Cryptococcal Meningitis: A Retrospective Analysis of Immunocompetent and Immunocompromised Cases

Introduction. Cryptococcal meningitis (CM) primarily affects immunocompromised individuals, but up to 20% of cases occur in immunocompetent patients. However, there are limited clinical comparisons between immunocompromised and immunocompetent patients. Methods. This is an IRB approved, single-centered retrospective chart review study. Patients aged >18 admitted between 2012 and 2022 with Cryptococcus neoformans meningitis were included. Demographic, associated conditions, clinical data, and clinical outcomes were obtained. Patients were categorized into immunocompromised and immunocompetent groups. Results. 37 patients with CM were identified, with 32 (86.5%) immunocompromised patients and 5 (13.5%) immunocompetent patients. The median time to first lumbar puncture was 1.07 days (IQR -0.43, 2.84) in immunocompromised versus 3.89 days (IQR 0.20, 12.1) in immunocompetent groups. ICU care was required in 7 (21.9%) immunocompromised patients and 2 (40.0%) immunocompetent patients. There were 8 readmissions (25.0%) within 30 days and 5 (15.6%) recurrences in the immunocompromised group while no readmission or recurrence among the immunocompetent group. Overall mortality was greater in the immunocompromised group than the immunocompetent group, with 13 deaths (40.6%) versus 1 death (20.0%), respectively. Conclusions. Based on our results, we speculate a greater delay in diagnostic lumbar puncture and greater disease severity requiring ICU level of care in the immunocompetent group compared to the immunocompromised counterpart. However, long-term outcomes such as mortality, recurrences, and readmissions were lower in the immunocompetent group. These findings may help guide future large dataset studies.