Immune mediators in cerebrospinal fluid during cryptococcosis are influenced by meningeal involvement and human immunodeficiency virus serostatus.
Pro- and anti-inflammatory mediators (tumor necrosis factor [TNF]-alpha, interleukin [IL]-6, IL-8, IL-10, and soluble TNF receptor II [sTNFR] II) were measured in cerebrospinal fluid (CSF) before treatment (day 0), and after 2 weeks and 3 months of antifungal therapy in 51 human immunodeficiency virus (HIV)-positive and 7 HIV-negative patients with culture-confirmed cryptococcosis. On day 0, all mediator concentrations, except IL-10 in HIV-positive patients, were higher in patients with meningeal, rather than extrameningeal cryptococcosis or in control subjects (P<.05). For meningitis patients, all mediator levels, except sTNFR II, were higher in HIV-negative than HIV-positive patients (P<.05). Day 0 CSF IL-8 levels were higher in HIV-positive patients receiving antiretroviral therapy than in untreated persons (P<.02). Day 0 sTNFR II levels were higher in HIV-positive survivors at 3 months, and elevated levels were sustained in HIV-positive patients with meningitis. Overall, these data support the idea that inflammatory responses are crucial to the eradication of cryptococcal infections in the central nervous system.
Lortholary
O
O
Unité de Mycologie, Centre National de Référence des Mycoses Humaines et des Antifongiques, Paris, France.
Dromer
F
F
Mathoulin-Pélissier
S
S
Fitting
C
C
Improvisi
L
L
Cavaillon
J M
JM
Dupont
B
B
D017088:AIDS-Related Opportunistic Infections / Q000134:cerebrospinal fluid / Q000276:immunology* / Q000382:microbiology; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000134:cerebrospinal fluid / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D003455:Cryptococcus neoformans / Q000276:immunology / Q000302:isolation & purification; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D018023:HIV Seronegativity / Q000276:immunology; D006801:Humans; D018836:Inflammation Mediators / Q000134:cerebrospinal fluid*; D008297:Male; D016919:Meningitis, Cryptococcal / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000276:immunology*; D008875:Middle Aged
D000935:Antifungal Agents; D015483:HIV Antibodies; D018836:Inflammation Mediators