Predictors of outcome in Cryptococcus neoformans var. gattii meningitis

In Papua New Guinea, Cryptococcus neoformans var.gattii meningitis has a high fatality rate even inimmunocompetent patients. Our retrospective study attempted to identifymarker of poor prognosis. Of 88 immunocompetent patients, 30 (34.1%) died,usually soon after admission, and mortality was higher in men(p = 0.025) and older patients (p= 0.039). Death was associated with altered consciousness(p<0.001), a history of convulsions prior totreatment (p = 0.002) and a maximum systolic bloodpressure of >150 mmHg (p = 0.017). These datasuggest that death results from raised intracranial pressure and subsequenttentorial herniation. However, CSF opening pressure measured on admissionwas raised in 29/36 (81%) patients and did not predict outcome. Insurvivors, relapse was uncommon and was not predicted by discharge serumcryptococcal antigen titres, which were frequently raised on completion oftherapy in asymptomatic patients. Mortality may be reduced if efforts aremade to lower intracranial pressure in those patients who present withmarkers of poor prognosis.