scholarly journals Comparisons of cryptococcal meningitis caused by Cryptococcus neoformans between HIV-negative patients with and without lung infection in two Chinese university hospitals

2019 ◽  
Author(s):  
Ming Yang ◽  
Fengjun Sun ◽  
Fu Liu ◽  
Wei Feng ◽  
Qian Yuan ◽  
...  
Keyword(s):  
Cryptococcus Neoformans ◽  
Clinical Features ◽  
Cryptococcal Meningitis ◽  
Medical Records ◽  
Maxillary Sinusitis ◽  
Lung Infection ◽  
University Hospitals ◽  
Chinese University ◽  
Multivariable Analyses ◽  
Hiv Negative

Abstract Background Lung infection may cause many symptoms, such as fever and headache, that may be confused with cryptococcal meningitis (CM) symptoms. This study aimed to investigate the discrepancy in clinical features and outcomes of CM between HIV-negative patients with and without lung infection.Methods We retrospectively reviewed the medical records of patients with CM admitted to two hospitals in Southwest China from 1 January 2014 to 31 December 2018.Results A total of 71 patients was included during the 5 years, among which 35 (49.3%) patients had lung disease. CM occurred more frequently in male (62.9% vs. 44.4%, P=0.12) and young (≤30 years, 31.4% vs. 16.7%, P=0.30) patients with lung infection than in the patients without lung infection, with more fever (77.1% vs. 30.6%, P=0.001) and less central nervous system symptoms (5.7% vs. 16.7%, P=0.28) and vomiting (25.0% vs. 14.3%, P=0.26). In addition, patients with lung infection presented higher percentages of white blood cell (WBC) counts ˂20×106/L (45.7% vs. 22.2%, P=0.036) and lower percentages of ethmoid sinusitis, maxillary sinusitis, paranasal sinusitis, and otitis media than patients without lung infection (8.6% vs. 30.6%, P=0.02). The Cryptococcus neoformans isolates were sensitive to itraconazole, voriconazole, fluconazole, and amphotericin B but resistant to flucytosine. Patients with lung infection had higher mortality at discharge compared with patients without lung infection (8.6% vs. 0, P=0.12). Multivariable analyses showed that WBC counts ˂20×106/L was significantly associated with treatment outcome (OR=0.01, 95% CI=0-0.833, P=0.041).Conclusions There were significant discrepancies in clinical features between CM patients with and without lung infection. Clinicians must consider the divergences in the diagnosis of CM in patients with lung infection.

scholarly journals Comparison of cryptococcal meningitis in HIV-negative patients with and without lung infections

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092959
Author(s):  
Ming Yang ◽  
Lin Cheng ◽  
Fengjun Sun ◽  
Fu Liu ◽  
Wei Feng ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cryptococcal Meningitis ◽  
Maxillary Sinusitis ◽  
Lung Infection ◽  
University Hospitals ◽  
Lung Infections ◽  
Wbc Count ◽  
Poor Treatment Outcome ◽  
Hiv Negative

Objective To investigate the clinical features and outcomes of cryptococcal meningitis (CM) in HIV-negative patients with and without lung infections. Methods We retrospectively reviewed the medical records of HIV-negative patients with CM admitted to two university hospitals in Southwest China over the past 5 years. Results Seventy-one patients were included, of whom 35 (49.3%) had lung disease. Compared with patients without lung infection, CM patients with lung infection tended to be male and younger (≤30 years), experienced more fever, less vomiting and fewer central nervous system symptoms; more often had low white blood cell (WBC) counts (<20 × 106/L), and fewer often had ethmoid sinusitis, maxillary sinusitis, paranasal sinusitis, and otitis media. Cryptococcus neoformans isolates from these patients were sensitive to itraconazole, voriconazole, fluconazole, and amphotericin B but resistant to flucytosine. CM patients with lung infection had higher mortality at discharge compared with patients without lung infection (8.6% vs. 0%). Multivariable analyses showed that a WBC count <20 × 106/L was significantly associated with poor treatment outcome (odds ratio 0.01, 95% confidence interval 0–0.83). Conclusion HIV-negative CM patients with lung infections tended to be male and younger. Fever, fewer central nervous system symptoms, and WBC counts <20 × 106/L were characteristic of this patient group.

scholarly journals Cryptococcal Meningitis amomg HIV-Infected and HIV-Uninfected Patients in Jos, North Central Nigeria

