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The clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: a hospital-based study
BACKGROUND: The elderly, and especially those with an immuno-compromised status, are vulnerable to infectious diseases. The purpose of this study was to examine the clinical characteristics and therapeutic outcomes of cryptococcal meningitis (CM) in elderly patients in Taiwan. METHODS: Ninety-nine a...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434878/ https://www.ncbi.nlm.nih.gov/pubmed/30909914 http://dx.doi.org/10.1186/s12877-019-1108-0 |
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author | Tsai, Wan-Chen Lien, Chia-Yi Lee, Jun-Jun Hsiao, Wen-Chiu Huang, Chi-Ren Tsai, Nai-Wen Chang, Chiung-Chih Lu, Cheng-Hsien Chang, Wen-Neng |
author_facet | Tsai, Wan-Chen Lien, Chia-Yi Lee, Jun-Jun Hsiao, Wen-Chiu Huang, Chi-Ren Tsai, Nai-Wen Chang, Chiung-Chih Lu, Cheng-Hsien Chang, Wen-Neng |
author_sort | Tsai, Wan-Chen |
collection | PubMed |
description | BACKGROUND: The elderly, and especially those with an immuno-compromised status, are vulnerable to infectious diseases. The purpose of this study was to examine the clinical characteristics and therapeutic outcomes of cryptococcal meningitis (CM) in elderly patients in Taiwan. METHODS: Ninety-nine adult patients with CM were identified during a 15-year study period (2002–2016), of whom 38 elderly (≥ 65 years) patients (16 men and 22 women, median age 72.9 years; range 65–86 years) were included for analysis. The clinical characteristics and therapeutic outcomes of these patients were analyzed and compared to non-elderly adult patients (< 65 years) with CM. RESULTS: Among the 38 patients, diabetes mellitus was the most common underlying condition (15), followed by adrenal insufficiency (7), malignancy (6), hematologic disorders (5), chronic obstructive pulmonary disease (5), autoimmune diseases (3), liver cirrhosis (3) and acquired immunodeficiency syndrome (1). Altered consciousness (29), fever (21) and headache (17) were the leading clinical manifestations. Positive cerebrospinal fluid and blood cultures for Cryptococcus (C.) neoformans were found in 26 and 9 patients, respectively. There were significant differences in gender, altered consciousness and recent cerebral infarction between the elderly and non-elderly groups. The elderly group had a high mortality rate (36.8%, 14/38), and the presence of cryptococcemia was the most significant prognostic factor. CONCLUSIONS: This study offers a preliminary view of the clinical characteristics of CM in the elderly. The results suggest that elderly patients (≥ 65 years) are more vulnerable to CM than adults aged < 65 years. Compared to the non-elderly group, the elderly group had female predominance, higher rates of altered consciousness and recent cerebral infarction as the clinical presentation. The presence of cryptococcemia was a significant prognostic factor in the elderly group. This study is limited by the small number of patients, and further large-scale studies are needed to better delineate this specific infectious syndrome. |
format | Online Article Text |
id | pubmed-6434878 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-64348782019-04-08 The clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: a hospital-based study Tsai, Wan-Chen Lien, Chia-Yi Lee, Jun-Jun Hsiao, Wen-Chiu Huang, Chi-Ren Tsai, Nai-Wen Chang, Chiung-Chih Lu, Cheng-Hsien Chang, Wen-Neng BMC Geriatr Research Article BACKGROUND: The elderly, and especially those with an immuno-compromised status, are vulnerable to infectious diseases. The purpose of this study was to examine the clinical characteristics and therapeutic outcomes of cryptococcal meningitis (CM) in elderly patients in Taiwan. METHODS: Ninety-nine adult patients with CM were identified during a 15-year study period (2002–2016), of whom 38 elderly (≥ 65 years) patients (16 men and 22 women, median age 72.9 years; range 65–86 years) were included for analysis. The clinical characteristics and therapeutic outcomes of these patients were analyzed and compared to non-elderly adult patients (< 65 years) with CM. RESULTS: Among the 38 patients, diabetes mellitus was the most common underlying condition (15), followed by adrenal insufficiency (7), malignancy (6), hematologic disorders (5), chronic obstructive pulmonary disease (5), autoimmune diseases (3), liver cirrhosis (3) and acquired immunodeficiency syndrome (1). Altered consciousness (29), fever (21) and headache (17) were the leading clinical manifestations. Positive cerebrospinal fluid and blood cultures for Cryptococcus (C.) neoformans were found in 26 and 9 patients, respectively. There were significant differences in gender, altered consciousness and recent cerebral infarction between the elderly and non-elderly groups. The elderly group had a high mortality rate (36.8%, 14/38), and the presence of cryptococcemia was the most significant prognostic factor. CONCLUSIONS: This study offers a preliminary view of the clinical characteristics of CM in the elderly. The results suggest that elderly patients (≥ 65 years) are more vulnerable to CM than adults aged < 65 years. Compared to the non-elderly group, the elderly group had female predominance, higher rates of altered consciousness and recent cerebral infarction as the clinical presentation. The presence of cryptococcemia was a significant prognostic factor in the elderly group. This study is limited by the small number of patients, and further large-scale studies are needed to better delineate this specific infectious syndrome. BioMed Central 2019-03-25 /pmc/articles/PMC6434878/ /pubmed/30909914 http://dx.doi.org/10.1186/s12877-019-1108-0 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Tsai, Wan-Chen Lien, Chia-Yi Lee, Jun-Jun Hsiao, Wen-Chiu Huang, Chi-Ren Tsai, Nai-Wen Chang, Chiung-Chih Lu, Cheng-Hsien Chang, Wen-Neng The clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: a hospital-based study |
title | The clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: a hospital-based study |
title_full | The clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: a hospital-based study |
title_fullStr | The clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: a hospital-based study |
title_full_unstemmed | The clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: a hospital-based study |
title_short | The clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: a hospital-based study |
title_sort | clinical characteristics and therapeutic outcomes of cryptococcal meningitis in elderly patients: a hospital-based study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434878/ https://www.ncbi.nlm.nih.gov/pubmed/30909914 http://dx.doi.org/10.1186/s12877-019-1108-0 |
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