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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Paucity of initial cerebrospinal fluid inflammation in cryptococcal meningitis is associated with subsequent immune reconstitution inflammatory syndrome
Journal of Infectious Diseases, Volume 202, No. 6, Year 2010
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Description
Background: Cryptococcal meningitis (CM)-related immune reconstitution inflammatory syndrome (IRIS) complicates antiretroviral therapy (ART) in 20%-40% of ART-naive persons with AIDS and prior CM. Pathogenesis is unknown. Methods: We compared initial cerebrospinal fluid (CSF) cultures, inflammatory markers, and cytokine profiles in ART-naive patients with AIDS who did or did not subsequently develop IRIS after starting ART. We also compared results obtained at IRIS events or CM relapse. Results: Of 85 subjects with CM, 33 (39%) developed CM-related IRIS and 5 (6%) developed culture-positive CM relapse. At CM diagnosis, subjects subsequently developing IRIS had less inflammation, with decreased CSF leukocytes, protein, interferon-γ, interleukin-6, interleukin-8, and tumor necrosis factor-α, compared with subjects not developing IRIS ( , for each). P <.05 Initial CSF white blood cell counts ≤25 cells/μL and protein levels ≤50 mg/dL were associated with development of IRIS (odds ratio, 7.2 [95% confidence interval, 2.7-18.7]; P <.001). Compared with baseline levels, we identified CSF elevations of interferon-γ, tumor necrosis factor-α, granulocyte colony-stimulating factor, vascular-endothelial growth factor, and eotaxin (CCL11) (P <.05, for each) at the time of IRIS but minimal inflammatory changes in those with CM relapse. Conclusions. Patients who subsequently develop CM-related IRIS exhibit less initial CSF inflammation at the time of CM diagnosis, compared with those who do not develop IRIS. The inflammatory CSF cytokine profiles observed at time of IRIS can distinguish IRIS from CM relapse. © 2010 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Boulware, David R.
United States
Division of Infectious Diseases and Internal Medicine
United States, Minneapolis
Center for Infectious Diseases and Microbiology Translational Research
Bonham, Shulamith C.
United States
Division of Infectious Diseases and Internal Medicine
United States, Minneapolis
Center for Infectious Diseases and Microbiology Translational Research
Meya, David B.
United States
Division of Infectious Diseases and Internal Medicine
Uganda, Kampala
Makerere University
Wiesner, Darin L.
United States, Minneapolis
Center for Infectious Diseases and Microbiology Translational Research
United States, Minneapolis
University of Minnesota Twin Cities
Park, Gregory S.
United States, Minneapolis
Center for Infectious Diseases and Microbiology Translational Research
Kambugu, Andrew Ddungu
United States
Division of Infectious Diseases and Internal Medicine
Uganda, Kampala
Makerere University
Janoff, Edward N.J.
United States, Aurora
University of Colorado School of Medicine
Bohjanen, Paul R.
United States
Division of Infectious Diseases and Internal Medicine
United States, Minneapolis
Center for Infectious Diseases and Microbiology Translational Research
United States, Minneapolis
University of Minnesota Twin Cities
Statistics
Citations: 182
Authors: 8
Affiliations: 5
Identifiers
Doi:
10.1086/655785
ISSN:
00221899
Research Areas
Cancer
Infectious Diseases
Study Design
Case-Control Study