Cryptococcal meningoencephalitis. Epidemiology and mortality risk factors in pre- and post-HAART era

Abstract Introduction and objective Cryptococcal meningoencephalitis (CM) is an uncommon entity, but remains a major cause of morbidity and mortality in patients with AIDS. Material and methods Review of CM cases in a university hospital. The diagnosis was determined by isolation of Cryptococcus neoformans in cerebrospinal fluid. Morbidity and mortality was assessed at 12 weeks (early mortality) and between 3 and 18 months after diagnosis (late mortality). Results We analyzed 32 patients from 2269 AIDS cases (1.41%). 10 patients between 1990 and 1996 and 22 between 1997 and 2014. Cryptococcal antigen in CSF was positive in all cases, with titers >1024 in 19 patients (63%); this group had lower CD4+ counts (40 ± 33 versus 139 ± 78 cell/μl) and greater disseminated involvement. After a first CM episode the relapse rate was 34%. Global mortality rate was 28% (9/32), much higher in the pre-HAART era. Conclusions CM morbidity and mortality is related to severe immunodeficiency, disseminated disease, high titers of antigen in CSF and delayed initiation of HAART.