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Cryptococcal meningitis

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https://www.readbyqxmd.com/read/28346317/the-csf-immune-response-in-hiv-1-associated-cryptococcal-meningitis-macrophage-activation-correlates-of-disease-severity-and-effect-of-antiretroviral-therapy
#1
James E Scriven, Lisa M Graham, Charlotte Schutz, Thomas J Scriba, Katalin A Wilkinson, Robert J Wilkinson, David R Boulware, Britta C Urban, Graeme Meintjes, David G Lalloo
BACKGROUND: Immune modulation may improve outcome in HIV-associated cryptococcal meningitis. Animal studies suggest alternatively activated macrophages are detrimental but human studies are limited. We performed a detailed assessment of the cerebrospinal fluid (CSF) immune response and examined immune correlates of disease severity and poor outcome, and the effects of antiretroviral therapy (ART). METHODOLOGY: We enrolled persons ≥18 years with first episode of HIV-associated cryptococcal meningitis...
March 24, 2017: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/28339414/update-on-the-application-of-optic-nerve-sheath-fenestration
#2
Hui Chen, Qian Zhang, Song Tan, Huazhu Fu, Bradley K Farris, Zhenglin Yang
BACKGROUND: With the ongoing development of surgical procedures and instruments, the safety of optic nerve sheath fenestration (ONSF) has been improved. OBJECTIVE: Through the past three decades, progress has been made in preventing visual loss from chronic optic nerve swelling in idiopathic intracranial hypertension (IIH), secondary intracranial hypertension and local optic nerve diseases. We now review the updated application of ONSF in those diseases. METHODS: The application of ONSF in papilledema due to IIH, secondary intracranial hypertension to cerebral venous sinus occlusion, Cryptococcal meningitis, and intracranial mass or tumors is reviewed...
March 23, 2017: Restorative Neurology and Neuroscience
https://www.readbyqxmd.com/read/28335769/cost-effectiveness-of-crag-lfa-screening-for-cryptococcal-meningitis-among-people-living-with-hiv-in-uganda
#3
Anu Ramachandran, Yukari Manabe, Radha Rajasingham, Maunank Shah
BACKGROUND: Cryptococcal meningitis (CM) constitutes a significant source of mortality in resource-limited regions. Cryptococcal antigen (CRAG) can be detected in the blood before onset of meningitis. We sought to determine the cost-effectiveness of implementing CRAG screening using the recently developed CRAG lateral flow assay in Uganda compared to current practice without screening. METHODS: A decision-analytic model was constructed to compare two strategies for cryptococcal prevention among people living with HIV with CD4 < 100 in Uganda: No cryptococcal screening vs...
March 23, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28334020/immune-correlates-of-hiv-associated-cryptococcal-meningitis
#4
Mark W Tenforde, James E Scriven, Thomas S Harrison, Joseph N Jarvis
No abstract text is available yet for this article.
March 2017: PLoS Pathogens
https://www.readbyqxmd.com/read/28333858/immune-reconstitution-inflammatory-syndrome-causing-progressive-optic-nerve-edema-in-cryptococcal-meningitis
#5
Astrid C Werner, Laurel N Vuong, Thomas R Hedges, Caroline R Baumal
PURPOSE: To report an human immunodeficiency virus-positive patient undergoing therapy for cryptococcal meningitis who developed progressive optic disc edema that was steroid responsive. METHODS: Observational case report. RESULTS: One month after commencing antifungal treatment for cryptococcal meningitis, the patient developed bilateral, progressive, recurrent optic disc edema with subretinal fluid that coincided with initiation of highly active antiretroviral therapy and recovery of CD4 cell counts...
