (72%) and fever (52%). All patients had lumbar puncture. Of the 18 patients with available complete CSF profiles, all had an elevated opening pressure on initial lumbar tap (mean: 396mmH₂0), 83% had elevated total protein (mean: 120mg/dl), 61% showed hypoglycorrhachia, 83% had CSF WBC count greater than 20 cells/mm³, 70% had a positive India ink test, and 89% had a CSF CALAS titer of at least 1 :8. The mortality rate was 49% and the most common cause of death was found to be brain herniation. Forty nine percent of the patients received treatment, 40% of whom died. The relationship between age, sex, CSF findings and mortality were analyzed using Chi square test or Fisher's exact test. Only the CSF CALAS titer was found to be predictive of subsequent outcome (p=0.0019).

CONCLUSION

Most Filipinos admitted at UP-PGH with cryptococcal meningitis were males, with a mean age of 54 years old. Only 11 patients were found to be immu11ocompromised. The most common presenting complaint was headache, whereas the most common sign was nuchal rigidity. All patients have elevated opening pressure, abnormal CSF profiles, positive India ink and elevated CALAS titers. The mortality rate was found to be 49%. Only a CALAS titer greater than 1 :32 was found to be predictive of outcome.

Human ; Adult: 25-44 Yrs Old ; Meningitis ; Prognostic Factors ; Prognosis