{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T05:10:28Z","timestamp":1768713028114,"version":"3.49.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2019,1,17]],"date-time":"2019-01-17T00:00:00Z","timestamp":1547683200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100011441","name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011441","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004835","name":"Zhejiang University","doi-asserted-by":"publisher","award":["491010"],"award-info":[{"award-number":["491010"]}],"id":[{"id":"10.13039\/501100004835","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004835","name":"Zhejiang University","doi-asserted-by":"publisher","award":["A61703"],"award-info":[{"award-number":["A61703"]}],"id":[{"id":"10.13039\/501100004835","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The national science and technology major project of China","award":["2018ZX10302104"],"award-info":[{"award-number":["2018ZX10302104"]}]},{"name":"Hangzhou science and technology development program","award":["20150733Q50"],"award-info":[{"award-number":["20150733Q50"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The clinical features of cryptococcal meningitis (CM) in patients without predisposing diseases (PD) remain unclear. In sum, 162 of the 167 patients without PD and 162 of the 309 patients with PD were enrolled after propensity score matching. Demographic characteristics, symptoms, blood, and cerebrospinal fluid (CSF) characteristics were compared between the two groups. Kaplan-Meier curves and a Cox proportional hazards model were used to assess the factors associated with 10-week mortality. In total, approximately 35.1% of CM patients were without PD. CM patients without PD had blood profiles of higher white blood cells (WBC) [8.9(6.7\u201311.0) \u00d7 109\/l], hemoglobin (128.4 \u00b1 20.9\u00a0g\/l), platelets [(226.2 \u00b1 64.1) \u00d7 109\/l], and serum albumin (41.2 \u00b1 5.8\u00a0g\/l) (all P \u2264 .001) and CSF profiles of lower glucose (2.0 \u00b1 1.2\u00a0mmol\/l), pleocytosis [65.0 (18.0\u2013160.0) \u00d7 106\/l] and higher total protein [0.9 (0.7\u20131.4)g\/l] (all P &lt; .05). CM patients without PD had lower Cryptococcus culture positivity in CSF (62.5%\u00a0vs. 74.1%, P = .039) but higher 2-week of CSF culture sterilization rates (69.4%\u00a0vs. 51.3%, P = .031). The overall 10-week survival rate was 84.7% in patients without PD and 81.1% in patients with PD (Log-rank P = .439). CSF glucose &lt;1.5\u00a0mmol\/l, CSF fungal burden &gt;20 cells\/high power field and treatment lacking amphotericin B had a 3\u20134 times higher risk of death in patients without PD, whereas serum albumin &lt;35\u00a0g\/l, CSF glucose &lt; 1.5\u00a0mmol\/l, and CSF WBC &lt;55 \u00d7 106 cell\/l were risk factors for patients with PD. CM patients without PD had unique blood and CSF profiles, especially, had lower Cryptococcus culture positivity in CSF, and higher 2-week CSF culture sterilization. Low CSF glucose levels, higher fungal burden, and treatment without amphotericin B were risk factors for 10-week mortality.<\/jats:p>","DOI":"10.1093\/mmy\/myy154","type":"journal-article","created":{"date-parts":[[2018,12,16]],"date-time":"2018-12-16T12:07:06Z","timestamp":1544962026000},"page":"944-953","source":"Crossref","is-referenced-by-count":14,"title":["Unique clinical features of cryptococcal meningitis among Chinese patients without predisposing diseases against patients with predisposing diseases"],"prefix":"10.1093","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7352-2086","authenticated-orcid":false,"given":"Lijun","family":"Xu","sequence":"first","affiliation":[{"name":"The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Rd, Hangzhou, China"},{"name":"Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Rd, Hangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinyue","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Medicine, Zhejiang University, Yuhangtang Rd, Hangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongzheng","family":"Guo","sequence":"additional","affiliation":[{"name":"The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Rd, Hangzhou, China"},{"name":"Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Rd, Hangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ran","family":"Tao","sequence":"additional","affiliation":[{"name":"The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Rd, Hangzhou, China"},{"name":"Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Rd, Hangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiahong","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Shulan Hospital, Dongxin Rd, Hangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zongxing","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of HIV\/AIDS, Xixi Hospital of Hangzhou, Hengbu