Paradoxical immune reconstitution inflammatory syndrome associated with cryptococcal meningitis in China: a 5-year retrospective cohort study

Yan, Shuo; Chen, L.; Wu, Wei‐Te; Li, Zhimin; Fu, Zhongxi; Zhang, H.; Xue, Jinjie; Hu, Yuhai; Mou, Jingsong; Fu, Chuhan

doi:10.1016/j.cmi.2014.11.011

Cited by 13 publications

(12 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The other possible cause of mortality in HIV infected patients may be immune reconstitution inflammatory syndrome (IRIS). Elevated CRP levels, which are associated with paradoxical IRIS[45, 46], were significantly higher in the high absolute neutrophil group. Weisner et al demonstrated that impaired CD4 Helper responses in immunosuppressed mice were responsible for switching between an eosinophilic and neutrophilic response to cryptococcal infection.…”

Section: Discussionmentioning

confidence: 99%

Blood neutrophil counts in HIV-infected patients with cryptococcal meningitis: Association with mortality

et al. 2018

View full text Add to dashboard Cite

BackgroundThe mortality from cryptococcal meningitis remains high, despite the availability of antiretroviral therapy (ART) and amphotericin-based fungal regimens. The role of neutrophils in cryptococcosis is controversial. Our objective was to examine the association between blood neutrophil counts and outcomes in terms of mortality, the incidence of bacterial infections (including Mycobacterium tuberculosis) and hospitalization among HIV-infected patients presenting with cryptococcal meningitis.MethodsWe used data from participants from the Cryptococcal Optimal ART Timing (COAT) trial (2010–2012; Uganda and South Africa) and the Adjunctive Sertraline for Treatment of Cryptococcal Meningitis (ASTRO-CM) trial (2013–2017; Uganda). We estimated 30-day mortality risk with Cox proportional hazards models by baseline neutrophil counts (a) on a continuous scale and (b) with indicators for both relatively high (> 3,500 cells/mm3) and low (≤ 1,000 cells/mm3) counts. Follow-up neutrophil counts from the COAT trial were used to examine the time-dependent association of neutrophil counts with 12-month mortality and rehospitalization.Results801 participants had an absolute neutrophil value at meningitis diagnosis. The median baseline absolute neutrophil count was 2100 cells/mm3 (IQR, 1400 to 3300 cells/mm3). Baseline neutrophil count was positively associated with 30-day mortality (adjusted hazard ratio = 1.09, 95%CI, 1.04–1.13, per 1000 cells/mm3 increase; p<0.001). Baseline absolute neutrophil counts ≤ 1000 cells/mm3 did not have increased risk of 30-day mortality compared to those with baseline neutrophils of 1001–3500 cells/mm3; however, baseline >3500 cells/mm3 had significantly increased risk, with an adjusted hazard ratio of 1.85(95%CI, 1.40–2.44; p<0.001). Among the COAT participants with follow-up neutrophil data, there was a strong association between time-updated neutrophil count and 12-month mortality (adjusted hazard ratio = 1.16, 95% CI 1.09–1.24; p<0.001.ConclusionHigher blood neutrophil counts in HIV-infected patients with cryptococcal meningitis were associated with mortality. Neutrophils role requires further investigation as to whether this may be a mediator directly contributing to mortality or merely a marker of underlying pathologies that increase mortality risk.

show abstract

Section: Discussionmentioning

confidence: 99%

Blood neutrophil counts in HIV-infected patients with cryptococcal meningitis: Association with mortality

et al. 2018

View full text Add to dashboard Cite

show abstract

“…When it comes to preventing paradoxical C‐IRIS, sufficient and effective antifungal treatment plays an irreplaceable role, because higher residual Cryptococcus burden and related marks such as CRP and IL‐5 indicate higher C‐IRIS incidence . The most simple way to achieve a lower fungal burden before ART is to elongate the antifungal treatment, that is, delaying the initiation of ART.…”

Section: Cryptococcus‐related Immune Reconstitution Inflammatory Syndmentioning

confidence: 99%

Management of human immunodeficiency virus–associated cryptococcal meningitis: Current status and future directions

Shen

2019

Mycoses

View full text Add to dashboard Cite

Summary Cryptococcal meningitis (CM) is one of the most common opportunistic infections of acquired immunodeficiency syndrome (AIDS), as well as an important cause of hospitalisation and death. In recent years, the mortality of CM has remained high in HIV/AIDS population, with up to 30%, including within developed countries. The treatment usually encompasses controls of Cryptococcus, HIV, and increased intracranial pressure. Recent progress on the management of HIV‐associated CM mainly centres in optimising induction regimens, looking for appropriate timing of initiating antiretroviral therapy and prevention of symptomatic onset and adverse consequences. This review compared several international guidelines combined with the results from some clinical researches to illustrate the similarities, differences and potential in CM treatment. The present practice is still far from satisfactory, and there remains much to explore due to our limited understanding of the pathogenesis of HIV‐associated CM. Thus, screening and monitoring should be strengthened, and better therapies in line with the actual situation of each country should be discovered.

show abstract

“…This immunological response is dysregulated and causes inadequate cryptococcal killing and clearance of the fungus within the neuraxis. Patients with HIV/AIDS and with high fungal burden at the time of diagnosis seem to be at the highest risk of IRIS, particularly with rapid restoration of immune activity following ART [ 37 , 39 , 40 ]. However, most of the reports of IRIS associated with CNS cryptococcosis appear to be meningeal involvement in terms of its clinical presentation and also by evidence of leptomeningitis in T1-weighted contrast images [ 22 ].…”

Section: The Intracranial Life Of Cryptococcusmentioning

confidence: 99%

“…CSF examination reveals important degrees of pleocytosis and high opening pressures but negative cultures [ 2 , 36 ]. Cryptococcal associated IRIS may manifest with a constellation of symptoms associated with leptomeningitis and intracranial hypertension [ 38 , 39 ]. This abrupt process occurring a few weeks or months after the institution of ART may manifest clinically with clinical neurologic deterioration; and sometimes with seizures, visual and hearing loss, or mass effect with herniation.…”

Section: The Intracranial Life Of Cryptococcusmentioning

confidence: 99%

Cryptococcal meningoencephalitis in HIV/AIDS: when to start antiretroviral therapy?

Franco‐Paredes

Chastain

Rodríguez‐Morales

et al. 2017

Ann Clin Microbiol Antimicrob

View full text Add to dashboard Cite

Paradoxical immune reconstitution inflammatory syndrome associated with cryptococcal meningitis in China: a 5-year retrospective cohort study

Cited by 13 publications

References 19 publications

Blood neutrophil counts in HIV-infected patients with cryptococcal meningitis: Association with mortality

Blood neutrophil counts in HIV-infected patients with cryptococcal meningitis: Association with mortality

Management of human immunodeficiency virus–associated cryptococcal meningitis: Current status and future directions

Cryptococcal meningoencephalitis in HIV/AIDS: when to start antiretroviral therapy?

Contact Info

Product

Resources

About