PMID- 38400871
OWN - NLM
STAT- MEDLINE
DCOM- 20240415
LR  - 20240425
IS  - 1548-3576 (Electronic)
IS  - 1548-3568 (Print)
IS  - 1548-3568 (Linking)
VI  - 21
IP  - 2
DP  - 2024 Apr
TI  - Complex Decisions in HIV-Related Cryptococcosis: Addressing Second Episodes of 
      Cryptococcal Meningitis.
PG  - 75-85
LID - 10.1007/s11904-024-00691-3 [doi]
AB  - 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.
CI  - (c) 2024. The Author(s).
FAU - Musubire, Abdu
AU  - Musubire A
AD  - Infectious Diseases Institute, Makerere University, Kampala, Uganda.
FAU - Kagimu, Enock
AU  - Kagimu E
AD  - Infectious Diseases Institute, Makerere University, Kampala, Uganda.
FAU - Mugabi, Timothy
AU  - Mugabi T
AD  - Infectious Diseases Institute, Makerere University, Kampala, Uganda.
FAU - Meya, David B
AU  - Meya DB
AD  - Infectious Diseases Institute, Makerere University, Kampala, Uganda.
FAU - Boulware, David R
AU  - Boulware DR
AD  - Division of Infectious Diseases and International Medicine, Department of 
      Medicine, University of Minnesota, Minneapolis, MN, USA.
FAU - Bahr, Nathan C
AU  - Bahr NC
AD  - Division of Infectious Diseases, Department of Medicine, University of Kansas 
      Medical Center, 3901 Rainbow Boulevard, Kansas City, 66160 KS, USA. 
      nate.bahr@gmail.com.
LA  - eng
GR  - K23 NS110470/NS/NINDS NIH HHS/United States
GR  - R01NS086312/NS/NINDS NIH HHS/United States
GR  - R01NS086312/NS/NINDS NIH HHS/United States
GR  - R01NS086312/NS/NINDS NIH HHS/United States
GR  - K23 NS110470/NS/NINDS NIH HHS/United States
PT  - Journal Article
PT  - Review
DEP - 20240224
PL  - United States
TA  - Curr HIV/AIDS Rep
JT  - Current HIV/AIDS reports
JID - 101235661
SB  - IM
MH  - Humans
MH  - *Meningitis, Cryptococcal/diagnosis/drug therapy/microbiology
MH  - *HIV Infections/complications/drug therapy
MH  - *Cryptococcosis/complications/diagnosis
MH  - CD4 Lymphocyte Count
MH  - *Immune Reconstitution Inflammatory Syndrome/diagnosis/drug therapy/etiology
MH  - Recurrence
PMC - PMC11016006
OTO - NOTNLM
OT  - Cryptococcal meningitis
OT  - Cryptococcosis
OT  - Immune reconstitution inflammatory syndrome
OT  - Second episode cryptococcal meningitis
COIS- Drs. Musubire, Kagimu, and Mugabi declare that they have no conflict of interest. 
      Drs. Meya Boulware and Bahr declare grant funding from the NIH. Dr. Bahr also 
      declares that his institution received funds for his role as a PI in an unrelated 
      trial from Karyopharm Therapeutics.
EDAT- 2024/02/24 21:42
MHDA- 2024/04/15 06:42
PMCR- 2024/02/24
CRDT- 2024/02/24 11:04
PHST- 2024/02/08 00:00 [accepted]
PHST- 2024/04/15 06:42 [medline]
PHST- 2024/02/24 21:42 [pubmed]
PHST- 2024/02/24 11:04 [entrez]
PHST- 2024/02/24 00:00 [pmc-release]
AID - 10.1007/s11904-024-00691-3 [pii]
AID - 691 [pii]
AID - 10.1007/s11904-024-00691-3 [doi]
PST - ppublish
SO  - Curr HIV/AIDS Rep. 2024 Apr;21(2):75-85. doi: 10.1007/s11904-024-00691-3. Epub 
      2024 Feb 24.