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

J Infect Dis. 2017 Mar 1;215(5):693-697. doi: 10.1093/infdis/jix033.

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.

Keywords: Cryptococcal meningitis; HIV; altered mental status; cytokines.; immunology.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • 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*
  • Meningitis, Cryptococcal / drug therapy
  • Meningitis, Cryptococcal / immunology
  • Mental Disorders / blood*
  • Mental Disorders / immunology
  • Pilot Projects
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors

Substances

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