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
M O Okolo ◽  
K I Onyedibe ◽  
F Dabe ◽  
E F Obishakin ◽  
EA Envuladu ◽  
...  
Keyword(s):  
Cryptococcus Neoformans ◽  
Clinical Features ◽  
Cryptococcal Meningitis ◽  
Antifungal Susceptibility ◽  
Bivariate Analysis ◽  
North Central ◽  
Healthcare Facilities ◽  
Tertiary Healthcare ◽  
Genomic Studies ◽  
Susceptibility Tests

Cryptococcal meningitis is a global opportunistic infection caused by several serovars of Cryptococcus neoformans and Cryptococcus gattii with significant morbidity and mortality, particularly in immunocompromised patients. Management principles involve early and specific diagnosis followed by appropriate antifungal therapy. The study was conducted among in-patients with clinical features of meningitis admitted into tertiary healthcare facilities in Jos, north-central Nigeria from November 2017 to December 2018. Cerebrospinal fluid and blood samples were collected from the patients for culture and sensitivity, serology and genomic studies. Univariate and bivariate analysis was carried out using STATA (version 14IC). The serologic prevalence of cryptococcal meningitis among patients with clinical features of meningitis was 16.8%. The prevalence among HIV-infected and HIV-uninfected patients were 13.4% and 18.8% respectively. The antifungal susceptibility of the Cryptococcus neoformans isolated from sample cultures at MIC90ug/ml to Amphotericin B, Fluconazole and Itraconazole were all within the reference range. Gene accession numbers of cryptococcal isolates deposited in the gene bank include MK886574.1, MK886568.1, MK886570.1, MK886563.1, MK886560.1, MK886573.1, MK886562.1, MK886558.1. Cryptococcus neoformans are a major cause of meningitis in both HIV-infected and HIV-uninfected patients. This study highlights the fact that routine surveillance should be put in place for culture, antifungal susceptibility tests and genomic studies to ascertain the antifungal susceptibility pattern and genotypes of cryptococcus in circulation.

Evaluation of Clinical Profile, Diagnostic Tests, And Prognosis of Cryptococcal Meningitis in HIV Infected Patients in Western India

2020 ◽  
Vol 20 ◽  
Author(s):  
Deepak Kumar ◽  
Suresh Bishnoi ◽  
Durga Shankar Meena ◽  
Gopal Krishana Bohra ◽  
Naresh Midha ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Clinical Features ◽  
Cryptococcal Meningitis ◽  
Fatal Outcome ◽  
Clinical Profile ◽  
Western India ◽  
Antigen Test ◽  
Cryptococcal Antigen ◽  
India Ink ◽  
Csf Examination

Background: Cryptococcal meningitis is a dreaded complication in HIV infected patients. It was associated with high mortality and morbidity before the advent of Highly Active Anti-Retroviral Therapy. A study was planned in our institute to evaluate the clinical profile, laboratory findings, and prognostic factors for survival in these patients. Settings and Design: A prospective hospital-based observational study, conducted in the Department of Medicine at a tertiary care centre in western Rajasthan. Method and Material: HIV infected patients presenting with clinical features of meningitis, and positive CSF culture for Cryptococcus were included in our study. All cases underwent detailed clinical history, physical examinations and relevant laboratory investigations including CD4 count and CSF examination. Results: 48 HIV infected cryptococcal meningitis patients were analysed, and the most common presenting clinical features were headache (85.42%), and fever (72.92%), followed by neck stiffness (62.50%). CSF examination was also done for Cryptococcal Antigen test which was reactive in all cases (100%), and India ink staining was positive in 43 cases (89.58%). Significant fatal outcome was associated with patients presenting with altered sensorium, loss of consciousness, cranial nerve palsy and CD4 cell count of less than 100. Similarly, on laboratory and imaging diagnosis, cryptococcal antigen test (>3+reactive), fundus examination (papilloedema) and abnormal CT/MRI brain imaging were associated with poor survival. Conclusion: Cryptococcal meningitis is a potentially lethal infection in immunocompromised individuals and should be diagnosed early with high clinical suspicion as around 10% of the cases may not be detected on India ink staining and a large proportion (75%) of cases may have normal imaging at initial evaluation. Early diagnosis, watchful eye on prognostic factors and treatment is vital to improve outcome in these patients.

scholarly journals Clinical characteristics of inpatients with coronavirus disease 2019 (COVID-19) in Sichuan province

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wen Wang ◽  
Lei Chen ◽  
Qiao He ◽  
Mingqi Wang ◽  
Mei Liu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Features ◽  
Medical Records ◽  
Clinical Characteristics ◽  
Sichuan Province ◽  
Chest Ct ◽  
Shortness Of Breath ◽  
Course Of Disease ◽  
West China ◽  
Radiologic Abnormality

