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Published on: February 27, 2018
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Differences in Immunologic Factors Among Patients Presenting with Altered Mental Status During Cryptococcal
Sarah Lofgren1,2, Kathy H Hullsiek1, Bozena M Morawski1
1University of Minnesota, Minneapolis, MN, USA.
The Journal of Infectious Diseases
|March 23, 2017
Summary
Altered mental status in cryptococcal meningitis is linked to host immune responses, not fungal load. Higher opening pressures and specific cytokines (IL-10, CCL3) were observed, suggesting inflammation plays a key role.
Area of Science:
- Neuroscience
- Immunology
- Infectious Diseases
Background:
- Altered mental status in cryptococcal meningitis correlates with poor survival.
- The specific causes of altered mentation in this condition remain unclear.
Purpose of the Study:
- To identify risk factors for altered mental status (Glasgow Coma Scale [GCS] score < 15) in patients with cryptococcal meningitis.
- To investigate the roles of clinical characteristics, cerebrospinal fluid (CSF) cytokines/chemokines, and antiretroviral therapy.
Main Methods:
- Analysis of data from 326 participants across two clinical trials.
- Assessment of baseline clinical data, CSF cytokine/chemokine profiles, and antiretroviral therapy status.
- Comparison of patients with GCS < 15 versus GCS = 15.
Main Results:
- 97 participants (30%) presented with GCS < 15.
- Patients with altered mental status had lower CSF cryptococcal antigen titers and CCL2 levels.
- Higher CSF opening pressures, IL-10, and CCL3 levels were found in patients with GCS < 15.
Conclusions:
- Altered mental status in cryptococcal meningitis may be driven by the host's immune response.
- Inflammatory markers (IL-10, CCL3) and elevated opening pressure are associated with altered mentation.
- Findings suggest focusing on host immune modulation for improved outcomes.
