Differences in Immunologic Factors Among Patients Presenting with Altered Mental Status During Cryptococcal Meningitis.
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 = .042) and CCL2 (P = .005) but higher opening pressures (320 vs. 269 mm H2O; P = .016), IL-10 (P = .044), and CCL3 (P = .008) compared with persons with GCS=15. Altered mental status may be associated with host immune response rather than Cryptococcus burden.
University of Minnesota, Minneapolis, MN, USA.|Infectious Disease Institute, Makerere University, Kampala, Uganda.
Sarah
S
Lofgren
University of Minnesota, Minneapolis, MN, USA.
Kathy H
KH
Hullsiek
University of Minnesota, Minneapolis, MN, USA.
Bozena M
BM
Morawski
Infectious Disease Institute, Makerere University, Kampala, Uganda.
Henry W
HW
Nabeta
Infectious Disease Institute, Makerere University, Kampala, Uganda.
Reuben
R
Kiggundu
Mbarara University of Science and Technology, Mbarara, Uganda.
Kabanda
K
Taseera
Infectious Disease Institute, Makerere University, Kampala, Uganda.
Abdu
A
Musubire
University of Cape Town, Cape Town, South Africa.
Charlotte
C
Schutz
University of Minnesota, Minneapolis, MN, USA.|Infectious Disease Institute, Makerere University, Kampala, Uganda.
Mahsa
M
Abassi
University of Minnesota, Minneapolis, MN, USA.|University of Kansas, Kansas City, KS, USA.
Nathan C
NC
Bahr
Infectious Disease Institute, Makerere University, Kampala, Uganda.
Lillian
L
Tugume
Mbarara University of Science and Technology, Mbarara, Uganda.
Conrad
C
Muzoora
University of Minnesota, Minneapolis, MN, USA.|Infectious Disease Institute, Makerere University, Kampala, Uganda.
Darlisha A
DA
Williams
University of Minnesota, Minneapolis, MN, USA.
Melissa A
MA
Rolfes
University of Minnesota, Minneapolis, MN, USA.
Sruti S
SS
Velamakanni
University of Minnesota, Minneapolis, MN, USA.
Radha
R
Rajasingham
University of Cape Town, Cape Town, South Africa.
Graeme
G
Meintjes
University of Minnesota, Minneapolis, MN, USA.|Infectious Disease Institute, Makerere University, Kampala, Uganda.
Joshua
J
Rhein
University of Minnesota, Minneapolis, MN, USA.|Infectious Disease Institute, Makerere University, Kampala, Uganda.
David B
DB
Meya
University of Minnesota, Minneapolis, MN, USA.
David R
DR
Boulware
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000097:blood; D054405:Chemokine CCL3 / Q000097:blood*; D018925:Chemokines / Q000097:blood; D003455:Cryptococcus neoformans; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood*; D008297:Male; D016919:Meningitis, Cryptococcal / Q000097:blood* / Q000188:drug therapy / Q000276:immunology; D001523:Mental Disorders / Q000097:blood* / Q000276:immunology; D010865:Pilot Projects; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
D000935:Antifungal Agents; D000946:Antigens, Fungal; C515429:CCL3 protein, human; D054405:Chemokine CCL3; D018925:Chemokines; D016207:Cytokines; C508609:IL10 protein, human; D016753:Interleukin-10
Cryptococcal meningitis; HIV; altered mental status; cytokines.; immunology