Treatment recommendations for non-HIV associated cryptococcal meningoencephalitis including management of post-infectious inflammatory response syndrome

Ssebambulidde, Kenneth; Anjum, Seher; Hargarten, Jessica C.; Chittiboina, Prashant; Shoham, Shmuel; Seyedmousavi, Seyedmojtaba; Marr, Kieren A.; Hammoud, Dima A.; Billioux, Bridgette Jeanne; Williamson, Peter R.

doi:10.3389/fneur.2022.994396

Cited by 11 publications

(9 citation statements)

References 99 publications

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“…Cryptococcal IRIS induces an aberrant inflammatory cascade that eventuates in host-mediated neuropathology ( 51 ). Experimental in vivo and in vitro inquiries posited that the pathogenesis of this affliction may originate from the hyperactivation of CD4+ T cells, engendering a cellular immune response that precipitates the proliferation of a myriad of inflammatory mediators within the central nervous system, including TNF-α, IFN-γ, and IL-6 ( 52 , 53 ). Furthermore, the established therapeutic protocol for Cryptococcus infection comprises a triad of amphotericin B, flucytosine, and fluconazole.…”

Section: Discussionmentioning

confidence: 99%

Global trends in Cryptococcus and its interactions with the host immune system: a bibliometric analysis

Tang,

Hao,

Liu

et al. 2024

Front. Immunol.

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ObjectivesThis manuscript undertakes a systematic examination of the research landscape concerning global Cryptococcus species and their dynamism with the host immune system spanning the past decade. It furnishes a detailed survey of leading knowledge institutions and critical focal points in this area, utilizing bibliometric analysis.MethodsVOSviewer and CiteSpace software platforms were employed to systematically analyze and graphically depict the relevant literature indexed in the WoSCC database over the preceding ten years.ResultsIn the interval between October 1, 2013, and October 1, 2023, a corpus of 795 publications was amassed. The primary research institutions involved in this study include Duke University, the University of Minnesota, and the University of Sydney. The leading trio of nations, in terms of publication volume, comprises the United States, China, and Brazil. Among the most prolific authors are Casadevall, Arturo; Wormley, Floyd L., Jr.; and Olszewski, Michal A., with the most highly cited author being Perfect, Jr. The most esteemed journal is Mbio, while Infection and Immunity commands the highest citation frequency, and the Journal of Clinical Microbiology boasts the most significant impact factor. Present research foci encompass the intricate interactions between Cryptococcus pathogenesis and host immunity, alongside immune mechanisms, complications, and immunotherapies.ConclusionThis represents the first exhaustive scholarly review and bibliometric scrutiny of the evolving landscapes in Cryptococcus research and its interactions with the host immune system. The analyses delineated herein provide insights into prevailing research foci and trajectories, thus furnishing critical directions for subsequent inquiries in this domain.

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Section: Discussionmentioning

confidence: 99%

Global trends in Cryptococcus and its interactions with the host immune system: a bibliometric analysis

Tang,

Hao,

Liu

et al. 2024

Front. Immunol.

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“…Treatment focuses on controlling inflammation with corticosteroids while addressing the underlying cause by optimizing antifungal therapy. PIRS requires prompt recognition to prevent long-term neurological complications and careful management balancing anti-inflammatory measures with the need for continued infection control [ 15 ]. Therefore, when the condition of a patient being treated for CM worsens, PIRS should be considered.…”

Section: Discussionmentioning

confidence: 99%

Chronic cryptococcal meningitis with a cryptococcoma presenting as normal pressure hydrocephalus: a case report

Seo,

Kim,

Shin

2023

encephalitis

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Chronic meningitis may present with clinical features related to hydrocephalus. We report a 76-year-old female who presented to an outpatient clinic with cognitive decline and gait disturbance with recurrent falls. The initial diagnosis of normal pressure hydrocephalus (NPH) was based on the clinical symptoms and magnetic resonance imaging (MRI) of the brain, which showed ventriculomegaly without an obstructive lesion. During follow-up, however, there was remarkable cognitive decline, and she was unable to walk without assistance. Lumbar puncture and brain MRI showed respective lymphocyte-dominant pleocytosis that was positive for cryptococcal antigen and a new encapsulated abscess-like lesion in a left caudate head. Treatment for cryptococcal meningitis was initiated, and the patient was cured after a long treatment with an antifungal agent. As chronic meningitis could be misdiagnosed as NPH, differential diagnoses of etiologies that can cause hydrocephalus should be addressed.

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“…Arguably the biggest question is the best treatment regimen for this patient group. Unfortunately, there is a lack of data in the non-HIV, nontransplant group, and treatment recommendations are extrapolated from patients with HIV [ 75 ]. Recently, Ssebambulidde et al did provide recommendations for non-HIV-associated cryptococcal meningoencephalitis, but the recommendations were still extrapolated mainly from patients with HIV [ 76 ].…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal Meningitis in Young, Immunocompetent Patients: A Single-Center Retrospective Case Series and Review of the Literature

Stack

Hiles

Valinetz

et al. 2023

Open Forum Infectious Diseases

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Background Cryptococcal meningitis is an uncommon but serious infection with a high mortality and morbidity. Classically described in immunocompromised patients, including those with solid organ transplants or HIV/AIDS, cryptococcosis has also been reported in young and otherwise healthy patients, albeit rarely. Methods We retrospectively searched for all cases of cryptococcal meningitis in young (≤50 years) and previously healthy patients with no known immunocompromising conditions from January 2015 to January 2022 at Indiana University Health (IU Health). Additionally, a PubMed literature review was performed with the keywords “cryptococcal meningitis” and “immunocompetent” from January 1988 to January 2022. Clinical courses, including outcomes and treatment regimens were evaluated. Results We identified 4 local cases of cryptococcal meningitis in otherwise healthy patients ≤50 years. Three cases were due to Cryptococcus neoformans with one experiencing a post-infectious inflammatory response syndrome (PIIRS). The PubMed search identified 51 additional cases with 32 (63%) being caused by Cryptococcus neoformans and 8 (17%) by Cryptococcus gattii. Of the 51 cases, only two resulted in death directly due to cryptococcosis. Fifteen (29%) had PIIRS with steroid treatment documented in 11 of 15. Antifungal induction regimens and duration were varied but predominately consisted of amphotericin and flucytosine with a mean induction duration of 5.0 weeks. Conclusions Cryptococcal meningitis in young, previously healthy patients is likely under-recognized. PIIRS (akin to IRIS observed in HIV/AIDS) with prolonged recovery should be of concern. Determining risks factors for cryptococcosis in these patients remains elusive.

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Treatment recommendations for non-HIV associated cryptococcal meningoencephalitis including management of post-infectious inflammatory response syndrome

Cited by 11 publications

References 99 publications

Global trends in Cryptococcus and its interactions with the host immune system: a bibliometric analysis

Global trends in Cryptococcus and its interactions with the host immune system: a bibliometric analysis

Chronic cryptococcal meningitis with a cryptococcoma presenting as normal pressure hydrocephalus: a case report

Cryptococcal Meningitis in Young, Immunocompetent Patients: A Single-Center Retrospective Case Series and Review of the Literature

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