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Cryptococcal Meningitis: A Rare Complication in HIV-Negative Patients with Nephrotic Syndrome in A Chinese Teaching Hospital

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Abstract

Cryptococcal meningitis (CM) is a rare complication in HIV-negative patients with nephrotic syndrome (NS), and knowledge about the clinical profile of NS with CM is limited. We performed a retrospective study of all patients with CM-NS admitted to the Jiangxi Chest Hospital (JCH) between 2011 and 2019 and systematically reviewed cases of CM-NS reported in the Chinese language. Among a total of 226 CM patients referred to the JCH, seven had NS (3.1%); these patients were combined with 22 CM-NS cases reported in the Chinese language for analysis. Headache, fever, nausea, and meningeal irritation were the most common initial symptoms, and the median time from symptom onset to CM diagnostic confirmation was 30 days. One patient initially tested negative for CM but was later confirmed to be positive. Among the 29 analysed patients, 41.4% (12/29) were misdiagnosed with other complications, including four patients from the JCH (4/7, 57.1%) and eight patients from published reports (8/22, 36.3%). The overall mortality rate was 17.2% (5/29); among these patients, 60% (3/5) were misdiagnosed. Induction treatment with amphotericin B plus 5-fluorocytosine (9/29) or amphotericin B plus fluconazole (7/29) successfully cleared the infection. Fluconazole may be a suitable alternative if 5-fluorocytosine is not readily available or not tolerated, and repetitive testing is important to reach a conclusive diagnosis in NS patients suspected of having CM.

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Acknowledgements

This work was supported by the Major National R&D Projects of the National Health Department (2018ZX10101003), the National Natural Science Foundation of China (31770161), the Shanghai Science and Technology Committee (Grant No. 17DZ2272900), the Shanghai Municipal Commission of Health and Family Planning (2017ZZ01024-001), the Shanghai Sailing Program (19YF1448000), and the Chinese Academy of Engineering (2019-XY-33, 19-HN-XZ-06 and 2020-XY-61-01).

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Author notes

  1. Dongying Hu, Qilong Zhang, and Weiwei Jiang equally contributed to this study.

Authors and Affiliations

  1. Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China

    Dongying Hu, Weiwei Jiang, Wenjie Fang, Hang Li, Xianzhen Chen, Lei Zhang, Weihua Pan & Wanqing Liao

  2. Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China

    Dongying Hu, Weiwei Jiang, Wenjie Fang, Hang Li, Xianzhen Chen, Lei Zhang, Weihua Pan & Wanqing Liao

  3. Department of Neurology, Jiangxi Chest Hospital, Jiangxi, China

    Qilong Zhang

  4. Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands

    Amir Arastehfar

  5. Faculty of Medicine, Çukurova University, Adana, Turkey

    Macit Ilkit

  6. Department of Dermatology, Affiliated Hospital of Hebei University of Engineering, Hebei, China

    Xiaojing Li

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  1. Dongying Hu
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Correspondence to Xiaojing Li or Weihua Pan.

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Hu, D., Zhang, Q., Jiang, W. et al. Cryptococcal Meningitis: A Rare Complication in HIV-Negative Patients with Nephrotic Syndrome in A Chinese Teaching Hospital. Mycopathologia 185, 959–969 (2020). https://doi.org/10.1007/s11046-020-00482-5

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  • DOI: https://doi.org/10.1007/s11046-020-00482-5

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