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Olivier Lortholary, Françoise Dromer, Simone Mathoulin-Pélissier, Catherine Fitting, Luce Improvisi, Jean-Marc Cavaillon, Bertrand Dupont, and the French Cryptococcosis Study Group, Immune Mediators in Cerebrospinal Fluid during Cryptococcosis Are Influenced by Meningeal Involvement and Human Immunodeficiency Virus Serostatus, The Journal of Infectious Diseases, Volume 183, Issue 2, 15 January 2001, Pages 294–302, https://doi.org/10.1086/317937
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Abstract
Pro- and anti-inflammatory mediators (tumor necrosis factor [TNF]—α, interleukin [IL]—6, IL-8, IL-10, and soluble TNF receptor II [sTNFR] II) were measured in cerebrospinal fluid (CSF) before treatment (day 0), and after 2 weeks and 3 months of antifungal therapy in 51 human immunodeficiency virus (HIV)—positive and 7 HIV-negative patients with cultureconfirmed cryptococcosis. On day 0, all mediator concentrations, except IL-10 in HIV-positive patients, were higher in patients with meningeal, rather than extrameningeal cryptococcosis or in control subjects (P < .05). For meningitis patients, all mediator levels, except sTNFR II, were higher in HIV-negative than HIV-positive patients (P < .05). Day 0 CSF IL-8 levels were higher in HIV-positive patients receiving antiretroviral therapy than in untreated persons (P < .02). Day 0 sTNFR II levels were higher in HIV-positive survivors at 3 months, and elevated levels were sustained in HIV-positive patients with meningitis. Overall, these data support the idea that inflammatory responses are crucial to the eradication of cryptococcal infections in the central nervous system.