Complex Decisions in HIV-Related Cryptococcosis: Addressing Second Episodes of Cryptococcal Meningitis.

Autor: Musubire A; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Kagimu E; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Mugabi T; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Meya DB; Infectious Diseases Institute, Makerere University, Kampala, Uganda., Boulware DR; Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA., Bahr NC; Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, 66160 KS, USA. nate.bahr@gmail.com.
Jazyk: angličtina
Zdroj: Current HIV/AIDS reports [Curr HIV/AIDS Rep] 2024 Apr; Vol. 21 (2), pp. 75-85. Date of Electronic Publication: 2024 Feb 24.
DOI: 10.1007/s11904-024-00691-3
Abstrakt: Purpose of Review: This review highlights the difficulties in diagnosing and treating persons with a prior history of cryptococcal meningitis who improve but suffer from a recurrence of symptoms. This scenario is well known to those who frequently care for patients with cryptococcal meningitis but is not well understood. We highlight major gaps in knowledge.
Recent Findings: We recently summarized our experience with 28 persons with paradoxical immune reconstitution inflammatory syndrome (IRIS) and 81 persons with microbiological relapse. CD4 count and cerebrospinal fluid white blood cell count were higher in IRIS than relapse but neither was reliable enough to routinely differentiate these conditions. Second-episode cryptococcal meningitis remains a difficult clinical scenario as cryptococcal antigen, while excellent for initial diagnosis has no value in differentiating relapse of infection from other causes of recurrent symptoms. Updated research definitions are proposed and rapid, accurate diagnostic tests are urgently needed.
(© 2024. The Author(s).)
Databáze: MEDLINE
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