Prognosis

Mortality varies from country to country depending on the resource settings.

The most important markers of poor prognosis in HIV-associated cryptococcal meningitis are altered mental status at presentation and high organism load, as determined by quantitative cerebrospinal fluid (CSF) culture or CSF antigen titres. (1) Low CSF white cell count and raised CSF opening pressure are also associated with a poor outcome.

Mortality remains high in the United States and France, with a 10-week mortality of 15% to 26%, and is higher in non-HIV patients because of delayed diagnosis and dysfunctional immune responses. (2)

In poor-resource countries, mortality increase from 30% to 70% in 10 weeks because of the late presentation and lack of access to drugs, manometers, and optimal monitoring. (2)

Chronic neuropsychiatric sequelae are common after cryptococcal meningitis. (3)

Reference

1. Brouwer AE et al. Combination antifungal therapies for HIV-associated cryptococcal meningitis: a randomised trial. Lancet. 2004 May 29;363(9423):1764-7.
2. Perfect JR et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2010 Feb 01;50(3):291-322.
3. Lu CH et al. Assessing the chronic neuropsychologic sequelae of human immunodeficiency virus-negative cryptococcal meningitis by using diffusion tensor imaging. AJNR Am J Neuroradiol. 2011 Aug;32(7):1333-9.