Differences in Immunologic Factors Among Patients Presenting with Altered Mental Status During Cryptococcal Meningitis.

Abstract

Altered mental status in cryptococcal meningitis results in poorer survival, but underlying causes of altered mentation are poorly understood. Within two clinical trials, we assessed risk factors for altered mental status (GCS score<15) considering baseline clinical characteristics, CSF cytokines/chemokines, and antiretroviral therapy. Among 326 enrolled participants, 97 (30%) had GCS<15 and these patients had lower median CSF cryptococcal antigen titers (P = .042) and CCL2 (P = .005) but higher opening pressures (320 vs. 269 mm H2O; P = .016), IL-10 (P = .044), and CCL3 (P = .008) compared with persons with GCS=15. Altered mental status may be associated with host immune response rather than Cryptococcus burden.

• Authors: Sarah Lofgren, Kathy H Hullsiek, Bozena M Morawski, Henry W Nabeta, Reuben Kiggundu, Kabanda Taseera, Abdu Musubire, Charlotte Schutz, Mahsa Abassi, Nathan C Bahr, Lillian Tugume, Conrad Muzoora, Darlisha A Williams, Melissa A Rolfes, Sruti S Velamakanni, Radha Rajasingham, Graeme Meintjes, Joshua Rhein, David B Meya, David R Boulware, COAT and ASTRO-CM Trial Teams
• Journal: The Journal of infectious diseases (J Infect Dis) Vol. 215 Issue 5 Pg. 693-697 (03 01 2017) ISSN: 1537-6613 [Electronic] United States
• PMID: 28329080 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Chemical References

• Antifungal Agents
• Antigens, Fungal
• CCL3 protein, human
• Chemokine CCL3
• Chemokines
• Cytokines
• IL10 protein, human
• Interleukin-10

Topics

• Adult
• Antifungal Agents (therapeutic use)
• Antigens, Fungal (blood)
• Chemokine CCL3 (blood)
• Chemokines (blood)
• Cryptococcus neoformans
• Cytokines (blood)
• Female
• Humans
• Interleukin-10 (blood)
• Male
• Meningitis, Cryptococcal (blood, drug therapy, immunology)
• Mental Disorders (blood, immunology)
• Pilot Projects
• Proportional Hazards Models
• Prospective Studies
• Risk Factors