Predictors of postinfectious inflammatory response syndrome in HIV-negative immunocompetent cryptococcal meningitis

Liu, Jia; Luo, Chongliang; Li, Min; Wang, Yijie; Xu, Xiaofeng; Yang, Lu; Qin, Bang-E; Chen, Yong; Jiang, Ying; Peng, Fuhua

doi:10.1136/jnnp-2020-324921

Cited by 7 publications

(5 citation statements)

References 4 publications

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“…Although the exact reason for CM-PIIRS remains unclear, some studies have also been carried out. Our previous study indicated that baseline hearing impairment and high CSF pressure (>230 mmH2O) may be predictors of PIIRS in HIV-negative immunocompetent CM patients (10,11), and a prospective study including 25 patients showed that 88% of non-HIV CM patients developed PIIRS after VPS (10,11). As some literature reported (5,6,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), our case got initial neurological improvement after the use of corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Post-Infectious Inflammatory Response Syndrome in an HIV-Negative Immunocompetent Elderly Patient With Cryptococcal Meningitis: A Case Report and Literature Review

et al. 2022

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We report a previously healthy 82-year-old male with cryptococcal meningitis (CM) who represented neurological deterioration due to post-infectious inflammatory response syndrome (PIIRS) occurring in 4 months after initial antifungal therapy. He was treated with corticosteroids for 2 months and recovered clinically. However, the clinical manifestation, cerebrospinal fluid (CSF), and brain magnetic resonance imaging (MRI) results got worse again on the next day after corticosteroid withdrawal. The analysis of inflammatory cytokines and culture on CSF, as well as brain MRI, still suggested a diagnosis of PIIRS. Therefore, corticosteroid therapy was used again and he subsequently obtained a complete resolution of symptoms.

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Section: Discussionmentioning

confidence: 99%

Post-Infectious Inflammatory Response Syndrome in an HIV-Negative Immunocompetent Elderly Patient With Cryptococcal Meningitis: A Case Report and Literature Review

et al. 2022

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“…Only a few studies have been conducted on CM-PIIRS, and there is no universal diagnostic criteria or a standardized treatment protocol. We diagnosed CM-PIIRS based on abnormal deterioration of clinical symptoms, changes in cranial MRI, and variations in relevant inflammatory parameters in CSF after effective antifungal therapy (persistently negative fungal culture), after excluding active infections, tumors, and drug causes [ 2 , 12 ]. C. gattii utilizes the neurotransmitters (including dopamine, epinephrine, etc.)…”

Section: Discussionmentioning

confidence: 99%

“…in the CSF, which contributes to the formation of melanin, protection against oxidative stress and phagocytosis, and development of CM-PIIRS [ 13 ]. There are reports that low-dose glucocorticoids can significantly improve symptoms of CM-PIIRS [ 12 , 14 ]. Therefore, we treated the patient with sodium phosphate dexamethasone and achieved a satisfactory effect.…”

Section: Discussionmentioning

confidence: 99%

Post-infectious inflammatory response syndrome in an HIV-negative patient after Cryptococcus gattii meningoencephalitis: a case report and review of the literature

Lan

et al. 2023

J Med Case Reports

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Background Cryptococcal meningitis (CM) is an inflammatory mycosis of the central nervous system caused by meninge infection or brain parenchyma with Cryptococcus species. It is associated with high morbidity and mortality, and patients with acquired immune deficiency syndrome are particularly susceptible. There have been increasing reports of CM in HIV-negative patients in China over the last few years. Case presentation A 31-year-old healthy Chinese male presented with fever and gradually developed headache, projectile vomiting, and other manifestations that were later confirmed as Cryptococcus gattii meningoencephalitis. However, multiple disease changes occurred during the course of treatment, and the regimen was accordingly modified after the diagnosis of post-infectious inflammatory response syndrome (PIIRS). The patient eventually recovered. Conclusion There has been a growing trend in the incidence of C. gattii meningoencephalitis in HIV-negative patients. It shows rapid onset and severe prognosis. This case report can provide a reference to treat PIIRS following CM in HIV-negative patients.

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“…Continuous variables were performed by nonparametric Mann–Whitney U test and categorical variables were compared using the chi‐square test. CSF fungal counts were modelled using a linear mixed‐effects model according to our recently published paper 17 . p < .05 was considered statistically significant.…”

Section: Methodsmentioning

confidence: 99%

Comparison of features and outcomes between HIV‐negative patients with Cryptococcus gattii meningitis and Cryptococcus neoformans meningitis in South China

Liu

et al. 2022

Mycoses

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Objectives The objective of this study is to compare the epidemiologic, clinical, laboratory, and imaging features, and outcomes in patients with Cryptococcus gattii meningitis (CGM) and Cryptococcus neoformans meningitis (CNM). Methods We performed a retrospective study of HIV‐negative patients with CGM and CNM (2015–2021) distinguished by metagenomic next‐generation sequencing in cerebrospinal fluid in South China. Results A total of 81 patients (17 CGM, 64 CNM) were enrolled (72.8% male, median age 49 years, range 21–77 years), and CGM patients were younger (median, 43 vs 53 years, p = .005). Of 17 CGM, VGI and VGII accounted for 70.6% and 29.4%, respectively. CGM patients had less underlying diseases (7/17 [41.2%] vs 48/64 [75%], p = .018) and focal neurologic deficit (3/17 [17.6%] vs 35/64 [54.7%], p = .022), had higher intracranial pressure (15/17 [88.2%] vs 25/64 [39.1%], p = .002), more meningeal enhancement (14/17 [82.4%] vs 32/64 [50%], p = .034), less parenchymal involvement (median, 1 vs 3, p = .018), more lung cryptococcomas (6/12 [50%] vs 6/47 [12.8%], p = .014), faster CSF fungal clearance (p = .004), less complications (median, 1 vs 3, p < .001), and more favourable outcomes (16/17 [94.1%] vs 41/64 [64.1%], p = .035). Conclusions This study demonstrated that species identification helps to guide therapy and predict outcomes.

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Predictors of postinfectious inflammatory response syndrome in HIV-negative immunocompetent cryptococcal meningitis

Cited by 7 publications

References 4 publications

Post-Infectious Inflammatory Response Syndrome in an HIV-Negative Immunocompetent Elderly Patient With Cryptococcal Meningitis: A Case Report and Literature Review

Post-Infectious Inflammatory Response Syndrome in an HIV-Negative Immunocompetent Elderly Patient With Cryptococcal Meningitis: A Case Report and Literature Review

Post-infectious inflammatory response syndrome in an HIV-negative patient after Cryptococcus gattii meningoencephalitis: a case report and review of the literature

Comparison of features and outcomes between HIV‐negative patients with Cryptococcus gattii meningitis and Cryptococcus neoformans meningitis in South China

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