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D-mannitol in cerebrospinal fluid of patients with AIDS and cryptococcal meningitis
G M Megson1, D A Stevens, J R Hamilton
1Department of Microbiology, Hope Hospital, Salford, United Kingdom.
Abstract:
Cryptococcal meningitis (CM) is associated with raised intracranial pressure which is linked with serious neurological sequelae. Cryptococcus neoformans produces D-mannitol in vitro and in experimental meningitis in rabbits. Mannitol present in the cerebrospinal fluid (CSF) of CM patients could exacerbate raised intracranial pressure and contribute to neurological damage. To link CSF mannitol to cryptococcal infection, levels of mannitol in the CSF of AIDS patients with CM were measured by gas-liquid chromatography. Mannitol was detected in 19 of 21 samples (range, 1.5 to 26.2 mg/liter), but there was no quantitative correlation between the mannitol concentration and the cryptococcal antigen titer.
Insights
Cryptococcal meningitis (CM) can cause dangerous intracranial pressure. This study found mannitol in the cerebrospinal fluid (CSF) of most AIDS patients with CM, suggesting it may worsen neurological damage.
Area of Science:
- Neuroscience
- Infectious Diseases
- Biochemistry
Background:
- Cryptococcal meningitis (CM) is a severe infection often leading to increased intracranial pressure and neurological deficits.
- The fungus Cryptococcus neoformans produces D-mannitol, a substance that may worsen intracranial pressure.
- Elevated mannitol in cerebrospinal fluid (CSF) could contribute to the neurological damage seen in CM.
Purpose of the Study:
- To investigate the presence and levels of D-mannitol in the CSF of patients with CM.
- To determine if CSF mannitol levels correlate with the severity of cryptococcal infection.
Main Methods:
- CSF samples were collected from AIDS patients diagnosed with CM.
- Gas-liquid chromatography was employed to quantify mannitol concentrations in the CSF samples.
- Cryptococcal antigen titers were measured to assess infection severity.
Main Results:
- Mannitol was detected in 19 out of 21 CSF samples from CM patients, with concentrations ranging from 1.5 to 26.2 mg/liter.
- No significant quantitative correlation was found between mannitol concentration and cryptococcal antigen titer in the studied samples.
Conclusions:
- D-mannitol is frequently present in the CSF of AIDS patients with cryptococcal meningitis.
- While present, mannitol levels do not directly correlate with the fungal load indicated by antigen titers.
- Further research is needed to understand the precise role of mannitol in CM pathogenesis and its impact on intracranial pressure.