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The use of mannitol in HIV-infected patients with symptomatic cryptococcal meningitis
Zhiliang Hu1, Yongfeng Yang, Jian Cheng
1Department of Infectious Diseases, the Second Affiliated Hospital of Medical School of the Southeast University.
Abstract:
Cryptococcal meningitis (CM) is a common opportunistic infection with a high mortality rate in human immunodeficiency virus (HIV)-infected patients. It is unclear whether mannitol could be used to manage neurological symptoms in HIV-associated CM. Here, we retrospectively analyzed the clinical data of 33 patients with HIV-associated symptomatic CM at our hospital where mannitol was used to relieve neurologic symptoms. With the empirical mannitol therapy, patients had a median of 2 episodes (range, 1-6 episodes) of headaches the day at the starting of anti-cryptococcal therapy. The median score of pain intensity assessed by numerical rating scales was 7-point (range, 4-8 points). After the administration of mannitol, the score of pain intensity was reduced to 3-point or less. Three weeks after anti-cryptococcal therapy, 75.8% (25/33) of the patients did not report headaches. During the initial 3 weeks of anti-cryptococcal therapy, 13 patients had a total of 42 episodes of seizures. 97.6% (41/42) of the episodes of seizures were controlled after the administration of mannitol. Overall, 87.9% (29/33) of the patients survived more than 10 weeks without the need of therapeutic cerebrospinal fluid drainage. Mannitol was used for median of 26 days (range, 1-85 days) in these 29 patients. One patient had permanent vision loss. This study indicates that mannitol may possibly relieve neurologic symptoms in HIV-associated CM. It is worth re-revaluating the role of mannitol administration as a symptom control strategy in mild cases of HIV-associated CM.
Insights
Mannitol may help manage neurological symptoms like headaches and seizures in patients with cryptococcal meningitis (CM) and human immunodeficiency virus (HIV). This study suggests mannitol could be a valuable symptom control strategy for HIV-associated CM.
Area of Science:
- Neurology
- Infectious Diseases
- Clinical Medicine
Background:
- Cryptococcal meningitis (CM) is a significant opportunistic infection in human immunodeficiency virus (HIV)-infected individuals, often associated with high mortality.
- Neurological complications are common in HIV-associated CM, and effective management strategies are crucial.
- The role of mannitol in managing neurological symptoms in HIV-associated CM remains unclear.
Purpose of the Study:
- To investigate the efficacy of mannitol in relieving neurological symptoms in patients with HIV-associated symptomatic cryptococcal meningitis.
- To assess the impact of mannitol on headache intensity, seizure control, and overall survival in this patient population.
Main Methods:
- Retrospective analysis of clinical data from 33 patients with HIV-associated symptomatic CM treated with mannitol.
- Evaluation of headache frequency and pain intensity before and after mannitol administration.
- Assessment of seizure episodes and their control with mannitol.
- Tracking patient survival and need for therapeutic cerebrospinal fluid drainage.
Main Results:
- Mannitol administration significantly reduced headache pain intensity and frequency, with 75.8% of patients reporting no headaches after 3 weeks.
- Mannitol effectively controlled 97.6% of seizure episodes.
- 87.9% of patients survived over 10 weeks without requiring therapeutic cerebrospinal fluid drainage.
- One patient experienced permanent vision loss, a potential adverse effect.
Conclusions:
- Mannitol may be a potentially beneficial treatment for managing neurological symptoms, including headaches and seizures, in HIV-associated CM.
- Further re-evaluation of mannitol's role as a symptom control strategy in mild cases of HIV-associated CM is warranted.
- While generally effective, potential adverse effects like vision loss should be considered.
