Clinical characteristics, treatment, and outcome of low-risk non-HIV associated cryptococcal meningitis: a retrospective cohort study.

Although non-HIV associated cryptococcal meningitis (CM) is a severe disease, there are still some non-HIV CM patients with a low risk of therapeutic failure. Recognizing clinical characteristics of low-risk non-HIV associated CM may enable clinicians to treat non-HIV associated CM more reasonably. According to the definition of low-risk non-HIV associated CM in the 2010 Infectious Diseases Society of America (IDSA) guideline, a total of 220 non-HIV CM patients were divided into two groups (Group 1: 35 low-risk patients; Group 2: 185 non-low-risk patients). Clinical characteristics, treatment, and outcome were compared between two groups. Compared with non-low risk patients, low-risk patients had lower rate of headache (82.9% vs 95.7%, p = 0.012), cerebrospinal fluid (CSF) opening pressure (OP) at baseline (CSF OP < 250 mmH2O, 60.0% vs 32.4%, p = 0.001), and baseline CSF cryptococcal count (median, 0 vs 2376, p < 0.001), higher baseline CSF white blood cell (median, 130 vs 90, p = 0.029) and CSF protein (median, 0.87 vs 0.73, p = 0.011). Multivariate analysis showed that baseline CSF OP < 250 mmH2O (OR: 2.545, 95%CI 1.168-5.545, p = 0.019) was independently associated with low-risk for non-HIV associated CM. The lengths of AMB-d based induction therapy of low-risk patients (median, 20 days) were shorter (p < 0.001) than that of non-low-risk patients (median, 38 days). The successful outcome rate of low-risk patients was higher than non-low risk patients (97.1% vs 54.6%, p < 0.001). We demonstrated non-HIV associated CM patients with baseline CSF OP < 250 mmH2O were prone to the low-risk status.