title: The effect of corticosteroids on visual loss in Cryptococcus neoformans var. gattii meningitis.
abstract: In Papua New Guinea visual loss is a frequent sequal to Cryptococcus neoformans var. gattii meningitis in immunocompetent patients. We have previously postulated that visual loss may occur as a result of the immunological response to infection around the optic nerve. This retrospective study set out to explore the effect of corticosteroids on visual outcome. Sixteen patients received varying doses of corticosteroid (mainly 100-250 mg of hydrocortisone daily for the prevention of febrile reactions to amphotericin) and 10 received anticryptococcal therapy alone. Visual deterioration occurred less frequently in those treated with corticosteroids (2/16 [12.5%] vs. 7/10 [70%], P = 0.007), blindness was less frequent (1/16 [5.3%] vs. 5/10 [50%], P = 0.018), and in 3 patients vision improved. Corticosteroids may have a role in preventing or halting visual loss in C. neoformans var. gattii meningitis in immunocompetent patients.
authors.affiliation: Department of Clinical Science, Medical Faculty, University of Papua New Guinea, Boroko, New Guinea.
authors.forename: R A
authors.initials: RA
authors.lastname: Seaton
authors.forename: N
authors.initials: N
authors.lastname: Verma
authors.forename: S
authors.initials: S
authors.lastname: Naraqi
authors.forename: J P
authors.initials: JP
authors.lastname: Wembri
authors.forename: D A
authors.initials: DA
authors.lastname: Warrell
mesh_terms: D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D001766:Blindness / Q000517:prevention & control; D002648:Child; D003453:Cryptococcosis / Q000150:complications / Q000188:drug therapy*; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008297:Male; D016921:Meningitis, Fungal / Q000188:drug therapy*; D011239:Prednisolone / Q000627:therapeutic use; D011559:Pseudotumor Cerebri / Q000150:complications / Q000188:drug therapy; D012189:Retrospective Studies; D014786:Vision Disorders / Q000150:complications / Q000517:prevention & control*
chemical_list: D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D003907:Dexamethasone; D000666:Amphotericin B; D011239:Prednisolone; D006854:Hydrocortisone