Prognostic Factors in Cryptococcal Meningitis

Abstract

Results of amphotericin B therapy were correlated with laboratory and clinical findings in 111 patients with cryptococcal meningitis. Compared with patients who were to be cured, patients who were to die during therapy more often had the following features on admission: lymphoreticular malignancy or corticosteroid therapy; cerebrospinal fluid with high opening pressure, a low glucose level, less than 20 leukocytes/mm3 and cryptococci seen in smear; cryptococci isolated from extraneural sites; and high titers of cryptococcal antigen in cerebrospinal fluid and serum. These last two features also characterized admission findings in the group of patients who were to be discharged with negative cultures after therapy but who later relapsed. Patients who were to relapse also had high, persistent posttreatment titers of cryptococcal antigen in serum or cerebrospinal fluid.