دورية أكاديمية
Symptomatic Cryptococcal Antigenemia Presenting as Early Cryptococcal Meningitis With Negative Cerebral Spinal Fluid Analysis.
| العنوان: | Symptomatic Cryptococcal Antigenemia Presenting as Early Cryptococcal Meningitis With Negative Cerebral Spinal Fluid Analysis. |
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| المؤلفون: | Ssebambulidde K; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda., Bangdiwala AS; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis., Kwizera R; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda., Kandole TK; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda., Tugume L; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda., Kiggundu R; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda., Mpoza E; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda., Nuwagira E; Department of Internal Medicine, Mbarara University of Science and Technology, Uganda., Williams DA; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.; Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis., Lofgren SM; Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis., Abassi M; Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis., Musubire AK; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.; Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda., Cresswell FV; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom., Rhein J; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.; Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis., Muzoora C; Department of Internal Medicine, Mbarara University of Science and Technology, Uganda., Hullsiek KH; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis., Boulware DR; Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis., Meya DB; Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.; Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis.; Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda. |
| مؤلفون مشاركون: | Adjunctive Sertraline for Treatment of HIV-associated Cryptococcal Meningitis Team |
| المصدر: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2019 May 30; Vol. 68 (12), pp. 2094-2098. |
| نوع المنشور: | Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: United States NLM ID: 9203213 Publication Model: Print Cited Medium: Internet ISSN: 1537-6591 (Electronic) Linking ISSN: 10584838 NLM ISO Abbreviation: Clin Infect Dis Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Jan. 2011- : Oxford : Oxford University Press Original Publication: Chicago, IL : The University of Chicago Press, c1992- |
| مواضيع طبية MeSH: | Cryptococcus neoformans*/immunology, Antigens, Fungal/*blood , Meningitis, Cryptococcal/*blood , Meningitis, Cryptococcal/*diagnosis, Adult ; Antigens, Fungal/cerebrospinal fluid ; Biomarkers ; Female ; Humans ; Male ; Meningitis, Cryptococcal/cerebrospinal fluid ; Meningitis, Cryptococcal/immunology ; Symptom Assessment |
| مستخلص: | Background: Individuals with cryptococcal antigenemia are at high risk of developing cryptococcal meningitis if untreated. The progression and timing from asymptomatic infection to cryptococcal meningitis is unclear. We describe a subpopulation of individuals with neurologic symptomatic cryptococcal antigenemia but negative cerebral spinal fluid (CSF) studies. Methods: We evaluated 1201 human immunodeficiency virus-seropositive individuals hospitalized with suspected meningitis in Kampala and Mbarara, Uganda. Baseline characteristics and clinical outcomes of participants with neurologic-symptomatic cryptococcal antigenemia and negative CSF cryptococcal antigen (CrAg) were compared to participants with confirmed CSF CrAg+ cryptococcal meningitis. Additional CSF testing included microscopy, fungal culture, bacterial culture, tuberculosis culture, multiplex FilmArray polymerase chain reaction (PCR; Biofire), and Xpert MTB/Rif. Results: We found 56% (671/1201) of participants had confirmed CSF CrAg+ cryptococcal meningitis and 4% (54/1201) had neurologic symptomatic cryptococcal antigenemia with negative CSF CrAg. Of those with negative CSF CrAg, 9% (5/54) had Cryptococcus isolated on CSF culture (n = 3) or PCR (n = 2) and 11% (6/54) had confirmed tuberculous meningitis. CSF CrAg-negative patients had lower proportions with CSF pleocytosis (16% vs 26% with ≥5 white cells/μL) and CSF opening pressure >200 mmH2O (16% vs 71%) compared with CSF CrAg-positive patients. No cases of bacterial or viral meningitis were detected by CSF PCR or culture. In-hospital mortality was similar between symptomatic cryptococcal antigenemia (32%) and cryptococcal meningitis (31%; P = .91). Conclusions: Cryptococcal antigenemia with meningitis symptoms was the third most common meningitis etiology. We postulate this is early cryptococcal meningoencephalitis. Fluconazole monotherapy was suboptimal despite Cryptococcus-negative CSF. Further studies are warranted to understand the clinical course and optimal management of this distinct entity. Clinical Trials Registration: NCT01802385. (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.) |
| التعليقات: | Comment in: Clin Infect Dis. 2019 May 17;68(11):1978-1979. (PMID: 30535266) Comment in: Clin Infect Dis. 2020 Mar 17;70(7):1521-1522. (PMID: 31312835) |
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| معلومات مُعتمدة: | MR/M007413/1 United Kingdom MRC_ Medical Research Council; M007413/1 United Kingdom MRC_ Medical Research Council; K01 TW010268 United States TW FIC NIH HHS; T32 AI055433 United States AI NIAID NIH HHS; 107742/Z/15/Z United Kingdom WT_ Wellcome Trust; United Kingdom WT_ Wellcome Trust; R25 TW009345 United States TW FIC NIH HHS; K43 TW010718 United States TW FIC NIH HHS; R01 NS086312 United States NS NINDS NIH HHS |
| فهرسة مساهمة: | Keywords: HIV; aseptic meningitis; cryptococcal meningitis; diagnosis; fungal antigen |
| سلسلة جزيئية: | ClinicalTrials.gov NCT01802385 |
| المشرفين على المادة: | 0 (Antigens, Fungal) 0 (Biomarkers) |
| تواريخ الأحداث: | Date Created: 20180927 Date Completed: 20200728 Latest Revision: 20231012 |
| رمز التحديث: | 20231012 |
| مُعرف محوري في PubMed: | PMC6541705 |
| DOI: | 10.1093/cid/ciy817 |
| PMID: | 30256903 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1537-6591 |
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| DOI: | 10.1093/cid/ciy817 |