Abstract Background The outbreak of COVID-19 has resulted in serious concerns in China and abroad. To investigate clinical features of confirmed and suspected patients with COVID-19 in west China, and to examine differences between severe versus non-severe patients. Methods Patients admitted for COVID-19 between January 21 and February 11 from fifteen hospitals in Sichuan Province, China were included. Experienced clinicians trained with methods abstracted data from medical records using pre-defined, pilot-tested forms. Clinical characteristics between severe and non-severe patients were compared. Results Of the 169 patients included, 147 were laboratory-confirmed, 22 were suspected. For confirmed cases, the most common symptoms from onset to admission were cough (70·7%), fever (70·5%) and sputum (33·3%), and the most common chest CT patterns were patchy or stripes shadowing (78·0%); throughout the course of disease, 19·0% had no fever, and 12·4% had no radiologic abnormality; twelve (8·2%) received mechanical ventilation, four (2·7%) were transferred to ICU, and no death occurred. Compared to non-severe cases, severe ones were more likely to have underlying comorbidities (62·5% vs 26·2%, P = 0·001), to present with cough (92·0% vs 66·4%, P = 0·02), sputum (60·0% vs 27·9%, P = 0·004) and shortness of breath (40·0% vs 8·2%, P <  0·0001), and to have more frequent lymphopenia (79·2% vs 43·7%, P = 0·003) and eosinopenia (84·2% vs 57·0%, P = 0·046). Conclusions The symptoms of patients in west China were relatively mild, and an appreciable proportion of infected cases had no fever, warranting special attention.

Cryptococcal Meningitis in HIV Negative Infant

2003 ◽  
Vol 21 (2) ◽  
pp. 145
Author(s):  
PS Nirwan ◽  
AS Dalal ◽  
BP Peters ◽  
VL Rastogi ◽  
K Mehta
Keyword(s):  
Cryptococcal Meningitis ◽  
Hiv Negative

Clinical features of pharyngeal cancer: a retrospective study of 258 consecutive patients

2001 ◽  
Vol 115 (2) ◽  
pp. 112-118 ◽  
Author(s):  
A. Escribano Uzcudun ◽  
P. Bravo Fernández ◽  
J. J. Sánchez ◽  
A. García Grande ◽  
I. Rabanal Retolaza ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Head And Neck ◽  
Clinical Features ◽  
Medical Records ◽  
Performance Status ◽  
Nasopharyngeal Cancer ◽  
University Hospital ◽  
Premalignant Lesions ◽  
Pharyngeal Cancer ◽  
Presenting Symptoms

Pharyngeal cancer still presents an unsatisfactory mortality (30-40 per cent in most series, with a slightly better prognosis for nasopharyngeal cancer relative to both oropharyngeal and hypophyarngeal cancers) despite advances in treatment. Therefore, it is critical to know the clinical features of pharyngeal cancer. The purpose of this study was to investigate the most relevant clinical features of pharyngeal cancer (oropharyngeal, hypopharyngeal, and nasopharyngeal) in order to improve knowledge of this malignancy with the aim of ameliorating diagnosis and treatment.The retrospective study was based on a review of medical records from 258 consecutive patients with pharyngeal cancer (oropharyngeal, hypopharyngeal and nasopharyngeal) diagnosed at La Paz University Hospital, Madrid, Spain, between January 1 1991 and and December 31 1995. Medical records were provided by the Departments of Otorhinolaryngology, Head and Neck Surgery, Radiation Oncology, and Medical Oncology.All medical records were analysed for the following clinical variables: 1) incidence, 2) sociodemographics, 3) sites (oropharynx, hypopharynx, nasopharynx) and subsites, 4) clinical and histological staging, 5) pathlogy, 6) presenting symptoms, 7) time to diagnosis, 8) patients’ general performance status at diagnosis, 9) personal cancer history and synchronous head and neck tumours, 10) premalignant lesions, and 11) paediatric cases.Our most outstanding finding was the excessively long time that elapsed between first clinical manifestation appearance and conclusive diagnosis of pharyngeal cancer (4.7 months for pharynx, 4.5 for oropharynx, 4.4 for hypopharynx and 6.5 for nasopharynx cancers). It was found that nasopharyngeal cancer was quite different from both oropharyngeal and hypopharyngeal cancers with respect to its potential aetiology, risk factors and clinical presentation. In addition it has a better prognosis.

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