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A Comparison of the Clinical Characteristics and Outcomes of Cryptococcal Meningitis in HIV-negative Individuals With and Without Immunosuppression

Li, Min, MD; Chen, Zhuolin, MD; Xu, Li, MD; Gan, Zhouqing, MD; Peng, Fuhua, PhD; Liu, Jia, MD

doi: 10.1097/NRL.0000000000000221
Original Articles

Cryptococcal meningitis (CM) is found to occur in immunosuppressed patients and those who are immunocompetent. This study aimed to compare the presentation and outcome of CM in patients who are human immunodeficiency virus (HIV) negative with and without immunosuppression. We reviewed 255 clinical records from patients with CM who are HIV negative. The demographic and clinical characteristics, cerebrospinal fluid profiles, brain magnetic resonance imaging, treatment, and outcomes of these individuals were retrospectively analyzed. Among the 255 patients with CM, 91 (35.7%) appeared immunocompetent. CM was present in a younger population in the immunocompetent group (above 50 y, 19.8% vs. 32.3%, P=0.026), with higher initial complaints of visual and auditory symptoms (45.1% vs. 27.4%, P=0.004; 19.8% vs. 9.1%, P=0.016; respectively) and higher cerebrospinal fluid white blood cell counts (30.8% vs. 45.1%, P=0.009) compared with the immunocompromised patients. In addition, the immunocompetent patients had a higher proportion of normal brain images than did the immunocompromised patients (10% vs. 2%, P=0.028). There were no differences in hospital mortality and satisfactory outcomes between the groups (mortality: 10.9% vs. 7.0%, P=0.416; satisfactory outcomes: 76.4% vs. 80.2%, P=0.585). We found significant differences between the immunocompetent and HIV-negative immunocompromised patients; however, there were fewer differences between the groups than expected. Further studies assessing the immune responses in both groups should be performed.

Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

Supported by National Science Foundation of Guangdong Province (No. 2015A03013167), Science & Technology Project of Guangzhou (No. 201510010251), and National Science Foundation of China (No. 81271327).

The authors declare no conflict of interest.

Correspondence to: Fuhua Peng, PhD, Department of Neurology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China. E-mail:

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