Risk factors for cryptococcal meningitis in HIV-lnfected patients

K. K. Oursler, R. D. Moore, R. E. Chaisson

Research output: Contribution to journalArticle

Abstract

To identify the risks factors for the development of cryptococcal meningitis, we conducted a nested case-control study of 37 incident cases of cryptococcal meningitis and 74 controls identified from a cohort of HIV-infected patients followed since 1988. Controls with entry CD4 counts less than 250 were randomly selected and were matched by entry year into the clinic and length of follow up time. No difference in age, sex, race, risk factors or stage of AIDS was detected between cases and controls. History of fluconazole use was associated with a 47% risk reduction of cryptococcal meningitis (OR=0.53, p=0.15). A two week course of fluconazole was associated with a 25% risk reduction of cryptococcal meningitis (OR=0.75, p=0.02). No association was found between cryptococcal meningitis and history of steroid use (p=0.72) or duration of steroid use (p=0.20). No difference in survival beyond follow up time was observed by logrank test (p=0.74). Among the cases, latex agglutination antigen was positive in 97% of the CSF samples and 100% of the blood samples. Cultures were positive in 81% of the CSF samples and 44% of the blood samples. Only 50% of the CSF India ink smears were diagnostic for Cryptococcus neoformans. While fluconazole use has a protective effect, steroid use was not associated with an increased risk of cryptococcal meningitis in HIV-infected patients.

Original languageEnglish (US)
Number of pages1
JournalClinical Infectious Diseases
Volume25
Issue number2
StatePublished - Dec 1 1997

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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