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Cryptococcal meningitis among other CNS infections

August 21 2017

In a 37 centre, 20 country study, Hakan Erdem, Ankara and colleagues examined the causes of central nervous system (CNS) infection and their outcomes. Among 2,583 patients seen in 24 months, 27 (1%) had cryptococccal meningitis, with only 50% of the cases having HIV infection. Nine of 14 (64%) had another immunosuppressed state, so overall 5 (19%) had no underlying condition.

All cases seen in this series were acute – chronic meningitis was confined to syphilis, tuberculosis, Brucella and Borrelia infection. Cases were diagnosed with antigen (25, 12% of those tested), fungal culture (19, 3.7% of those tested), bacterial CSF culture (8, 0.6% of those tested) and blood culture (7, 0.4% of patients). Cases were seen only in France (n=4), Romania (n=4), Italy (n=4), Portugal (n=6), Turkey, Iran, Hong Kong (n=5) and Texas, USA.

Overall in the study, 8.8% died in hospital and 18.5% survived with sequelae. Among those with cryptococcal meningitis, 18 (66.7%) were cured, 4 (15%) died and 5 (19%) survived with sequelae, 2 with cranial neuropathies, 1 with epilepsy, 1 with cognitive impairment and 1 with another problem.

Eye movements. Bilateral symmetrical near complete ophthalmoplegia.(Images from Liyanage et al.BMC Research Notes, 2014, 7:328 )

The study also found 5 patients with Candida meningitis and 1 with Saccharomyces cerevisiae meningitis.