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

Wan Chen Tsai, Chia Yi Lien, Jun Jun Lee, Wen Chiu Hsiao, Chi Ren Huang, Nai Wen Tsai, Chiung Chih Chang, Cheng Hsien Lu, Wen Neng Chang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

22 Scopus citations

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish
Article number91
JournalBMC Geriatrics
Volume19
Issue number1
DOIs
StatePublished - 25 03 2019

Bibliographical note

Publisher Copyright:
© 2019 The Author(s).

Keywords

  • Altered consciousness
  • Cerebral infarction
  • Cryptococcal meningitis
  • Cryptococcemia
  • Elderly
  • Gender

Fingerprint

Dive into the research topics of 'The clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: A hospital-based study'. Together they form a unique fingerprint.

Cite this