Scholarlink

Background <p>The clinical features of India ink-negative and culture-negative cryptococcal meningitis (CM) in HIV-negative patients remain unclear.</p> Methods <p>A total of 395 antifungal-naïve HIV-negative CM patients were enrolled in this retrospective study. The 90-day poor outcome and associated risk factors were compared between patients with positive and negative India ink, and those with positive and negative culture in cerebrospinal fluid (CSF).</p> Results <p>India ink-negative patients had a high level of glucose [mmol/L; 2.6 ± 1.5 vs. 2.1 ± 1.4, <i>P</i> = 0.005], total protein level [g/L; 1.1 (0.7–1.8) vs. 0.9 (0.6–1.2), <i>P</i> = 0.002] and WBC count [×10<sup>6</sup>/L; 121.9 (36.5–210.0) vs. 67.5 (18.0-140.0), <i>P</i> = 0.001] in CSF but lower intracranial pressure (ICP) (mmH<sub>2</sub>O; 185.0 (130.0-250.0) vs. 270.0 (191.0-397.5), <i>P</i> &lt; 0.001) at the time of CM diagnosis. Culture-negative patients showed a high CSF glucose level (mmol/L; 2.9 ± 1.6 vs. 2.1 ± 1.3, <i>P</i> &lt; 0.001) and low ICP [mmH<sub>2</sub>O; 215.0 (150.0-277.3) vs. 250.0 (180.0-360.0), <i>P</i> = 0.006]. The 90-day poor outcome was 9.3% for India ink-negative patients, 24.5% for India ink-positive patients (log-rank <i>P</i> = 0.003), 21.7% for culture-negative patients and 19.8% for culture-positive patients (log-rank <i>P</i> = 0.579). ICP ≥ 300.0 mmH<sub>2</sub>O [adjusted odds ratio (AOR) (95% confidence interval): 4.6 (1.0-20.7), <i>P</i> = 0.045] and not going CrAg Assay [AOR:4.4(1.0-18.4), <i>P</i> = 0.045] were independent risk factors for India ink-negative patients. Low CSF count (&lt; 20.0 × 10<sup>6</sup>/L) [AOR: 2.7 (1.0-7.2), <i>P</i> = 0.047] and and positive India ink [AOR:5.3(1.2–23.5), <i>P</i> = 0.028] were independent risk factors for 90-day poor outcome in culture negative patients.</p> Conclusions <p>India ink-/culture-negative CM patients had mild CSF profile changes. The CrAg assay was associated with an increased survival rate of India ink- negative CM patients and positive India ink was associated with poor outcome of culture-negative CM patients. The mortality of patients with a positive India ink was significantly increased.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

India ink-negative and culture-negative cryptococcal meningitis in HIV-negative patients

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年1月17日

查看全文
  • Longda Chen,
  • Gong Chen,
  • Shasha Ye,
  • Jiaying Qin,
  • Guancheng Huang,
  • Lijun Xu

摘要

Background

The clinical features of India ink-negative and culture-negative cryptococcal meningitis (CM) in HIV-negative patients remain unclear.

Methods

A total of 395 antifungal-naïve HIV-negative CM patients were enrolled in this retrospective study. The 90-day poor outcome and associated risk factors were compared between patients with positive and negative India ink, and those with positive and negative culture in cerebrospinal fluid (CSF).

Results

India ink-negative patients had a high level of glucose [mmol/L; 2.6 ± 1.5 vs. 2.1 ± 1.4, P = 0.005], total protein level [g/L; 1.1 (0.7–1.8) vs. 0.9 (0.6–1.2), P = 0.002] and WBC count [×106/L; 121.9 (36.5–210.0) vs. 67.5 (18.0-140.0), P = 0.001] in CSF but lower intracranial pressure (ICP) (mmH2O; 185.0 (130.0-250.0) vs. 270.0 (191.0-397.5), P < 0.001) at the time of CM diagnosis. Culture-negative patients showed a high CSF glucose level (mmol/L; 2.9 ± 1.6 vs. 2.1 ± 1.3, P < 0.001) and low ICP [mmH2O; 215.0 (150.0-277.3) vs. 250.0 (180.0-360.0), P = 0.006]. The 90-day poor outcome was 9.3% for India ink-negative patients, 24.5% for India ink-positive patients (log-rank P = 0.003), 21.7% for culture-negative patients and 19.8% for culture-positive patients (log-rank P = 0.579). ICP ≥ 300.0 mmH2O [adjusted odds ratio (AOR) (95% confidence interval): 4.6 (1.0-20.7), P = 0.045] and not going CrAg Assay [AOR:4.4(1.0-18.4), P = 0.045] were independent risk factors for India ink-negative patients. Low CSF count (< 20.0 × 106/L) [AOR: 2.7 (1.0-7.2), P = 0.047] and and positive India ink [AOR:5.3(1.2–23.5), P = 0.028] were independent risk factors for 90-day poor outcome in culture negative patients.

Conclusions

India ink-/culture-negative CM patients had mild CSF profile changes. The CrAg assay was associated with an increased survival rate of India ink- negative CM patients and positive India ink was associated with poor outcome of culture-negative CM patients. The mortality of patients with a positive India ink was significantly increased.