TY - JOUR
T1 - Outcomes of central nervous system cryptococcosis vary with host immune function
T2 - Results from a multi-center, prospective study
AU - Nguyen, M. Hong
AU - Husain, Shahid
AU - Clancy, Cornelius J.
AU - Peacock, James E.
AU - Hung, Chien Ching
AU - Kontoyiannis, Dimitrios P.
AU - Morris, Arthur J.
AU - Heath, Christopher H.
AU - Wagener, Marilyn
AU - Yu, Victor L.
N1 - Funding Information:
JEP had received past research funding from Pfizer, Bayer, Roche, and Fujisawa and has current research funding from Cubist and Basilea.
Funding Information:
SH has been a consultant for Cylex, Inc. and Schering Plough. He has received research funding from Enzon, Astellas and Pfizer.
Funding Information:
CJC has received research funding from Pfizer, Astellas and Merck.
PY - 2010/11
Y1 - 2010/11
N2 - Background: Central nervous system (CNS) cryptococcosis is most commonly encountered among HIV-infected and other immunosuppressed hosts but is less well-characterized among non-immunosuppressed patients. Methods: We conducted a three year, prospective, observational study to compare the clinical manifestations and outcome of CNS cryptococcosis in three patient populations: HIV-infected patients (n = 54), HIV-negative immunosuppressed patients (n = 21), and non-immunosuppressed patients (n = 11). Results: Time from initial symptoms to presentation did not differ between the groups. HIV-infected patients were significantly more likely to present with fevers (p < 0.0001), but were less likely to have abnormal mental status, CNS mass lesions and pulmonary involvement (p = 0.001, 0.01 and 0.03, respectively). The clinical manifestations among HIV-negative immunosuppressed patients were generally intermediate to the other groups. Overall, acuity of illness was worse among non-immunosuppressed patients, as measured by APACHE II scores (p = 0.02). Intracranial pressure was higher in HIV-infected and non-immunosuppressed patients than immunosuppressed patients (p = 0.008 and 0.01, respectively). Repeated lumbar punctures were more common among HIV-infected patients (p = 0.01). There was a trend toward more frequent placement of permanent CNS shunts among non-HIV patients (p = 0.05). The mortality rate was greatest for non-immunosuppressed patients (p = 0.04). Conclusion: CNS cryptococcosis in non-immunosuppressed patients was associated with poorer prognosis. Our findings suggest that host immune responses may contribute to pathogenesis of CNS cryptococcosis, with more intact immune function associated with increased CNS-related morbidity and overall mortality.
AB - Background: Central nervous system (CNS) cryptococcosis is most commonly encountered among HIV-infected and other immunosuppressed hosts but is less well-characterized among non-immunosuppressed patients. Methods: We conducted a three year, prospective, observational study to compare the clinical manifestations and outcome of CNS cryptococcosis in three patient populations: HIV-infected patients (n = 54), HIV-negative immunosuppressed patients (n = 21), and non-immunosuppressed patients (n = 11). Results: Time from initial symptoms to presentation did not differ between the groups. HIV-infected patients were significantly more likely to present with fevers (p < 0.0001), but were less likely to have abnormal mental status, CNS mass lesions and pulmonary involvement (p = 0.001, 0.01 and 0.03, respectively). The clinical manifestations among HIV-negative immunosuppressed patients were generally intermediate to the other groups. Overall, acuity of illness was worse among non-immunosuppressed patients, as measured by APACHE II scores (p = 0.02). Intracranial pressure was higher in HIV-infected and non-immunosuppressed patients than immunosuppressed patients (p = 0.008 and 0.01, respectively). Repeated lumbar punctures were more common among HIV-infected patients (p = 0.01). There was a trend toward more frequent placement of permanent CNS shunts among non-HIV patients (p = 0.05). The mortality rate was greatest for non-immunosuppressed patients (p = 0.04). Conclusion: CNS cryptococcosis in non-immunosuppressed patients was associated with poorer prognosis. Our findings suggest that host immune responses may contribute to pathogenesis of CNS cryptococcosis, with more intact immune function associated with increased CNS-related morbidity and overall mortality.
KW - Cryptococcal meningitis
KW - Cryptococcosis
KW - HIV
KW - Immunocompetent
KW - Immunosuppressed
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U2 - 10.1016/j.jinf.2010.08.004
DO - 10.1016/j.jinf.2010.08.004
M3 - Article
C2 - 20732350
AN - SCOPUS:78149358512
SN - 0163-4453
VL - 61
SP - 419
EP - 426
JO - Journal of Infection
JF - Journal of Infection
IS - 5
ER -