| Paucity of initial cerebrospinal fluid inflammation in cryptococcal meningitis is associated with subsequent immune reconstitution inflammatory syndrome. | |
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MedLine Citation:
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PMID: 20677939 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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-gamma, interleukin-6, interleukin-8, and tumor necrosis factor-alpha, compared with subjects not developing IRIS (P<.05, for each). Initial CSF white blood cell counts < or =25 cells/microL and protein levels < or =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-gamma, tumor necrosis factor-alpha, 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. |
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Authors:
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David R Boulware; Shulamith C Bonham; David B Meya; Darin L Wiesner; Gregory S Park; Andrew Kambugu; Edward N Janoff; Paul R Bohjanen |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S. |
Journal Detail:
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Title: The Journal of infectious diseases Volume: 202 ISSN: 1537-6613 ISO Abbreviation: J. Infect. Dis. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-19 Completed Date: 2010-09-09 Revised Date: 2012-04-26 |
Medline Journal Info:
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Nlm Unique ID: 0413675 Medline TA: J Infect Dis Country: United States |
Other Details:
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Languages: eng Pagination: 962-70 Citation Subset: AIM; IM |
Affiliation:
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Division of Infectious Diseases & International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA. boulw001@umn.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acquired Immunodeficiency Syndrome
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complications*,
drug therapy Cerebrospinal Fluid / chemistry, immunology*, microbiology* Cryptococcus neoformans / immunology* Cytokines / analysis Diagnosis, Differential Humans Immune Reconstitution Inflammatory Syndrome / microbiology*, pathology* Inflammation Mediators / analysis Meningitis, Cryptococcal / complications*, immunology, pathology Recurrence Severity of Illness Index |
| Grant Support | |
ID/Acronym/Agency:
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K12 RR023247-04/RR/NCRR NIH HHS; K12RR023247-04/RR/NCRR NIH HHS; K23 AI073192-01A2/AI/NIAID NIH HHS; K23 AI073192-03/AI/NIAID NIH HHS; K23AI073192-01A2/AI/NIAID NIH HHS; L30 AI066779-03/AI/NIAID NIH HHS; L30AI066779/AI/NIAID NIH HHS; R03 AI078750-02/AI/NIAID NIH HHS; R03AI078750-01/AI/NIAID NIH HHS; T32 AI055433-05/AI/NIAID NIH HHS; T32AI055433-05/AI/NIAID NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Cytokines; 0/Inflammation Mediators |
| Comments/Corrections | |
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