PMID- 31964348
OWN - NLM
STAT- MEDLINE
DCOM- 20200406
LR  - 20201209
IS  - 1471-2334 (Electronic)
IS  - 1471-2334 (Linking)
VI  - 20
IP  - 1
DP  - 2020 Jan 21
TI  - Cryptococcal meningitis and immune reconstitution inflammatory syndrome in a 
      pediatric patient with HIV after switching to second line antiretroviral therapy: 
      a case report.
PG  - 68
LID - 10.1186/s12879-020-4797-2 [doi]
LID - 68
AB  - BACKGROUND: Cryptococcal meningitis (CCM) is a common and deadly disease among 
      HIV-infected patients. Notable about CCM is its association with the immune 
      reconstitution inflammatory syndrome (IRIS). Though it has been posited a switch 
      from first to second-line antiretroviral therapy (ART) can induce CCM IRIS, a 
      case presentation of CCM IRIS has not been published. CASE PRESENTATION: A 
      10-year-old, HIV-infected girl who initially presented with severe headache and 
      new-onset seizures, with cerebrospinal fluid that returned antigen, India Ink, 
      and culture positive for Cryptococcus neoformans. Notably, 8 weeks prior to 
      seizures, she had switched from first line to second-line ART 
      (abacavir-lamivudine-efavirenz to zidovudine-lamivudine-lopinavir/ritonavir) due 
      to virologic failure, with a viral load of 224,000 copies/milliliter. At time of 
      seizures and 8 weeks on second-line ART, her viral load had reduced to 262 
      copies/milliliter. Her hospital course was prolonged, as she had ongoing 
      headaches and developed bilateral cranial nerve VI palsies despite clearance of 
      Cryptococcus from cerebrospinal fluid on antifungal therapy and therapeutic 
      lumbar punctures. However, symptoms stabilized, and she was discharged with oral 
      fluconazole. Cranial nerve palsies resolved 10 weeks post discharge and she has 
      remained disease free. CONCLUSIONS: We describe a case of CCM IRIS in a 
      10-year-old HIV infected child after changing to second-line ART. This case 
      provides evidence that screening for cryptococcal antigenaemia prior to switch 
      from first-line to second-line ART could be an important measure to prevent 
      cryptococcal disease.
FAU - Otto, Ssegujja Boniface Joseph
AU  - Otto SBJ
AD  - Department of Paediatrics and Child Health, Makerere University College of Health 
      Sciences, P.O. Box 7062, Kampala, Uganda. ottobonnie87@gmail.com.
FAU - George, Paul E
AU  - George PE
AD  - Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
FAU - Mercedes, Rebecca
AU  - Mercedes R
AD  - Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
FAU - Nabukeera-Barungi, Nicolette
AU  - Nabukeera-Barungi N
AD  - Department of Paediatrics and Child Health, Makerere University College of Health 
      Sciences, P.O. Box 7062, Kampala, Uganda.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20200121
PL  - England
TA  - BMC Infect Dis
JT  - BMC infectious diseases
JID - 100968551
RN  - 0 (Alkynes)
RN  - 0 (Anti-HIV Agents)
RN  - 0 (Antifungal Agents)
RN  - 0 (Antigens, Fungal)
RN  - 0 (Benzoxazines)
RN  - 0 (Cyclopropanes)
RN  - 0 (Dideoxynucleosides)
RN  - 0 (Drug Combinations)
RN  - 0 (abacavir, lamivudine drug combination)
RN  - 0 (lamivudine, zidovudine drug combination)
RN  - 2494G1JF75 (Lopinavir)
RN  - 2T8Q726O95 (Lamivudine)
RN  - 4B9XT59T7S (Zidovudine)
RN  - 8VZV102JFY (Fluconazole)
RN  - JE6H2O27P8 (efavirenz)
RN  - O3J8G9O825 (Ritonavir)
SB  - IM
MH  - AIDS-Related Opportunistic Infections/complications/*drug therapy
MH  - Alkynes
MH  - Anti-HIV Agents/*therapeutic use
MH  - Antifungal Agents/therapeutic use
MH  - Antigens, Fungal/blood
MH  - Benzoxazines/therapeutic use
MH  - Child
MH  - Cryptococcus neoformans/*isolation & purification
MH  - Cyclopropanes
MH  - Dideoxynucleosides/therapeutic use
MH  - Drug Combinations
MH  - Female
MH  - Fluconazole/therapeutic use
MH  - HIV/*drug effects/isolation & purification
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*diagnosis/etiology
MH  - Lamivudine/adverse effects/*therapeutic use
MH  - Lopinavir/*therapeutic use
MH  - Meningitis, Cryptococcal/*diagnosis/drug therapy/etiology
MH  - Ritonavir/adverse effects/*therapeutic use
MH  - Treatment Outcome
MH  - Viral Load
MH  - Zidovudine/adverse effects/*therapeutic use
PMC - PMC6974974
OTO - NOTNLM
OT  - Antiretroviral therapy
OT  - Cryptococcal meningitis (CCM)
OT  - Cryptococcus neoformans
OT  - HIV
OT  - Immune reconstitution inflammatory syndrome (IRIS)
COIS- The authors declare that they have no competing interests.
EDAT- 2020/01/23 06:00
MHDA- 2020/04/09 06:00
PMCR- 2020/01/21
CRDT- 2020/01/23 06:00
PHST- 2019/07/27 00:00 [received]
PHST- 2020/01/15 00:00 [accepted]
PHST- 2020/01/23 06:00 [entrez]
PHST- 2020/01/23 06:00 [pubmed]
PHST- 2020/04/09 06:00 [medline]
PHST- 2020/01/21 00:00 [pmc-release]
AID - 10.1186/s12879-020-4797-2 [pii]
AID - 4797 [pii]
AID - 10.1186/s12879-020-4797-2 [doi]
PST - epublish
SO  - BMC Infect Dis. 2020 Jan 21;20(1):68. doi: 10.1186/s12879-020-4797-2.