Outcomes in Previously Healthy Cryptococcal Meningoencephalitis Patients Treated With Pulse Taper Corticosteroids for Post-infectious Inflammatory Syndrome

作者：Seher Anjum, Owen Dean, Péter Kósa, M. Teresa Magone, Kelly King, Edmond J. FitzGibbon, H Jeff Kim, Chris Zalewski, Elizabeth Murphy, Bridgette Jeanne Billioux, Jennifer Chisholm, Carmen C. Brewer, Chantal Krieger, Waleed Elsegeiny, Terri Scott, Jing Wang, Sally Hunsberger, John E. Bennett, Avindra Nath, Kieren A. Marr, Bibiana Bielekova, David Wendler, Dima A. Hammoud, Peter R. Williamson · 发表于：Clinical Infectious Diseases · 年份：2020 · DOI：10.1093/cid/ciaa1901 · 被引用次数：60 · 研究领域：Fungal Infections and Studies、Antifungal resistance and susceptibility、Infectious Diseases and Tuberculosis

BACKGROUND: Cryptococcal meningoencephalitis (CM) is a major cause of mortality in immunosuppressed patients and previously healthy individuals. In the latter, a post-infectious inflammatory response syndrome (PIIRS) is associated with poor clinical response despite antifungal therapy and negative cerebrospinal fluid (CSF) cultures. Data on effective treatment are limited. METHODS: Between March 2015 and March 2020, 15 consecutive previously healthy patients with CM and PIIRS were treated with adjunctive pulse corticosteroid taper therapy (PCT) consisting of intravenous methylprednisolone 1 gm daily for 1 week followed by oral prednisone 1 mg/kg/day, tapered based on clinical and radiological response plus oral fluconazole. Montreal cognitive assessments (MOCA), Karnofsky performance scores, magnetic resonance imaging (MRI) brain scanning, ophthalmic and audiologic exams, and CSF parameters including cellular and soluble immune responses were compared at PIIRS diagnosis and after methylprednisolone completion. RESULTS: The median time from antifungal treatment to steroid initiation was 6 weeks. The most common symptoms at PIIRS diagnosis were altered mental status and vision changes. All patients demonstrated significant improvements in MOCA and Karnofsky scores at 1 month (P < .0003), which was accompanied by improvements in CSF glucose, white blood cell (WBC) count, protein, cellular and soluble inflammatory markers 1 week after receiving corticosteroids (CS) (P < .003). Al...