March 22, 2017: Retinal Cases & Brief Reports
https://www.readbyqxmd.com/read/28329080/differences-in-immunologic-factors-among-patients-presenting-with-altered-mental-status-during-cryptococcal-meningitis
#6
Sarah Lofgren, Kathy H Hullsiek, Bozena M Morawski, Henry W Nabeta, Reuben Kiggundu, Kabanda Taseera, Abdu Musubire, Charlotte Schutz, Mahsa Abassi, Nathan C Bahr, Lillian Tugume, Conrad Muzoora, Darlisha A Williams, Melissa A Rolfes, Sruti S Velamakanni, Radha Rajasingham, Graeme Meintjes, Joshua Rhein, David B Meya, David R Boulware
Altered mental status in cryptococcal meningitis results in poorer survival, but underlying causes of altered mentation are poorly understood. Within two clinical trials, we assessed risk factors for altered mental status (GCS score<15) considering baseline clinical characteristics, CSF cytokines/chemokines, and antiretroviral therapy. Among 326 enrolled participants, 97 (30%) had GCS<15 and these patients had lower median CSF cryptococcal antigen titers (P=0.042) and CCL2 (P=0.005) but higher opening pressures (320 vs...
January 30, 2017: Journal of Infectious Diseases
https://www.readbyqxmd.com/read/28326747/laboratory-methods-for-diagnostics-of-hiv-infection-and-hiv-associated-neuroinfections
#7
Pavol Beno, Alzbeta Kaiglova, Martin Samohyl
HIV Infection resulting in AIDS remains serious global public health problem. In the fight with the global health problem plays a key role a simple, reliable and fast diagnostics. An important method in diagnostics is the identification and detection of viral capside p24 antigen levels. Fourth generation tests for the diagnostics of HIV infection simultaneously detect the presence of HIV antibodies and p24 antigen. Based on the monitoring of CD4 count, we can estimate the stage in which the infection is, and we can also suggest a therapeutic approach...
January 2017: Neuro Endocrinology Letters
https://www.readbyqxmd.com/read/28320715/experimental-models-of-short-courses-of-liposomal-amphotericin-b-for-induction-therapy-for-cryptococcal-meningitis
#8
Jodi Lestner, Laura McEntee, Adam Johnson, Joanne Livermore, Sarah Whalley, Julie Schwartz, John R Perfect, Thomas Harrison, William Hope
Cryptococcal meningoencephalitis is a rapidly lethal infection in immunocompromised patients. Induction regimens are usually administered for 2-weeks. The shortest effective period of induction therapy with liposomal amphotericin B (LAmB) is unknown. The pharmacodynamics of LAmB were studied in murine and rabbit models of cryptococcal meningoencephalitis. The concentrations of LAmB in plasma and brain of mice were measured using HPLC. Histopathological changes were determined. The penetration of LAmB into the brain was determined by immunohistochemistry using an antibody directed to amphotericin B...
March 20, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28303828/high-prevalence-of-cryptococcal-antigenaemia-amongst-asymptomatic-advanced-hiv-patients-in-pune-india
#9
Dileep Kadam, Ajay Chandanwale, Renu Bharadwaj, Neetal Nevrekar, Samir Joshi, Sandesh Patil, Nikhil Gupte, Shashi Sangle, Kavita Chopade, Vandana Kulkarni, Usha Balasubramanian, Nishi Suryavanshi, Divyashri Jain, Savita Kanade, Sujata Dharmashale, Anju Kagal, Amita Gupta, Vidya Mave
BACKGROUND: The World Health Organization recommends routine cryptococcal antigen (CrAg) screening in advanced AIDS patients initiating antiretroviral treatment (ART). India has yet to adopt this strategy as the burden of cryptococcal antigenaemia is unknown. METHODS: A prospective study was conducted in a large public sector ART centre and the inpatient wards of Sassoon Hospital, Pune, India. All consenting patients> 18 years of age with CD4 count <100 cells/mm3 were screened for CrAg by latex agglutination assay...
