Cerebrospinal fluid profiles in acquired immunodeficiency syndrome with and without neurocryptococcosis

Garlipp, Célia Regina; Rossi, Claudio; Bottini, P.V.

doi:10.1590/s0036-46651997000600003

Cited by 14 publications

(13 citation statements)

References 11 publications

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“…In AIDS patients and those with cryptococcosis, abnormal CSF is found in 69%, and in the group with no identified neurological dysfunction, abnormal CSF is found in 61%. Lymphocytes were the most frequent cells in both groups (39). …”

Section: Discussionmentioning

confidence: 97%

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Quantification of cerebrospinal fluid lactic acid in the differential diagnosis between HIV chronic meningitis and opportunistic meningitis

Almeida

Boritza²,

Cogo³

et al. 2011

Clinical Chemistry and Laboratory Medicine

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Background Approximately 40% of HIV infected patients have chronic meningitis at various stages during the infection, 59% are asymptomatic. This is a diagnosis of exclusion and a confounding factor in cerebrospinal fluid (CSF) analysis, any other causes of chronic meningitis by opportunistic or co-infection must be ruled out. The aim of this study was to analyze CSF lactic acid (LA) as an adjuvant biomarker in chronic meningitis due to HIV. Methods CSF LA was quantified in 223 CSF samples by the Dimension AR (Dade Behring, Deerfield, IL, USA), distributed into nine groups: 1) HIV positive with an increase in CSF WBCs (n = 17); 2) HIV positive with normal CSF (n = 20); 3) enterovirus meningitis (n = 33); 4) Herpesviridae meningoencephalitis (n = 30); 5) fungal meningitis (n = 25); 6) tuberculosis (TB) meningitis (n = 17); 7) toxoplasmosis (n = 18); 8) neurosyphilis (n = 6); 9) control group (n = 57). Results CSF LA (median; IQR) was higher in samples with TB meningitis (5.5; 2.9–7.5 mmol/L) and Cryptococcus neoformans meningitis (3.9; 2.7–5.8 mmol/L) compated with samples with HIV chronic meningitis (1.7; 1.4–1.9 mmol/L) and other groups (p≤0.0001). For the diagnosis of HIV chronic meningitis, using a cut-off of 3.5 mmol/L, CSF LA showed high sensitivity and negative predictive value, although low specificity. Conclusions CSF LA helps to discriminate between C. neoformans or TB meningitis and HIV chronic meningitis: CSF LA can be included with the methods currently used to identify these specific pathogens, though it does not replace them. It is rapid, inexpensive and easy to perform, and can be used in developing countries.

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Section: Discussionmentioning

confidence: 97%

“…CSF abnormalities are quite frequent in these patients, are non-specific and difficult to interpret. In these circumstances, a systematic search to identify the etiologic agent using microbiological and/or immunological assays or molecular biology, when available, should be routinely performed (39). …”

Section: Discussionmentioning

confidence: 99%

Quantification of cerebrospinal fluid lactic acid in the differential diagnosis between HIV chronic meningitis and opportunistic meningitis

Almeida

Boritza²,

Cogo³

et al. 2011

Clinical Chemistry and Laboratory Medicine

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“…One possible explanation of the noninflammatory CSF profile was that the disseminated infection was detected relatively early in the course before a detectable level of antigen could be achieved in the CSF. In contrast, the noninflammatory CSF analysis may be due to an immune defect similar to that seen in acquired immunodeficiency syndrome, where 25%–30% of patients will have normal CSF profiles despite CNS infection documented by positive fungal cultures [22, 23]. …”

Section: Discussionmentioning

confidence: 99%

Disseminated Cryptococcosis With Brain Involvement in Patients With Chronic Lymphoid Malignancies on Ibrutinib

Messina

Maziarz

Spec

et al. 2017

Open Forum Infectious Diseases

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“…Brain imaging should be sent before the procedure in patients who have focal neurological deficits or impaired consciousness. Analysis of the CSF generally reveals normal to mild pleocytosis, with a mononuclear predominance, mildly elevated protein levels, and low-to normal glucose levels [52–54]. Normal CSF white blood cell (WBC) counts, protein levels and glucose levels can be occasionally observed.…”

Section: Introductionmentioning

confidence: 99%

Integrated therapy for HIV and cryptococcosis

Srichatrapimuk

Sungkanuparph

2016

AIDS Res Ther

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Cryptococcosis has been one of the most common opportunistic infections and causes of mortality among HIV-infected patients, especially in resource-limited countries. Cryptococcal meningitis is the most common form of cryptococcosis. Laboratory diagnosis of cryptococcosis includes direct microscopic examination, isolation of Cryptococcus from a clinical specimen, and detection of cryptococcal antigen. Without appropriate treatment, cryptococcosis is fatal. Early diagnosis and treatment is the key to treatment success. Treatment of cryptococcosis consists of three main aspects: antifungal therapy, intracranial pressure management for cryptococcal meningitis, and restoration of immune function with antiretroviral therapy (ART). Optimal integration of these three aspects is crucial to achieving successful treatment and reducing the mortality. Antifungal therapy consists of three phases: induction, consolidation, and maintenance. A combination of two drugs, i.e. amphotericin B plus flucytosine or fluconazole, is preferred in the induction phase. Fluconazole monotherapy is recommended during consolidation and maintenance phases. In cryptococcal meningitis, intracranial pressure rises along with CSF fungal burden and is associated with morbidity and mortality. Aggressive control of intracranial pressure should be done. Management options include therapeutic lumbar puncture, lumbar drain insertion, ventriculostomy, or ventriculoperitoneal shunt. Medical treatment such as corticosteroids, mannitol, and acetazolamide are ineffective and should not be used. ART has proven to have a great impact on survival rates among HIV-infected patients with cryptococcosis. The time to start ART in HIV-infected patients with cryptococcosis has to be deferred until 5 weeks after the start of antifungal therapy. In general, any effective ART regimen is acceptable. Potential drug interactions between antiretroviral agents and amphotericin B, flucytosine, and fluconazole are minimal. Of most potential clinical relevance is the concomitant use of fluconazole and nevirapine. Concomitant use of these two drugs should be cautious, and patients should be monitored closely for nevirapine-associated adverse events, including hepatotoxicity. Overlapping toxicities of antifungal and antiretroviral drugs and immune reconstitution inflammatory syndrome are not uncommon. Early recognition and appropriate management of these consequences can reinforce the successful integrated therapy in HIV-infected patients with cryptococcosis.

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Cerebrospinal fluid profiles in acquired immunodeficiency syndrome with and without neurocryptococcosis

Cited by 14 publications

References 11 publications

Quantification of cerebrospinal fluid lactic acid in the differential diagnosis between HIV chronic meningitis and opportunistic meningitis

Quantification of cerebrospinal fluid lactic acid in the differential diagnosis between HIV chronic meningitis and opportunistic meningitis

Disseminated Cryptococcosis With Brain Involvement in Patients With Chronic Lymphoid Malignancies on Ibrutinib

Integrated therapy for HIV and cryptococcosis

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