Article Text

  1. G. B. Baxter1,
  2. W. K. Green1,
  3. J. A Vande Waa1
  1. 1Division of Infectious Diseases, University of South Alabama College of Medicine, Mobile, AL.


Background Although Cryptococcus rarely infects patients who are immunocompetent, it remains among the most common causes of CNS infection in patients with AIDS. We reviewed all cases of Cryptococcus infection during a 9-year period to determine characteristics of admitted patients, estimated incidence, treatment agent and course, relapse, and patient outcome.

Methods A retrospective analysis of infections due to Cryptococcus occurring between January 1, 1997, and March 31, 2006.

Results Sixty-six patients were admitted 110 times during the study period. Sixty-eight percent had only one admission, 11% had ≥ three admissions, and two patients accounted for 16% of admissions. The most common reason for relapse was nonadherence with treatment or prophylaxis. Ninety-four percent were HIV infected. The mean age at initial presentation was 41.3 years, with a range of 19 to 82 years, and 77% were men. Seventy-seven percent had a positive culture at initial presentation, and CSF (59%) and blood (12%) were the most common sources. Among the 15 patients with negative cultures, diagnosis was made based on a positive India ink smear and positive antigen titers in 6 (40%). Of the 66 patients, mortality could be determined for 59 (89%). The overall mortality rate was 76%.

Conclusions In our patient population, Cryptococcus meningitis is a common diagnosis among HIV-infected patients. Relapses are common, and nonadherence with treatment or prophylaxis is the most frequent cause. Mortality remains high in HIV-infected populations.

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