1. Differences in Immunologic Factors Among Patients Presenting with Altered Mental Status During Cryptococcal Meningitis.
- Author
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Lofgren, Sarah, Hullsiek, Kathy H., Morawski, Bozena M., Nabeta, Henry W., Kiggundu, Reuben, Taseera, Kabanda, Musubire, Abdu, Schutz, Charlotte, Abassi, Mahsa, Bahr, Nathan C., Tugume, Lillian, Muzoora, Conrad, Williams, Darlisha A., Rolfes, Melissa A., Velamakanni, Sruti S., Rajasingham, Radha, Meintjes, Graeme, Rhein, Joshua, Meya, David B., and Boulware, David R.
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MENINGITIS , *CRYPTOCOCCALES , *CYTOKINES , *IMMUNOLOGY , *PATHOLOGICAL psychology , *MENTAL status examination , *PATIENTS , *ANTIFUNGAL agents , *CHEMOKINES , *COMPARATIVE studies , *CRYPTOCOCCUS neoformans , *CRYPTOCOCCUS , *FUNGAL antigens , *INTERLEUKINS , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *MENTAL illness , *RESEARCH , *RESEARCH funding , *PILOT projects , *EVALUATION research , *RANDOMIZED controlled trials , *PROPORTIONAL hazards models , *GLASGOW Coma Scale ,RISK factors - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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