A one-year longitudinal evaluation of cerebrospinal fluid and blood neurochemical markers in a patient with cryptococcal meningitis complicated by ischemic stroke.

Abu‐Rumeileh, Samir; Garibashvili, Tamara; Hagemann, Jürgen Benjamin; Still, Veronika; Bachhuber, Franziska; Tumani, Hayrettin; Şenel, Makbule

doi:10.1016/j.jns.2021.120090

Cited by 3 publications

(9 citation statements)

References 15 publications

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“…Inflammation of cerebral vessels, i.e., vasculitis, is not mentioned in pathology reports of cryptococcal meningitis [ 30 , 31 ]. In published reports, CT angiography and MR angiography (MRA) have either shown normal or narrowed cerebral arteries in cryptococcal meningitis patients with infarcts [ 32 , 33 , 34 ] Most of those infarcts were seen in the basal ganglia, along the distribution of the lenticulostriate arteries.…”

Section: Discussionmentioning

confidence: 99%

Neuroimaging of Cryptococcal Meningitis in Patients without Human Immunodeficiency Virus: Data from a Multi-Center Cohort Study

Anjum

Bennett

Dean

et al. 2023

JoF

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Background: A clearer understanding is needed about the use of brain MRI in non-HIV patients with cryptococcal meningitis. Methods: Cerebral CT and MRI were studied in 62 patients in a multicenter study of cryptococcal meningitis in non-HIV patients. CT was performed in 51 and MRI in 44. MRI results are reported for the images read at NIH for 29 of the 44 patients. CT reports obtained from the original REDCap database were added to calculate the incidence of normal findings. Results: CTs were read as normal in 24 of 51 (47%), MRIs were normal in 10% (three of 29). The most characteristic lesions of cryptococcal meningitis on MRI were small basal ganglia lesions representing dilated perivascular spaces in 24% and basal ganglia lesions with restricted diffusion (infarcts) in 38%. In the 18 patients who received contrast, contrast-enhancing lesions, likely representing masses of cryptococci and inflammatory cells, were found in the basal ganglia in 22% and elsewhere in the brain in 22%. Meningeal enhancement was seen in 56%, ependymal enhancement in 24%, and choroid plexus enhancement in 11%. Hydrocephalus was found in five (18%), though increased intacranial pressure was not detected. Suboptimal imaging (n = 6), lack of contrast administration (n = 11) and lack of follow-up, however, markedly limited the accurate assessment of abnormalities in multiple cases. Conclusion: MRI characteristics of non-HIV cryptococcal meningitis include hydrocephalus, meningeal and ependymal enhancement and basal ganglia lesions. Optimal imaging is, however, necessary to maximize the diagnostic and prognostic usefulness of MRI.

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Section: Discussionmentioning

confidence: 99%

Neuroimaging of Cryptococcal Meningitis in Patients without Human Immunodeficiency Virus: Data from a Multi-Center Cohort Study

Anjum

Bennett

Dean

et al. 2023

JoF

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“…Three patients with cerebral cryptococcosis and concomitant neurosarcoidosis had CSF-CXCL13 levels considerably above the threshold (1380 pg/mL, 2307 pg/mL, 45,609 pg/mL), similar to in one patient with aspergillosis and CNS involvement (480 pg/mL). Three of them had meningoencephalitis, and one patient had meningitis due to cerebral cryptococcosis with vasculitis and stroke [ 17 ]. Similarly, three patients with optic neuritis due to serologically confirmed syphilis and probable neurosyphilis (Treponema pallidum specific AI < 1.5) but pleocytosis (3/3), blood–CSF barrier dysfunction (2/3), and intrathecal IgM synthesis (1/3) had CSF-CXCL13 levels surpassing the cut-off (5600 pg/mL, 1865 pg/mL, 959 pg/mL).…”

Section: Resultsmentioning

confidence: 99%

“…(B) In neuroinfectious diseases, CSF-CXCL13 can be used for differential diagnosis since in some diseases, such as neuroborreliosis, cryptococcal meningitis, or neurosyphilis, very high CSF-CXCL13 values could be observed. (C) Additionally, as described in our study and the literature, CSF-CXCL13 can be used for therapy monitoring in neuroborreliosis, cryptococcal meningitis, autoimmune encephalitis, and primary CNS B-cell lymphoma [9,10,17,19,20]. As summarized in Table 4 and Figure 7, implementing CXCL13 into the clinical routine diagnostics is discussed considering its advantages and limitations and the proposed cut-offs.…”

Section: Conclusion and Future Perspectivementioning

confidence: 89%

“…In neurological inflammatory diseases, the value of CSF-CXCL13 correlates with the level of CSF pleocytosis, CSF/serum albumin ratio, level of intrathecal immunoglobulin synthesis, CSF-specific oligoclonal IgG bands, B cells, plasmablasts, CXCR5+ T cells, and monocytes [ 4 , 13 , 14 , 15 , 16 ]. The marked elevation of CSF-CXCL13 has also been reported in neurosyphilis, primary and secondary CNS lymphoma, autoimmune encephalitis, multiple sclerosis, and cryptococcosis with CNS involvement [ 17 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 91%

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CXCL13 in Cerebrospinal Fluid: Clinical Value in a Large Cross-Sectional Study

Erhart,

Klose,

Schäper

et al. 2023

IJMS

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C-X-C-motif chemokine ligand 13 (CXCL13) in cerebrospinal fluid (CSF) is increasingly used in clinical routines, although its diagnostic specificity and divergent cut-off values have been defined so far mainly for neuroborreliosis. Our aim was to evaluate the value of CSF-CXCL13 as a diagnostic and treatment response marker and its role as an activity marker in a larger disease spectrum, including neuroborreliosis and other neuroinflammatory and malignant CNS-disorders. Patients who received a diagnostic lumbar puncture (LP) (n = 1234) between July 2009 and January 2023 were included in our retrospective cross-sectional study. The diagnostic performance of CSF-CXCL13 for acute neuroborreliosis was highest at a cut-off of 428.92 pg/mL (sensitivity: 92.1%; specificity: 96.5%). In addition, CXCL13 levels in CSF were significantly elevated in multiple sclerosis with clinical (p = 0.001) and radiographic disease activity (p < 0.001). The clinical utility of CSF-CXCL13 appears to be multifaceted. CSF-CXCL13 is significantly elevated in patients with neuroborreliosis and shows a rapid and sharp decline with antibiotic therapy, but it is not specific for this disease and is also highly elevated in less common subacute neuroinfectious diseases, such as neurosyphilis and cryptococcal meningitis or in primary/secondary B-cell lymphoma.

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“…Moreover, other CSF and blood markers (i.e. chemokine ligand 13 and neurofilament light chain protein) have been investigated recently ( 3 ). Nevertheless, diagnostic errors and delays might still occur and be associated with worse neurological outcomes and increased mortality.…”

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confidence: 99%