Factors Associated to Mortality in Meningeal Cryptococcosis in a Tertiary Center in Bogota, Colombia
Angela Villamil Saldarriaga1, Alejandra Moncaleano Calderón1, Juan Martinez Lemus2, Maria Reyes3
1Hospital Simón Bolívar, 2The University of Texas Science Center at Houston, 3Hospital Simon Bolivar
Objective:
Describe demographic characteristics of patients with meningeal cryptococcosis from a tertiary center in Bogota, Colombia and evaluate factors associated to mortality.
Background:
Cryptococcal meningitis is the most frequent cause of meningitis in adults in areas with high HIV prevalence. Additionally, its incidence has increased in patients with other forms of immunosuppression. Despite advances in early diagnosis and treatment, this entity is associated with a high mortality, that can range from 50-80% in low-income countries.
Design/Methods:
Descriptive, cross-sectional study, evaluated patients with meningeal cryptococcosis from 2019- 2022. Parametric and non-parametric tests were used to analyze risk factors associated to death (mRs=6) by the time of discharge.
Results:
We identified 24 cases with cryptococcal meningitis. The median age was 38 (IQR 31-47). Most of the patients were HIV positive (n=22, 91.6%) with a median CD4 count of 13.5 (IQR 7-83). Nadir from symptom onset was a median of 15 days (IQR 7-30). The cerebrospinal fluid was abnormal in all cases with a median opening pressure of 23 cm H2O (IQR 10-34), mild pleocytosis (median 13.5 IQR 3-67), high protein (median 81, IQR 61-141mg/dl) and low glucose (median 36, IQR 0-43). The mortality rate was 45.8% (n=11) and there was a trend towards longer nadir time (p=0.39), lower CD4 count (p=0.44) and higher pleocytosis (p=0.128) although without reaching statistical significance. With regards treatment, 84% (n=11) were prescribed with Amphotericin B deoxycholate with 61.5% dispatch rate while only 3 patients received flucytosine.
Conclusions:
Cryptococcal meningitis affects young male patients, VIH positive with advanced disease. The mortality rate is high, affecting almost 50% of the patients. Despite most of the patients receiving Amphotericin B, the dispatch rate is poor and only 23% received flucytosine in the induction phase.