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Cryptococcal Meningitis in AIDS Patients | Risk Factors for Poor Outcome

Purpose: To predict prognosis for a patient with AIDS who has cryptococcal meningitis.

Description

A patient with AIDS who develops cryptococcal meningitis can have the likely response to therapy and probable outcome predicted by the presence or absence of certain risk factors. This can help identify patients who might benefit from more aggressive therapy.


 

Risk factors for poor outcome:

(1) decreased mental status (confusion, lethargy or obtundation) at presentation was the most important factor predicting outcome

(2) high titer (> 1:1024) of cryptococcal antigen in cerebrospinal fluid (CSF)

(3) low white cell count in the CSF (< 20 per µL)

(4) hyponatremia

(5) age < 35 years

(6) extraneural cultures (other than CSF, CNS) positive for Cryptococcus neoformans

 

where:

• The cause for the hyponatremia is not stated but would probably be related to SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion).

 

Patients without these risk factors respond well to treatment.

 

NOTE: This article was written before the impact of highly active antiretroviral therapy.

 


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Specialty

Objective

ICD-10