ArticleThe Journal of infectious diseases2010
Paucity of initial cerebrospinal fluid inflammation in cryptococcal meningitis is associated with subsequent immune reconstitution inflammatory syndrome.
Article in The Journal of infectious diseases, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 126 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
126 citing papers in PubMed, 1 synthesis or guideline pooled it, 193 citations in OpenAlex.
- Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics.The Pediatric infectious disease journal · 2013Guideline
- Trial of High-Dose Oral Rifampin in Adults with Tuberculous Meningitis.The New England journal of medicine · 2025Trial
- Early ART After Cryptococcal Meningitis Is Associated With Cerebrospinal Fluid Pleocytosis and Macrophage Activation in a Multisite Randomized Trial.The Journal of infectious diseases · 2015Trial
- Cerebrospinal fluid cytokine profiles predict risk of early mortality and immune reconstitution inflammatory syndrome in HIV-associated cryptococcal meningitis.PLoS pathogens · 2015Trial
- Timing of antiretroviral therapy after diagnosis of cryptococcal meningitis.The New England journal of medicine · 2014Trial
- Talaromycosis-associated immune reconstitution inflammatory syndrome exhibits immune dysregulation in patients with acquired immunodeficiency syndrome.PLoS neglected tropical diseases · 2026Article
- CSF Leukocytes in Intracranial Infections: Diagnostic, Mechanistic, and Therapeutic Insights for Neurocritical Care.Cellular and molecular neurobiology · 2026Review
- Review of Risk Factors and Factors Influencing Outcomes of Cryptococcal Meningitis in Persons Living with HIV.Infection and drug resistance · 2026Review
- The Pain Is in the Brain With the Sugar-Coated Killer.The Journal of infectious diseases · 2025Review
- Neuroinflammation in fungal infections: from pathogen recognition to pathological manifestations.Disease models & mechanisms · 2025Review
- Foxp3Research square · 2025Article
- Analysis of intracranial lesions in patients with HIV-associated cryptococcal meningitis.Frontiers in cellular and infection microbiology · 2025Article
- Clinical importance of cerebrospinal fluid protein levels in HIV-associated cryptococcal meningitis: Insights from a prospective cohort study in Uganda.Medical mycology · 2024Article
- Meningeal cryptococcosis in a pancreas transplant recipient requiring grafectomy: A case report.World journal of gastrointestinal surgery · 2024Article
- Molecular Diagnostics ofDiseases (Basel, Switzerland) · 2024Review
- Complex Decisions in HIV-Related Cryptococcosis: Addressing Second Episodes of Cryptococcal Meningitis.Current HIV/AIDS reports · 2024Review
- Recurrent Cryptococcal Meningitis in a Late Presenter of HIV: A Rare Case Report and Review of Literature.The American journal of case reports · 2023Review
- Utility of Cerebrospinal Fluid Protein Levels as a Potential Predictive Biomarker of Disease Severity in HIV-Associated Cryptococcal Meningitis.medRxiv : the preprint server for health sciences · 2023Article
- Cryptococcal meningitis.Nature reviews. Disease primers · 2023Review
- Recurrence of Symptoms Following Cryptococcal Meningitis: Characterizing a Diagnostic Conundrum With Multiple Etiologies.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
66 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundCryptococcal meningitis (CM)-related immune reconstitution inflammatory syndrome (IRIS) complicates antiretroviral therapy (ART) in 20%-40% of ART-naive persons with AIDS and prior CM. Pathogenesis is unknown.
methodsWe compared initial cerebrospinal fluid (CSF) cultures, inflammatory markers, and cytokine profiles in ART-naive patients with AIDS who did or did not subsequently develop IRIS after starting ART. We also compared results obtained at IRIS events or CM relapse.
resultsOf 85 subjects with CM, 33 (39%) developed CM-related IRIS and 5 (6%) developed culture-positive CM relapse. At CM diagnosis, subjects subsequently developing IRIS had less inflammation, with decreased CSF leukocytes, protein, interferon-gamma, interleukin-6, interleukin-8, and tumor necrosis factor-alpha, compared with subjects not developing IRIS (P<.05, for each). Initial CSF white blood cell counts < or =25 cells/microL and protein levels < or =50 mg/dL were associated with development of IRIS (odds ratio, 7.2 [95% confidence interval, 2.7-18.7]; P<.001). Compared with baseline levels, we identified CSF elevations of interferon-gamma, tumor necrosis factor-alpha, granulocyte colony-stimulating factor, vascular-endothelial growth factor, and eotaxin (CCL11) (P<.05, for each) at the time of IRIS but minimal inflammatory changes in those with CM relapse.
conclusionsPatients who subsequently develop CM-related IRIS exhibit less initial CSF inflammation at the time of CM diagnosis, compared with those who do not develop IRIS. The inflammatory CSF cytokine profiles observed at time of IRIS can distinguish IRIS from CM relapse.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.