Rd, Hangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Huang","sequence":"additional","affiliation":[{"name":"The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Rd, Hangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Biao","family":"Zhu","sequence":"additional","affiliation":[{"name":"The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Rd, Hangzhou, China"},{"name":"Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Rd, Hangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Xu","sequence":"additional","affiliation":[{"name":"The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Rd, Hangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,1,16]]},"reference":[{"key":"2019100313120254300_bib1","doi-asserted-by":"crossref","first-page":"169","DOI":"10.2147\/CLEP.S38850","article-title":"Cryptococcal meningitis: epidemiology and therapeutic options","volume":"6","author":"Sloan","year":"2014","journal-title":"Clinical Epidemiology"},{"key":"2019100313120254300_bib2","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1038\/nrneurol.2016.167","article-title":"Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy","volume":"13","author":"Williamson","year":"2017","journal-title":"Nat Rev Neurol"},{"key":"2019100313120254300_bib3","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.jmii.2010.08.011","article-title":"Comparisons of clinical features and mortality of cryptococcal meningitis between patients with and without human immunodeficiency virus infection","volume":"44","author":"Lee","year":"2011","journal-title":"J Microbiol Immunol Infect"},{"key":"2019100313120254300_bib4","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1093\/jac\/49.suppl_1.37","article-title":"Amphotericin B nephrotoxicity","volume":"49","author":"Deray","year":"2002","journal-title":"J Antimicrob Chemother"},{"key":"2019100313120254300_bib5","doi-asserted-by":"crossref","first-page":"570","DOI":"10.3109\/13693780903437876","article-title":"Cryptococcal meningitis in non-HIV-infected patients in a Chinese tertiary care hospital, 1997\u20132007","volume":"48","author":"Zhu","year":"2010","journal-title":"Med Mycol"},{"key":"2019100313120254300_bib6","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.fgb.2014.10.017","article-title":"Epidemiology of Cryptococcus and cryptococcosis in China","volume":"78","author":"Fang","year":"2015","journal-title":"Fungal Genet Biol"},{"key":"2019100313120254300_bib7","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1093\/infdis\/jir152","article-title":"Genotypes coding for mannose-binding lectin deficiency correlated with cryptococcal meningitis in HIV-uninfected Chinese patients","volume":"203","author":"Ou","year":"2011","journal-title":"J Infect Dis"},{"key":"2019100313120254300_bib8","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1099\/jmm.0.000830","article-title":"Correlation between serum cryptococcal antigen titre and meningitis in immunocompetent patients","volume":"67","author":"Gassiep","year":"2018","journal-title":"J Med Microbiol"},{"key":"2019100313120254300_bib9","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.jns.2016.06.069","article-title":"Spectrum of neuroimaging findings in cryptococcal meningitis in immunocompetent patients in China: a series of 18 cases","volume":"368","author":"Tan","year":"2016","journal-title":"J Neurol Sci"},{"key":"2019100313120254300_bib10","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2017-221435","article-title":"Cryptococcal meningitis in a daily cannabis smoker without evidence of immunodeficiency","volume":"2018","author":"Shapiro Bb Md","year":"2018","journal-title":"BMJ Case Rep"},{"key":"2019100313120254300_bib11","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1086\/649858","article-title":"Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america","volume":"50","author":"Perfect","year":"2010","journal-title":"Clin Infect Dis"},{"key":"2019100313120254300_bib12","first-page":"407348","article-title":"A case of recurrent cryptococcal meningoencephalitis in an immunocompetent female","volume":"2014","author":"Niknam","year":"2014","journal-title":"Case Rep Infect Dis"},{"key":"2019100313120254300_bib13","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.3892\/etm.2016.3440","article-title":"Cryptococcal meningitis initially presenting with eye symptoms in an immunocompetent patient: a case report","volume":"12","author":"Li","year":"2016","journal-title":"Exp Ther Med"},{"key":"2019100313120254300_bib14","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.2169\/internalmedicine.56.7356","article-title":"Disseminated cryptococcosis with adrenal insufficiency and meningitis in an immunocompetent individual","volume":"56","author":"Ito","year":"2017","journal-title":"Intern Med"},{"key":"2019100313120254300_bib15","doi-asserted-by":"crossref","first-page":"765","DOI":"10.3109\/13693786.2013.781692","article-title":"Evaluation of a rapid lateral flow immunoassay for the detection of cryptococcal antigen for the early diagnosis of cryptococcosis in HIV patients in Colombia","volume":"51","author":"Escandon","year":"2013","journal-title":"Med Mycol"},{"key":"2019100313120254300_bib16","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1093\/mmy\/myx066","article-title":"Survey of laboratory practices for