CRYPTOCOCCUS-NEOFORMANS INFECTION IN FRANCE - EPIDEMIOLOGIC FEATURES OF AND EARLY PROGNOSTIC PARAMETERS FOR 76 PATIENTS WHO WERE INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

We retrospectively carried out a descriptive and prognostic study of 7 6 human immunodeficiency virus-infected patients with cryptococcosis d iagnosed by a positive culture of cerebrospinal fluid (CSF), blood, ur ine, or other body fluid or tissue. We focused on the 65 patients with cryptococcal meningitis, At diagnosis, the mean CD4 lymphocyte count was 46/mm(3); 86% of patients had fever; 67%, headache; 37%, stiff nec k; 29%, altered mentation or confusion; 20% cranial nerve deficiency; and 48%, other focal deficiencies. Analysis of CSF specimens revealed the following results: normal (25% of the specimens), leukocyte count of <20/mm(3) (62%), positive India ink smear (87%), and positive crypt ococcal antigen (92%). Twenty patients died within the first 3 months (3-month survival rate, 70%), A Cox regression model selected the foll owing as prognostic parameters: age older than 30 years (relative risk [RR] = 2.1), CSF glucose level of <2 mmol/L (RR = 3.7), previous admi ssion to an intensive care unit (RR = 4.7), and mechanical ventilation (RR = 4.6). The outcome of cryptococcal meningitis in patients with A IDS remains difficult to predict at admission, and every case should b e considered as potentially severe.