Cryptococcal meningitis in non-HIV-infected patients

There are few reports on cryptococcal meningitis in non-HIV-infected patien ts in subtropical areas. We reviewed 94 non-HIV-infected patients microbiol ogically diagnosed with cryptococcal meningitis and hospitalized at Nationa l Taiwan University Hospital, 1977-1996. Forty-two patients (44.7%) had und erlying diseases. The main initial manifestations were headache (86.2%), vo miting (72.3%) and fever (69.1%). The 30 patients with T-cell suppression h ad more acute illnesses (median duration of symptoms: 14 days vs. 29 days), less typical presentations of meningitis, and reduced inflammatory respons es compared with the 64 without T cell suppression. There was no statistica l difference between patients who received amphotericin B treatment for 10 weeks and those received amphotericin B with subsequent fluconazole treatme nt, in terms of mortality rate and recurrence rate. Seventy-five patients ( 79.8%) had satisfactory clinical responses, and two relapsed. Eighteen pati ents died (19.1%) and 10 of these died within 2 weeks of hospitalization. P atients in this series had outcomes comparable with those from temperate an d even tropical countries with high percentages of immunocompetent hosts. F actors significantly associated with death were lymphoma, semicoma, leukocy tosis, and initial high titres of cryptococcal antigen in cerebral spinal f luid (especially greater than or equal to 1:512). On multivariate analysis, lymphoma and initial high cryptococcal antigen titres were independent pre dictors of mortality.