Profile of Central Nervous System Disease in HIV/AIDS Patients With Special Reference to Cryptococcal Infections

Wadhwa, Anupriya; Kaur, Ravinder

doi:10.1097/nrl.0b013e3181678a7a

Cited by 14 publications

(14 citation statements)

References 9 publications

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“…The importance of a Th1 immune response for controlling the cryptococcal burden is evident from the high incidence of severe C. neoformans infections in human immunodeficiency virus (HIV)-infected patients (51) and from data obtained with numerous mouse models (19,29,36,53). Here, we provide a molecular explanation for these in vivo observations.…”

Section: Discussionmentioning

confidence: 89%

Cytokine Signaling Regulates the Outcome of Intracellular Macrophage Parasitism byCryptococcus neoformans

2009

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The pathogenic yeast Cryptococcus neoformans and C. gattii commonly cause severe infections of the central nervous system in patients with impaired immunity but also increasingly in immunocompetent individuals. Cryptococcus is phagocytosed by macrophages but can then survive and proliferate within the phagosomes of these infected host cells. Moreover, Cryptococcus is able to escape into the extracellular environment via a recently discovered nonlytic mechanism (termed expulsion or extrusion). Although it is well established that the host's cytokine profile dramatically affects the outcome of cryptococcal disease, the molecular basis for this effect is unclear. Here, we report a systematic analysis of the influence of Th1, Th2, and Th17 cytokines on the outcome of the interaction between macrophages and cryptococci. We show that Th1 and Th17 cytokines activate, whereas Th2 cytokines inhibit, anticryptococcal functions. Intracellular yeast proliferation and cryptococcal expulsion rates were significantly lower after treatment with the Th1 cytokines gamma interferon and tumor necrosis factor alpha and the Th17 cytokine interleukin-17 (IL-17). Interestingly, however, the Th2 cytokines IL-4 and IL-13 significantly increased intracellular yeast proliferation while reducing the occurrence of pathogen expulsion. These results help explain the observed poor prognosis associated with the Th2 cytokine profile (e.g., in human immunodeficiency virus-infected patients).

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Section: Discussionmentioning

confidence: 89%

Cytokine Signaling Regulates the Outcome of Intracellular Macrophage Parasitism byCryptococcus neoformans

2009

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“…[71112] While diagnosis of tuberculosis is often presumptive, cryptococcal meningitis has been proven on CSF examination and toxoplasmosis has been diagnosed only after response to anti-toxoplasma therapy along with a positive antibody screen in plasma.…”

Section: Discussionmentioning

confidence: 99%

Neurological complications in late-stage hospitalized patients with HIV disease

Singh

Kaur

Arora

2011

Ann Indian Acad Neurol

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Background and Objective:The nervous system is the most frequent and serious targets of human immunodeficiency virus (HIV) infection. In spite of a wide prevalence of neurological manifestations in HIV there are not many studies to look into it, especially from this part of the world. We investigated various neurological manifestations of HIV and their association with CD4 and CD8 counts at the time of presentation.Materials and Methods:All HIV-infected patients who presented to 750 bedded teaching hospital in North India were subjected to thorough neurological and neuropsychological evaluation. Wherever indicated, neuroimaging, cerebrospinal fluid study, electromyography, and nerve-conduction studies were performed to confirm the diagnosis. CD4 and CD8 counts were calculated.Results:A total of 416 HIV-positive patients were seen. Of them 269 were males. A total of 312 neurological events were identified in 268 patients having evidence of neurological involvement. HIV-associated dementia (HAD) was the most common cause of morbidity (33.65%), followed by CNS infections (21.63%). Most common CNS infection was tuberculosis (65.56%). CD4 counts in CNS infections and HAD were 64.8/μl and 83.52/μl, respectively. Most of the patients in our study had low scores on MMSE (22.32).Conclusions:Even in the absence of overt neurological disease, subclinical involvement in the form of subtle cognitive and motor decline is found to occur with greater frequency. Most of these patients have lower CD4 and CD8 counts, thus substantiating the proposition that neuroAIDS is a late manifestation. Significant correlation exists between CD4 counts and type of neurological manifestation. We concluded that neuropsychological assessment should be mandatory for all HIV-positive patients.

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“…Fungal meningitis predominantly affects immune compromised, and in particular HIV/AIDS patients, and is usually caused by Cryptococcus neoformans [21]. In CSF, WBCs range from as low as 20 to a maximum of 2000 × 10 6 /L, with a preponderance ( > 50%) of lymphocytes [22].…”

Section: Cerebrospinal Fluid (Csf)mentioning

confidence: 99%

Clinical relevance and contemporary methods for counting blood cells in body fluids suspected of inflammatory disease

Fleming

Russcher

Lindemans

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:In many inflammatory diseases, the cellular components in body fluids [cerebrospinal fluid (CSF), serous fluids] are increased, rendering essential diagnostic information. The diagnostic value of the total white blood cell count (WBC) and differential count has been evaluated extensively over the years, and a remarkable amount of knowledge has been gained; yet, there is a great deal of clinical uncertainty whether the diagnosis should be based solely on these variables. In some diseases, such as peritonitis, the total WBC and differential count has high sensitivity; whereas, in differentiating pleural effusions, it lacks the sensitivity required to be clinically useful. Nevertheless, many guidelines consider these tests as cornerstone parameters, and in combination with clinical variables, they can successfully guide clinical decision making in initiating or postponing a treatment course for infection and/or inflammatory diseases while awaiting culture results. Although other methods are available for detecting and differentiating WBCs in body fluids, manual microscopy is still considered the gold standard despite its many limitations. During the last decade, automated analyzers have become a popular method for first line screening. Continued progress in their design has led to major improvements including their speed, improved accuracy and lower variability compared with microscopy. Disadvantages of this method include high imprecision in low ranges (depending on the method) and interfering factors.In a time where automation is at the front line in clinical laboratories, it is essential the results obtained are precise, accurate and reproducible. This review provides an overview of the relevance for cell counting in a variety of diagnostic body fluids, and highlights the current technologies used.

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Profile of Central Nervous System Disease in HIV/AIDS Patients With Special Reference to Cryptococcal Infections

Cited by 14 publications

References 9 publications

Cytokine Signaling Regulates the Outcome of Intracellular Macrophage Parasitism byCryptococcus neoformans

Cytokine Signaling Regulates the Outcome of Intracellular Macrophage Parasitism byCryptococcus neoformans

Neurological complications in late-stage hospitalized patients with HIV disease

Clinical relevance and contemporary methods for counting blood cells in body fluids suspected of inflammatory disease

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