January 2017: Indian Journal of Medical Microbiology
https://www.readbyqxmd.com/read/28270580/microevolution-of-serial-clinical-isolates-of-cryptococcus-neoformans-var-grubii-and-c-%C3%A2-gattii
#10
Yuan Chen, Rhys A Farrer, Charles Giamberardino, Sharadha Sakthikumar, Alexander Jones, Timothy Yang, Jennifer L Tenor, Omar Wagih, Marelize Van Wyk, Nelesh P Govender, Thomas G Mitchell, Anastasia P Litvintseva, Christina A Cuomo, John R Perfect
The pathogenic species of Cryptococcus are a major cause of mortality owing to severe infections in immunocompromised as well as immunocompetent individuals. Although antifungal treatment is usually effective, many patients relapse after treatment, and in such cases, comparative analyses of the genomes of incident and relapse isolates may reveal evidence of determinative, microevolutionary changes within the host. Here, we analyzed serial isolates cultured from cerebrospinal fluid specimens of 18 South African patients with recurrent cryptococcal meningitis...
March 7, 2017: MBio
https://www.readbyqxmd.com/read/28247152/magnetic-resonance-imaging-study-of-cryptococcal-neuroradiological-lesions-in-hiv-negative-cryptococcal-meningitis
#11
Y Zhong, Z Zhou, X Fang, F Peng, W Zhang
Magnetic resonance (MR) scanning has become an important diagnostic and management tool in cryptococcal meningitis (CM). However, there are only isolated case reports documenting neuroradiological findings in human immunodeficiency virus (HIV)-negative patients with CM and none has clearly addressed the relationship between cerebral lesions on magnetic resonance imaging (MRI) and prognosis. The MR brain images available from 114 HIV-negative patients with CM were retrospectively analysed. Patients were divided into Group I with one or more CM-related lesions and Group II without CM-related lesions...
February 28, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/28243758/burden-of-serious-fungal-infections-in-guatemala
#12
N Medina, B Samayoa, D Lau-Bonilla, D W Denning, R Herrera, D Mercado, B Guzmán, J C Pérez, E Arathoon
Guatemala is a developing country in Central America with a high burden of HIV and endemic fungal infections; we attempted to estimate the burden of serious fungal infections for the country. A full literature search was done to identify epidemiology papers reporting fungal infections from Guatemala. We used specific populations at risk and fungal infection frequencies in the population to estimate national rates. The population of Guatemala in 2013 was 15.4 million; 40% were younger than 15 and 6.2% older than 60...
February 27, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/28220745/is-it-possible-to-differentiate-tuberculous-and-cryptococcal-meningitis-in-hiv-infected-patients-using-only-clinical-and-basic-cerebrospinal-fluid-characteristics
#13
J E Vidal, E J F Peixoto de Miranda, J Gerhardt, M Croda, D R Boulware
BACKGROUND: Tuberculous and cryptococcal meningitis (TBM and CM) are the most common causes of opportunistic meningitis in HIVinfected patients from resource-limited settings, and the differential diagnosis is challenging. OBJECTIVE: To compare clinical and basic cerebrospinal fluid (CSF) characteristics between TBM and CM in HIV-infected patients. METHODS: A retrospective analysis was conducted of clinical, radiological and laboratory records of 108 and 98 HIV-infected patients with culture-proven diagnosis of TBM and CM, respectively...
January 30, 2017: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/28220322/serious-fungal-infections-in-the-philippines
#14
M C R Batac, D Denning
The Philippines is a low middle-income, tropical country in Southeast Asia. Infectious diseases remain the main causes of morbidity, including tuberculosis. AIDS/HIV prevalence is still low at <1%, but is rapidly increasing. Fungal disease surveillance has not been done, and its burden has never been estimated. This becomes more important as the population of immunocompromised patients increases, drawn from patients with AIDS, TB, malignancies, and autoimmune diseases requiring chronic steroid use. Using the methodology of the LIFE program ( www...
February 21, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/28217607/concurrent-central-nervous-system-infective-pathology-in-a-severely-immunocompromised-patient
#15
Thein Swe, Bordes P Laurent, Nickul N Shah
To our knowledge and literature search, concurrent cryptococcal meningitis and neurosyphilis in a patient have rarely been reported. Here, we report a 37-year-old male with HIV infection presented with headache and dizziness for 5 days along with memory difficulty and personality changes for about 1 week. During the hospital stay, cryptococcal meningitis was confirmed with positive cerebral spinal fluid (CSF) cryptococcal antigen titer (1:320) and positive CSF culture. Diagnosis of neurosyphilis was made based upon CSF white blood cell count of 85 cells/μL, with CSF total protein of 87 mg/dL, reactive CSF treponemal antibody, and fluorescent treponemal antibody...
