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Randomized Controlled Trial
. 2017 Mar 1;215(5):693-697.
doi: 10.1093/infdis/jix033.

Differences in Immunologic Factors Among Patients Presenting with Altered Mental Status During Cryptococcal Meningitis

Sarah Lofgren  1   2 , Kathy H Hullsiek  1 , Bozena M Morawski  1 , Henry W Nabeta  2 , Reuben Kiggundu  2 , Kabanda Taseera  3 , Abdu Musubire  2 , Charlotte Schutz  4 , Mahsa Abassi  1   2 , Nathan C Bahr  1   5 , Lillian Tugume  2 , Conrad Muzoora  3 , Darlisha A Williams  1   2 , Melissa A Rolfes  1 , Sruti S Velamakanni  1 , Radha Rajasingham  1 , Graeme Meintjes  4 , Joshua Rhein  1   2 , David B Meya  1   2 , David R Boulware  1 ; COAT and ASTRO-CM Trial Teams
Affiliations
Randomized Controlled Trial

Differences in Immunologic Factors Among Patients Presenting with Altered Mental Status During Cryptococcal Meningitis

Sarah Lofgren et al. J Infect Dis. .

Abstract

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.

Keywords: Cryptococcal meningitis; HIV; altered mental status; cytokines.; immunology.

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References

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