scholarly journals A preliminary study on the characteristics of Th1/Th2 immune response in cerebrospinal fluid of AIDS patients with cryptococcal meningitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aixin Li ◽  
Wenjiao Zhu ◽  
Jiming Yin ◽  
Xiaojie Huang ◽  
Lijun Sun ◽  
...  
Keyword(s):  
Immune Response ◽  
Cerebrospinal Fluid ◽  
Antifungal Therapy ◽  
Cryptococcal Meningitis ◽  
Treatment Strategies ◽  
Cytokine Network ◽  
Aids Patients ◽  
Th2 Immune Response ◽  
Common Opportunistic Infection ◽  
Immunodeficiency Syndrome

Abstract Background Cryptococcal Meningitis (CM) is a common opportunistic infection in the late stage of acquired immunodeficiency syndrome (AIDS). Despite the wide use of effective antiretroviral and antifungal therapy in AIDS patients, CM is still a major morbidity and mortality cause. Understanding the immune response in cryptococcal infection may help to improve the treatment strategies. Methods We established a prospective cohort of twelve AIDS patients with CM (HIV + CM+) admitted to the hospital from 2019 to 2020. All patients were examined at the baseline, 2 weeks, and 4 weeks thereafter. The level of 19 cytokines in cerebrospinal fluid (CSF) were recorded to analyze the characteristics and dynamic changes of Th1/Th2 immune response. Meanwhile, six AIDS patients without CM (HIV + CM-) and seventeen healthy subjects (HIV-CM-) were included as control groups for CSF assessment. Results The HIV+ CM+ group had higher CSF IFN-γ, TNF-α, IL-6, IL-7, IL-8, IL-10, IL-12 (P40), IL-15, IL-18, CCL2 levels but lower IL-4 when compared with the HIV-CM- group at baseline. And they also had a higher level of IL-12 (P40) and IL-17A compared with HIV + CM- patients. Except one patient dropped out of the study, eleven HIV + CM+ patients received induction antifungal therapy and regular CSF testing, and the mortality rate was 9.1% (1/11) and 18.2% (2/11) respectively at week 2 and week 4. Compared with baseline CSF cytokines, IL-2, IL-13, IL-17A, and VEGF-A decreased in week 2, and the VEGF-A levels further decreased in week 4. But there was no difference in the levels of all cytokines between survivors and the dead. Conclusion No evidence of Th1/Th2 imbalance was found in AIDS patients with CM. However, the CSF cytokine network may provide new clues for the treatment of AIDS patients with CM. Trial registration This trial was prospectively registered in 2019.7.16. The registered number is ChiCTR1900024565.

scholarly journals Cerebrospinal Fluid Culture Positivity and Clinical Outcomes After Amphotericin-Based Induction Therapy for Cryptococcal Meningitis

2015 ◽  
Vol 2 (4) ◽  
Author(s):  
Melissa A. Rolfes ◽  
Joshua Rhein ◽  
Charlotte Schutz ◽  
Kabanda Taseera ◽  
Henry W. Nabeta ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cerebrospinal Fluid ◽  
Clinical Outcomes ◽  
Antifungal Therapy ◽  
Induction Therapy ◽  
Cryptococcal Meningitis ◽  
Cox Regression ◽  
Culture Positivity ◽  
Immunodeficiency Virus ◽  
Cerebrospinal Fluid Culture

Abstract Background.  Amphotericin-based combination antifungal therapy reduces mortality from human immunodeficiency virus (HIV)-associated cryptococcal meningitis. However, 40%–50% of individuals have positive cerebrospinal fluid (CSF) fungal cultures at completion of 2 weeks of amphotericin induction therapy. Residual CSF culture positivity has historically been associated with poor clinical outcomes. We investigated whether persistent CSF fungemia was associated with detrimental clinical outcomes in a contemporary African cohort. Methods.  Human immunodeficiency virus-infected individuals with cryptococcal meningitis in Uganda and South Africa received amphotericin (0.7–1.0 mg/kg per day) plus fluconazole (800 mg/day) for 2 weeks, followed by “enhanced consolidation” therapy with fluconazole 800 mg/day for at least 3 weeks or until cultures were sterile, and then 400 mg/day for 8 weeks. Participants were randomized to receive antiretroviral therapy (ART) either 1–2 or 5 weeks after diagnosis and observed for 6 months. Survivors were classified as having sterile or nonsterile CSF based on 2-week CSF cultures. Mortality, immune reconstitution inflammatory syndrome (IRIS), and culture-positive relapse were compared in those with sterile or nonsterile CSF using Cox regression. Results.  Of 132 participants surviving 2 weeks, 57% had sterile CSF at 2 weeks, 23 died within 5 weeks, and 40 died within 6 months. Culture positivity was not significantly associated with mortality (adjusted 6-month hazard ratio, 1.2; 95% confidence interval, 0.6–2.3; P = .28). Incidence of IRIS or relapse was also not significantly related to culture positivity. Conclusions.  Among patients, all treated with enhanced consolidation antifungal therapy and ART, residual cryptococcal culture positivity was not found to be associated with poor clinical outcomes.

