Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
Future Microbiol. 2020 May;15:613-621. doi: 10.2217/fmb-2019-0252. Epub 2020 Jun 3.
The aim of our study was to describe the characteristics of postinfectious inflammatory response syndrome (PIIRS) in HIV-uninfected and nontransplant men after cryptococcal meningitis (CM). A case-control study was designed to compare HIV-uninfected and nontransplant male CM patients with and without PIIRS. CM-PIIRS patients had increased rates of hearing loss, V-P shunt placement, amphotericin B treatment, higher cerebrospinal fluid pressures and counts in the first CM episode. CM-PIIRS episode was characterized by higher frequencies of headache and fever, higher C-reactive protein, erythrocyte sedimentation rate, cerebrospinal fluid white blood cell (WBC) counts and modified Rankin Score. Brain MRI scans revealed the high signal lesions on axial flair imaging. Receipt of corticosteroid therapy was associated with lower rates of fever and better modified Rankin Score scores at 1 month after treatment. CM-PIIRS episode differs to the initial presentation, may help to identify which patients are at risk to develop PIIRS. Steroids therapy could be beneficial.
本研究旨在描述 HIV 阴性和非移植男性在感染新型隐球菌性脑膜炎（CM）后发生感染后炎症反应综合征（PIIRS）的特征。采用病例对照研究比较了 HIV 阴性和非移植男性 CM 患者中有无 PIIRS 的差异。CM-PIIRS 患者在首次 CM 发作时听力丧失、VP 分流术、两性霉素 B 治疗、更高的脑脊髓液压力和细胞计数的发生率增加。CM-PIIRS 发作时头痛和发热的频率更高，C 反应蛋白、红细胞沉降率、脑脊髓液白细胞（WBC）计数和改良 Rankin 评分更高。脑 MRI 扫描显示轴向 Flair 成像上有高信号病变。皮质类固醇治疗与发热发生率降低和治疗后 1 个月改良 Rankin 评分更好相关。CM-PIIRS 发作与初始表现不同，可能有助于识别哪些患者有发生 PIIRS 的风险。皮质类固醇治疗可能有益。
