Importance of follow-up cerebrospinal fluid analysis in cryptococcal meningoencephalitis.
Cryptococcal meningoencephalitis represents a serious infection of the central nervous system, where reliable prognostic factors during the disease course are needed. Twenty-one patients diagnosed with cryptococcal meningoencephalitis in a German university hospital from 1999 to 2013 were analysed retrospectively. CSF parameters were analysed prior to therapy and during antifungal treatment and were compared between patients who survived or deceased. Fifteen patients clinically improved after antifungal therapy, while six patients died. No differences were observed between the outcome groups for the CSF parameters cell count, lactate, total protein, and CSF-serum albumin quotients (QAlb). Follow-up examinations of serum cryptococcal antigen titer and CSF cell count have shown that these parameters cannot be used to monitor the efficacy of antifungal therapy as well. In contrast, the course of QAlb during therapy was indicative for the outcome as a possible prognostic marker. In patients with clinical improvement QAlb values were falling under therapy, while rising QAlb values were found in patients with fatal outcome indicating a continuing dysfunction of the blood-CSF barrier. In conclusion, our results indicate that, among the various CSF parameters, the course of QAlb presents a promising marker that might be used to monitor the efficacy of antifungal therapy.
Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße-1, 30625 Hanover, Germany.
Thomas
0000-0001-8550-335X
T
Skripuletz
Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße-1, 30625 Hanover, Germany.
Philipp
P
Schwenkenbecher
Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße-1, 30625 Hanover, Germany.
Kaweh
0000-0002-1600-4263
K
Pars
Department of Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany.
Matthias
M
Stoll
Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, 30625 Hannover, Germany.
Josef
J
Conzen
Department of Neurology, University of Lübeck, 23538 Lübeck, Germany.
Seza
S
Bolat
Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße-1, 30625 Hanover, Germany.
Refik
0000-0002-0577-5206
R
Pul
Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, 30625 Hannover, Germany.
Ralf-Peter
RP
Vonberg
Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, 30625 Hannover, Germany.
Ludwig
0000-0001-9715-7255
L
Sedlacek
Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße-1, 30625 Hanover, Germany.
Ulrich
U
Wurster
Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße-1, 30625 Hanover, Germany.
Martin
0000-0003-2504-5398
M
Stangel
Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße-1, 30625 Hanover, Germany.
Corinna
C
Trebst
D000328:Adult; D006801:Humans; D016919:Meningitis, Cryptococcal / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000188:drug therapy; D008590:Meningoencephalitis / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000188:drug therapy; D008875:Middle Aged