scholarly journals Fungal Mastoiditis in AIDS Patients: Reported Cases

2011 ◽  
Vol 15 (02) ◽  
pp. 245-248
Author(s):  
Flavia Silveira ◽  
Gabriel Bijos Faidiga ◽  
Tassiana do Lago ◽  
Camila Carrara Yassuda ◽  
Eduardo Tanaka Massuda ◽  
...  
Keyword(s):  
Case Report ◽  
Facial Nerve ◽  
Antifungal Therapy ◽  
Acquired Immunodeficiency Syndrome ◽  
Aids Patients ◽  
Aspergillus Fumigates ◽  
Immunosuppressed Patients ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
Fatal Complications

Summary Introduction: Fungal mastoidits by Aspergillus fumigates predominantly occurs in immunosuppressed patients. Diagnosis is usually hard and disease is potentially fatal. Treatment is comprised of antifungal therapy, surgical debridement and immunosuppression correction. Case Report: This article reports a case of fungal mastoiditis in a patient with acquired immunodeficiency syndrome (AIDS). The treatment performed was that of surgery associated with antifungal therapy. The patient's facial nerve was not affected, what does not exclude potentially fatal complications of mastoiditis.

Monitoring Cytomegalovirus Retinitis Prevalence in an HIV-Seropositive Cohort: The Assessment of Improvements Observed following the Introduction of Highly Active Antiretroviral Triple Therapy

1999 ◽  
Vol 10 (10) ◽  
pp. 652-656 ◽  
Author(s):  
Sacha Hutchinson ◽  
Richeal Courtney ◽  
Fiona Mulcahy ◽  
Martin O'connor ◽  
Susan Mullaney Mcophth ◽  
...  
Keyword(s):  
Stage Iv ◽  
Clinical Findings ◽  
Aids Patients ◽  
Highly Active ◽  
Number Of Patients ◽  
Before And After ◽  
Common Opportunistic Infection ◽  
Long Term Trends ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

This paper concerns the ophthalmic assessment of patients with acquired immunodeficiency syndrome (AIDS) for a number of eye conditions and in particular cytomegalovirus (CMV) retinitis. CMV has been the most common opportunistic infection associated with AIDS and the leading cause of blindness among AIDS patients. There have been early indications of a widespread fall in CMV prevalence internationally following the introduction of a new highly active antiretroviral triple (HAART) therapy. Our study sought to assess the position for Ireland. Our cohort was the entire population of stage IV AIDS patients attending the country's leading referral centre. The total number of patients examined was 167 and the period of examination was 1 May 1995 to 30 April 1997. HAART was introduced in March 1996, so the data permitted a ‘before and after’ comparison of various clinical findings. The incidence of new CMV cases was found to be 4 among the 102 patients examined in the first 12-month period and one among 107 patients examined in the second 12-month period. There were accompanying declines in HIV-related non-infectious retinal vasculopathy (HIVR), keratitis and other conditions. The findings are promising, but we argue that caution is needed in assessing long-term trends. In the paper we discuss a number of methodological issues in the collection and analysis of the clinical data and in the interpretation of results.

scholarly journals Cerebrospinal fluid profiles in acquired immunodeficiency syndrome with and without neurocryptococcosis

1997 ◽  
Vol 39 (6) ◽  
pp. 323-326 ◽  
Author(s):  
Célia Regina GARLIPP ◽  
Cláudio Lúcio ROSSI ◽  
Paula Virginia BOTTINI
Keyword(s):  
Cerebrospinal Fluid ◽  
Fungal Infections ◽  
Etiologic Agent ◽  
Aids Patients ◽  
The Central Nervous System ◽  
Acquired Immunodeficiency ◽  
Group 2 ◽  
Immunological Assays ◽  
Immunodeficiency Syndrome ◽  
Group 1

Cryptococcosis is one of the most common fungal infections of the central nervous system (CNS) in AIDS patients and meningoencephalitis or meningitis is a frequently observed manifestation. However, systematic studies of cerebrospinal fluid (CSF) composition from AIDS patients with CNS cryptococcosis have been few. CSF samples from 114 HIV seropositive patients whose clinical complaint suggested CNS involvement, were analyzed; 32 samples from patients diagnosed as having neurocryptococcosis (Group 1) and 82 samples from patients with no identified neurological disfunction (Group 2). Based on cytological and biochemical results, two distinct profiles were observed: Normal (Group 1 = 31%, Group 2 = 39%); Abnormal (Group 1 = 69%, Group 2 = 61%). Lymphocytes were the most frequent cells in both groups. Our CSF cytological and biochemical findings showed that in AIDS patients liquoric abnormalities are quite frequent, non-specific and difficult to interpret. In these circumstances a systematic search to identify the etiologic agent using microbiological and/or immunological assays must be routinely performed

scholarly journals The Contribution of Host Cells to Pneumocystis Immunity: An Update

