A clinical study of 26 cases of cryptococcal meningitis

Objective To study the diagnosis and therapy of cryptococcal meningitis Methods Retrospective review of the clinical features, treatment and outcome of 26 patients with cryptococcal meningitis from October 1981 to September 2001 at Peking Union Medical College Hospital Results The age of the patients ranged from 5 to 62 years (mean:35 6 years), 12 were male and 14 were female There were 16 patients with underlying diseases ,9 had systemic lupus erythematosus(SLE),4 had human immunodeficiency virus (HIV)infection and/or acquired immunodeficiency syndrome(AIDS) and 3 had other diseases 12 patients had contact with pigeons The nonspecific clinical and laboratory findings in these patients led to misdiagnosis: as lupus encephalopathy in 6 cases and tuberculous meningitis in 5 cases 23 of the 26 cases were positive of cryptococcus on cerebrospinal fluid (CSF) smear 13 cases were positive on CSF culture, but latex coagulate test performed in 20 cases were all positive,15 patients had high intracranial pressure(300 mm H 2O),9 patients with dilated ventricle received brain ventricular draining Only 2 cases used fluconazole monotherapy One patient only used amphotericin B. The rest of the patients were given amphotericin B in combination with flucytosine(12 patients) or fluconazole(5 cases),or flucytosine combined with fluconazole(6 cases) The mean dose of amphotericin B was 2 6 g, the highest dose of amphotericin B and liposomal amphotericin B was 10 05 g and 20 g, respectively. The outcome of the 26 cases showed that 17 were cured,4 improved, 3 patients were died and 2 patients gave up any further treatment. From Oct 1981 to Sep 1996 we found only 9 cases, but in recent 5 years we found 17 cases Conclusions The incidence of cryptococcal meningitis was increasing in the recent 5 years The conditions associated with this disease include extensive broad spectrum antibiotics, immunosuppressive drugs or ligh dose corticosteriods and increasing cases of HIV/AIDS The early diagnosis and treatment of cryptococcal meningitis may reduce death rate We still recommended amphotericin B plus flucytosine as the standard therapy for cryptococcal meningitis Ventricular drainage and amphotericin B intraventricularly via an implanted tube into dilated ventricle could improve the clinical condition of serious cryptococcal meningitis and decrease the dosage of systemic use of amphotericin B, therefore, reduce the side effects of the drugs