July 2016: Journal of Family Medicine and Primary Care
https://www.readbyqxmd.com/read/28213689/serious-fungal-infections-in-egypt
#16
S M Zaki, D W Denning
We aimed to estimate the burden of serious fungal infections in Egypt, currently unknown, based on the size of the populations at risk and available epidemiological data. Data were obtained from the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and published reports with clearcut denominators. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology. The population of Egypt in 2011 was ∼82,500,000; 31% children, and 8% women >60 years of age...
February 17, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/28208916/delirium-in-parkinson-s-disease-a-cocktail-diagnosis
#17
Robin George Manappallil
Mental disturbances have been described in patients with Parkinson's Disease (PD). Of these, the common conditions are delirium and psychosis. Delirium has been attributed to change of environment, especially hospital stay and infections; while psychosis is due to drugs like dopamine agonists. This is a case of a 75-year-old male, on levodopa therapy for PD, who presented with delirium and ended up with a cocktail diagnosis: Cryptococcal meningitis, Hashimoto's Encephalopathy (HE), Urinary tract infection with acute renal failure, Uremic encephalopathy and Levodopa induced psychosis...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28198210/a-minority-of-patients-newly-diagnosed-with-aids-are-started-on-antiretroviral-therapy-at-the-time-of-diagnosis-in-a-large-public-hospital-in-the-southeastern-united-states
#18
Neela D Goswami, Jonathan Colasanti, Jonathan J Khoubian, Yijian Huang, Wendy S Armstrong, Carlos Del Rio
Prompt antiretroviral therapy (ART) initiation after AIDS diagnosis, in the absence of certain opportunistic infections such as tuberculosis and cryptococcal meningitis, delays disease progression and death, but system barriers to inpatient ART initiation at large hospitals in the era of modern ART have been less studied. We reviewed hospitalizations for persons newly diagnosed with AIDS at Grady Memorial Hospital in Atlanta, Georgia in 2011 and 2012. Individual- and system-level variables were collected. Logistic regression models were used to estimate the odds ratios (ORs) for ART initiation prior to discharge...
January 1, 2017: Journal of the International Association of Providers of AIDS Care
https://www.readbyqxmd.com/read/28188493/serious-fungal-infections-in-chile
#19
E Alvarez Duarte, D W Denning
The incidence and prevalence of fungal infections in Chile are unknown. Here, we have estimated the burden of serious fungal diseases from data obtained from clinical reports, WHO reports, Chilean census, OECD reports and comprehensive literature search available on PubMed and SciELO, among other scientific resources. Due the lack of official data about fungal diseases, frequencies were calculated based on the specific populations at risk. Recurrent vulvovaginal candidiasis (>4 episodes/year) is estimated to occur in 3108/100,000...
February 10, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/28188180/a-population-genomics-approach-to-assessing-the-genetic-basis-of-within-host-microevolution-underlying-recurrent-cryptococcal-meningitis-infection
#20
Johanna Rhodes, Mathew A Beale, Mathieu Vanhove, Joseph N Jarvis, Shichina Kannambath, John A Simpson, Anthea Ryan, Graeme Meintjes, Thomas S Harrison, Matthew C Fisher, Tihana Bicanic
Recurrence of meningitis due to Cryptococcus neoformans after treatment causes substantial mortality in HIV/AIDS patients across sub-Saharan Africa. In order to determine whether recurrence occurred due to relapse of the original infecting isolate or reinfection with a different isolate weeks or months after initial treatment, we used whole-genome sequencing to assess the genetic basis of infection in 17 HIV-infected individuals with recurrent cryptococcal meningitis. Comparisons revealed a clonal relationship for 15 pairs of isolates recovered before and after recurrence showing relapse of the original infection...
February 10, 2017: G3: Genes—Genomes—Genetics
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