The clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: a hospital-based study

• Published in: BMC geriatrics Vol. 19; no. 1; p. 91
• Main Authors: Tsai, Wan-Chen, Lien, Chia-Yi, Lee, Jun-Jun, Hsiao, Wen-Chiu, Huang, Chi-Ren, Tsai, Nai-Wen, Chang, Chiung-Chih, Lu, Cheng-Hsien, Chang, Wen-Neng
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25.03.2019; BioMed Central; BMC
• Subjects: Acquired immune deficiency syndrome; Adult; Adults; Age; Aged; Aged, 80 and over; Aging; AIDS; Altered consciousness; Antigens; Autoimmune diseases; Blood; Blood tests; Care and treatment; Cerebral infarction; Cerebral Infarction - blood; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - epidemiology; Cerebrospinal fluid; Chronic obstructive pulmonary disease; Cirrhosis; Clinical medicine; Communicable diseases; Consciousness; Cryptococcal meningitis; Cryptococcemia; Cysts; Demographic aspects; Diabetes; Diabetes mellitus; Diabetes Mellitus - blood; Diabetes Mellitus - diagnostic imaging; Diabetes Mellitus - epidemiology; Diagnosis; Disease susceptibility; Elderly; Elderly patients; Epidemiology; Female; Fever; Fungal infections; Gender; Geriatrics; Gerontology; Headache; Hearing loss; Hematological diseases; HIV; Hospitalization - trends; Hospitals; Human immunodeficiency virus; Humans; Immunodeficiency; Infectious diseases; Laboratories; Liver; Liver cirrhosis; Liver diseases; Lung diseases; Male; Malignancy; Medical imaging; Medical prognosis; Medical research; Meningitis; Meningitis, Cryptococcal - blood; Meningitis, Cryptococcal - diagnostic imaging; Meningitis, Cryptococcal - epidemiology; Middle Aged; Mortality; Nervous system; NMR; Nuclear magnetic resonance; Obstructive lung disease; Older people; Patient outcomes; Respiratory tract diseases; Retrospective Studies; Stroke; Taiwan - epidemiology; Treatment Outcome; Taiwan; India; Cerebral infarction; Cryptococcemia; Cryptococcal meningitis; Altered consciousness; Gender; Elderly
• ISSN: 1471-2318; 1471-2318
• DOI: 10.1186/s12877-019-1108-0

The elderly, and especially those with an immuno-compromised status, are vulnerable to infectious diseases. The purpose of this study was to examine the clinical characteristics and therapeutic outcomes of cryptococcal meningitis (CM) in elderly patients in Taiwan. Ninety-nine adult patients with CM were identified during a 15-year study period (2002-2016), of whom 38 elderly (≥ 65 years) patients (16 men and 22 women, median age 72.9 years; range 65-86 years) were included for analysis. The clinical characteristics and therapeutic outcomes of these patients were analyzed and compared to non-elderly adult patients (< 65 years) with CM. Among the 38 patients, diabetes mellitus was the most common underlying condition (15), followed by adrenal insufficiency (7), malignancy (6), hematologic disorders (5), chronic obstructive pulmonary disease (5), autoimmune diseases (3), liver cirrhosis (3) and acquired immunodeficiency syndrome (1). Altered consciousness (29), fever (21) and headache (17) were the leading clinical manifestations. Positive cerebrospinal fluid and blood cultures for Cryptococcus (C.) neoformans were found in 26 and 9 patients, respectively. There were significant differences in gender, altered consciousness and recent cerebral infarction between the elderly and non-elderly groups. The elderly group had a high mortality rate (36.8%, 14/38), and the presence of cryptococcemia was the most significant prognostic factor. This study offers a preliminary view of the clinical characteristics of CM in the elderly. The results suggest that elderly patients (≥ 65 years) are more vulnerable to CM than adults aged < 65 years. Compared to the non-elderly group, the elderly group had female predominance, higher rates of altered consciousness and recent cerebral infarction as the clinical presentation. The presence of cryptococcemia was a significant prognostic factor in the elderly group. This study is limited by the small number of patients, and further large-scale studies are needed to better delineate this specific infectious syndrome.