Pathogens ◽  
2019 ◽  
Vol 8 (2) ◽  
pp. 52 ◽  
Author(s):  
Patricia Otieno-Odhiambo ◽  
Sean Wasserman ◽  
J. Claire Hoving
Keyword(s):  
Treatment Strategies ◽  
Pneumocystis Pneumonia ◽  
Host Cells ◽  
Causative Organism ◽  
Aids Patients ◽  
Host Immune Responses ◽  
Life Threatening ◽  
New Treatment ◽  
Poor Outcomes ◽  
Immunodeficiency Syndrome

Pneumocystis is a ubiquitous atypical fungus that is distributed globally. The genus comprises morphologically similar but genetically heterogeneous species that have co-evolved with specific mammalian hosts as obligate intra-pulmonary pathogens. In humans, Pneumocystis jirovecii is the causative organism of Pneumocystis pneumonia (PCP) in immunocompromised individuals, a serious illness frequently leading to life-threatening respiratory failure. Initially observed in acquired immunodeficiency syndrome (AIDS) patients, PCP is increasingly observed in immunocompromised non-AIDS patients. The evolving epidemiology and persistently poor outcomes of this common infection will require new strategies for diagnosis and treatment. A deeper understanding of host immune responses and of the cells that mediate them will improve the chance of developing new treatment strategies. This brief review provides an update on recent studies on the role of host immunity against Pneumocystis.

scholarly journals Cryptococcal Antigen in Serum and Cerebrospinal Fluid for Detecting Cryptococcal Meningitis in Adults Living With Human Immunodeficiency Virus: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies

2020 ◽  
Author(s):  
Elvis Temfack ◽  
Jean Joel Bigna Rim ◽  
Rene Spijker ◽  
Angela Loyse ◽  
Tom Chiller ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cerebrospinal Fluid ◽  
Sensitivity And Specificity ◽  
Antifungal Therapy ◽  
Cryptococcal Meningitis ◽  
Meta Analysis ◽  
Test Accuracy ◽  
Fungal Culture ◽  
Cryptococcal Antigen ◽  
Immunodeficiency Virus

Abstract Cryptococcal antigen (CrAg) detection could direct the timely initiation of antifungal therapy. We searched MEDLINE and Embase for studies where CrAg detection in serum/cerebrospinal fluid (CSF) and CSF fungal culture were done on adults living with human immunodeficiency virus (HIV) who had suspected cryptococcal meningitis (CM). With Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), we evaluated the risk of bias in 11 included studies with 3600 participants, and used a random-effects meta-analysis to obtain summary sensitivity and specificity of serum and CSF CrAg, as well as agreement between CSF CrAg and CSF culture. Summary sensitivity and specificity of serum CrAg were 99.7% (97.4–100) and 94.1% (88.3–98.1), respectively, and summary sensitivity and specificity of CSF CrAg were 98.8% (96.2–99.6) and 99.3% (96.7–99.9), respectively. Agreement between CSF CrAg and CSF culture was 98% (97–99). In adults living with HIV who have CM symptoms, serum CrAg negativity may rule out CM, while positivity should prompt induction antifungal therapy if lumbar puncture is not feasible. In a first episode of CM, CSF CrAg positivity is diagnostic.

scholarly journals Mycobacterium avium complex (MAC): an unusual potential pathogen in cerebrospinal fluid of AIDS patients

1995 ◽  
Vol 37 (2) ◽  
pp. 93-98 ◽  
Author(s):  
David Jamil Hadad ◽  
Tereza Cristina Petry ◽  
Anaenza Freie Maresca ◽  
Lucilaine Ferrazoli ◽  
Maria Conceição Martins ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Latin American ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Late Complications ◽  
Aids Patients ◽  
Potential Pathogen ◽  
The Central Nervous System ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

Mycobacterium avium complex (MAC) is frequently isolated from patients with late complications of Acquired Immunodeficiency Syndrome (AIDS), especially in North America and Europe. However, its isolation from the central nervous system (CNS) has been seldom reported in these countries. MAC infections in AIDS patients in African and Latin American countries are believed to be uncommon. We report the isolation of MAC from cerebrospinal fluid (CSF) of 11 AIDS patients out of 1723 (0.63%) seen at "Centro de Referência e Treinamento - AIDS", São Paulo and discuss the significance of its isolation.

Sign in / Sign up

Export Citation Format

Share Document