ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021
Outcomes in Previously Healthy Cryptococcal Meningoencephalitis Patients Treated With Pulse Taper Corticosteroids for Post-infectious Inflammatory Syndrome.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 1 of them a synthesis that pooled it.
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Who cites it
36 citing papers in PubMed, 1 synthesis or guideline pooled it, 54 citations in OpenAlex.
- Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM.The Lancet. Infectious diseases · 2024Guideline
- How have global guidelines advanced the management of cryptococcosis in two years?Expert review of anti-infective therapy · 2026Article
- Prediction of Post-Infectious Inflammatory Response Syndrome in Patients with Cryptococcal Meningitis Based on Clinical and Radiomics Data.Diagnostics (Basel, Switzerland) · 2026Article
- Cerebral Venous Thrombosis in Previously Healthy Patients with Cryptococcal Meningitis.The Journal of infectious diseases · 2026Article
- Corticosteroid Therapy and Long-Term Outcomes of Post-Infectious Inflammatory Syndrome in Non-HIV Immunosuppressed Cryptococcal Meningitis: A Multicenter Case Series.The Journal of infectious diseases · 2026Article
- Adrenal Corticosteroids and Increased Intracranial Pressure in Nonimmunocompromised Patients With Cryptococcal Meningitis.The Journal of infectious diseases · 2026Article
- Article
- The Pain Is in the Brain With the Sugar-Coated Killer.The Journal of infectious diseases · 2025Review
- Target product profile and discovery and development path for novel cryptococcal disease treatments.The Journal of infection · 2025Review
- Pathway-instructed therapeutic selection of ruxolitinib reduces neuroinflammation in fungal postinfectious inflammatory syndrome.Science advances · 2025Observational
- A fatal case of chronicASM case reports · 2025Article
- Article
- Multiple dimensions of neurological injury in a liver transplant recipient with cryptococcal meningitis.ASM case reports · 2025Article
- MRI changes in cryptococcal meningoencephalitis exacerbated by antifungal treatment due to post-infectious inflammatory syndrome: A case report.Radiology case reports · 2024Article
- JAK/STAT Signaling Predominates in Human and Murine Fungal Post-infectious Inflammatory Response Syndrome.medRxiv : the preprint server for health sciences · 2024Article
- Case report: A diabetic patient with cryptococcal meningoencephalitis complicated by post-infectious inflammatory response syndrome.Frontiers in immunology · 2024Article
- Cryptococcal meningitis.Nature reviews. Disease primers · 2023Review
- Tocilizumab as a Potential Adjunctive Therapy to Corticosteroids in Cryptococcal Post-infectious Inflammatory Response Syndrome (PIIRS): a Report of Two Cases.Journal of clinical immunology · 2023Article
- Cryptococcal Meningoencephalitis in Phenotypically Normal Patients.Pathogens (Basel, Switzerland) · 2023Review
- Post-infectious inflammatory response syndrome in an HIV-negative patient after Cryptococcus gattii meningoencephalitis: a case report and review of the literature.Journal of medical case reports · 2023Review
Corrections and comments
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Authors and funding
24 authors at 7 institutions in 1 country.
Funding
Abstract
backgroundCryptococcal meningoencephalitis (CM) is a major cause of mortality in immunosuppressed patients and previously healthy individuals. In the latter, a post-infectious inflammatory response syndrome (PIIRS) is associated with poor clinical response despite antifungal therapy and negative cerebrospinal fluid (CSF) cultures. Data on effective treatment are limited.
methodsBetween March 2015 and March 2020, 15 consecutive previously healthy patients with CM and PIIRS were treated with adjunctive pulse corticosteroid taper therapy (PCT) consisting of intravenous methylprednisolone 1 gm daily for 1 week followed by oral prednisone 1 mg/kg/day, tapered based on clinical and radiological response plus oral fluconazole. Montreal cognitive assessments (MOCA), Karnofsky performance scores, magnetic resonance imaging (MRI) brain scanning, ophthalmic and audiologic exams, and CSF parameters including cellular and soluble immune responses were compared at PIIRS diagnosis and after methylprednisolone completion.
resultsThe median time from antifungal treatment to steroid initiation was 6 weeks. The most common symptoms at PIIRS diagnosis were altered mental status and vision changes. All patients demonstrated significant improvements in MOCA and Karnofsky scores at 1 month (P < .0003), which was accompanied by improvements in CSF glucose, white blood cell (WBC) count, protein, cellular and soluble inflammatory markers 1 week after receiving corticosteroids (CS) (P < .003). All patients with papilledema and visual field deficits also exhibited improvement (P < .0005). Five out of 7 patients who underwent audiological testing demonstrated hearing improvement. Brain MRI showed significant improvement of radiological findings (P = .001). CSF cultures remained negative.
conclusionsPCT in this small cohort of PIIRS was associated with improvements in CM-related complications with minimal toxicity in the acute setting.
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