diagnosis of fungal infection in seven Asian countries: An Asia Fungal Working Group (AFWG) initiative","volume":"56","author":"Chindamporn","year":"2018","journal-title":"Med Mycol"},{"key":"2019100313120254300_bib17","first-page":"255","article-title":"Different characteristics of cryptococcal meningitis between HIV-infected and HIV-uninfected patients in the Southwest of China","volume":"55","author":"Liu","year":"2017","journal-title":"Med Mycol"},{"key":"2019100313120254300_bib18","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1097\/QAD.0b013e32832605fe","article-title":"Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures","volume":"23","author":"Bicanic","year":"2009","journal-title":"AIDS"},{"key":"2019100313120254300_bib19","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1086\/313603","article-title":"Diagnosis and management of increased intracranial pressure in patients with AIDS and cryptococcal meningitis: The NIAID Mycoses Study Group and AIDS Cooperative Treatment Groups","volume":"30","author":"Graybill","year":"2000","journal-title":"Clin Infect Dis"},{"key":"2019100313120254300_bib20","doi-asserted-by":"crossref","first-page":"329","DOI":"10.5582\/ddt.2016.01054","article-title":"The use of mannitol in HIV-infected patients with symptomatic cryptococcal meningitis","volume":"10","author":"Hu","year":"2016","journal-title":"Drug Discoveries & Therapeutics"},{"key":"2019100313120254300_bib21","doi-asserted-by":"crossref","first-page":"1764","DOI":"10.1016\/S0140-6736(04)16301-0","article-title":"Combination antifungal therapies for HIV-associated cryptococcal meningitis: a randomised trial","volume":"363","author":"Brouwer","year":"2004","journal-title":"Lancet"},{"key":"2019100313120254300_bib22","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1093\/cid\/cit794","article-title":"Determinants of mortality in a combined cohort of 501 patients with HIV-associated cryptococcal meningitis: implications for improving outcomes","volume":"58","author":"Jarvis","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2019100313120254300_bib23","doi-asserted-by":"crossref","first-page":"694","DOI":"10.3109\/23744235.2015.1044260","article-title":"Voriconazole: a novel treatment option for cryptococcal meningitis","volume":"47","author":"Yao","year":"2015","journal-title":"Infect Dis"},{"key":"2019100313120254300_bib24","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.diagmicrobio.2012.08.009","article-title":"Successful salvage therapy of refractory HIV-related cryptococcal meningitis with the combination of liposomal amphotericin B, voriconazole, and recombinant interferon-gamma","volume":"74","author":"Gamaletsou","year":"2012","journal-title":"Diagn Microbiol Infect Dis"},{"key":"2019100313120254300_bib25","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s10072-011-0496-5","article-title":"Difficulty diagnosing chronic cryptococcal meningitis in idiopathic CD4+ lymphocytopenia","volume":"32","author":"Sancesario","year":"2011","journal-title":"Neurol Sci"},{"key":"2019100313120254300_bib26","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1136\/practneurol-2017-001800","article-title":"Cryptococcal meningitis in apparently immunocompetent patients: association with idiopathic CD4+ lymphopenia","volume":"18","author":"Shribman","year":"2018","journal-title":"Pract Neurol"},{"key":"2019100313120254300_bib27","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ijid.2013.11.017","article-title":"Comparisons of presentations and outcomes of cryptococcal meningitis between patients with and without hepatitis B virus infection","volume":"20","author":"Zhong","year":"2014","journal-title":"Int J Infect Dis"},{"key":"2019100313120254300_bib28","doi-asserted-by":"crossref","first-page":"ofv197","DOI":"10.1093\/ofid\/ofv197","article-title":"End-stage liver disease is a strong predictor of early mortality in cryptococcosis","volume":"3","author":"Spec","year":"2016","journal-title":"Open Forum Infect Dis"},{"key":"2019100313120254300_bib29","doi-asserted-by":"publisher","DOI":"10.1111\/tid.12639","article-title":"Cryptococcal infections in solid organ transplant recipients over a 15-year period at a state transplant center","volume":"19","author":"Gassiep","year":"2017","journal-title":"Transpl Infect Dis"}],"container-title":["Medical Mycology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/mmy\/article-pdf\/57\/8\/944\/30098506\/myy154.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T12:58:31Z","timestamp":1662641911000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mmy\/article\/57\/8\/944\/5290022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,16]]},"references-count":29,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,1,16]]},"published-print":{"date-parts":[[2019,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/mmy\/myy154","relation":{},"ISSN":["1369-3786","1460-2709"],"issn-type":[{"value":"1369-3786","type":"print"},{"value":"1460-2709","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,11]]},"published":{"date-parts":[[2019,1,16]]}}}