Cargando…

Intrathecal IgG Synthesis and Persistent Inflammation Are Associated with White Matter Lesions in HIV-negative Patients with Cryptococcal Meningoencephalitis

OBJECTIVE: Cryptococcal meningoencephalitis (CM) causes significant morbidity and mortality in human immunodeficiency virus (HIV)-negative and HIV-positive populations. White matter lesions (WMLs) have been reported in both populations of CM patients; however, the mechanisms underlying WML formation...

Descripción completa

Detalles Bibliográficos
Autores principales: Ohyagi, Masaki, Irioka, Takashi, Ohkubo, Takuya, Ishibashi, Satoru, Takahashi, Yuko K, Amano, Eiichiro, Machida, Akira, Kuwahara, Hiroya, Yokota, Takanori
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japanese Society of Internal Medicine 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875458/
https://www.ncbi.nlm.nih.gov/pubmed/31243232
http://dx.doi.org/10.2169/internalmedicine.2338-18
_version_ 1783473035354832896
author Ohyagi, Masaki
Irioka, Takashi
Ohkubo, Takuya
Ishibashi, Satoru
Takahashi, Yuko K
Amano, Eiichiro
Machida, Akira
Kuwahara, Hiroya
Yokota, Takanori
author_facet Ohyagi, Masaki
Irioka, Takashi
Ohkubo, Takuya
Ishibashi, Satoru
Takahashi, Yuko K
Amano, Eiichiro
Machida, Akira
Kuwahara, Hiroya
Yokota, Takanori
author_sort Ohyagi, Masaki
collection PubMed
description OBJECTIVE: Cryptococcal meningoencephalitis (CM) causes significant morbidity and mortality in human immunodeficiency virus (HIV)-negative and HIV-positive populations. White matter lesions (WMLs) have been reported in both populations of CM patients; however, the mechanisms underlying WML formation remain unknown. We herein report the relationship between the intrathecal immune response and the development of WMLs in HIV-negative patients with CM. METHODS: Eleven consecutive HIV-negative patients with CM who presented at one of three emergency hospitals in Japan from April 2001 to March 2018 were enrolled. For all patients, we retrospectively assessed the relationships between clinical and laboratory information and the presence of WMLs. RESULTS: At presentation, 6 patients had WMLs on magnetic resonance imaging (MRI). The cerebrospinal fluid immunoglobulin G (CSF IgG) index was significantly higher in the patients with WMLs than in those without WMLs (mean, 1.34 vs. 0.70, p=0.017). The time from the symptom onset to initial neuroimaging was also significantly longer in the patients with WMLs than in those without WMLs (median, 31.5 vs. 7.0 days; p=0.008). The clinical outcome was comparable among the patients with and without WMLs. CONCLUSION: In HIV-negative patients with CM, a persistent, aberrant immune response to Cryptococcus, such as intrathecal IgG synthesis, may induce WML formation.
format Online
Article
Text
id pubmed-6875458
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher The Japanese Society of Internal Medicine
record_format MEDLINE/PubMed
spelling pubmed-68754582019-11-25 Intrathecal IgG Synthesis and Persistent Inflammation Are Associated with White Matter Lesions in HIV-negative Patients with Cryptococcal Meningoencephalitis Ohyagi, Masaki Irioka, Takashi Ohkubo, Takuya Ishibashi, Satoru Takahashi, Yuko K Amano, Eiichiro Machida, Akira Kuwahara, Hiroya Yokota, Takanori Intern Med Original Article OBJECTIVE: Cryptococcal meningoencephalitis (CM) causes significant morbidity and mortality in human immunodeficiency virus (HIV)-negative and HIV-positive populations. White matter lesions (WMLs) have been reported in both populations of CM patients; however, the mechanisms underlying WML formation remain unknown. We herein report the relationship between the intrathecal immune response and the development of WMLs in HIV-negative patients with CM. METHODS: Eleven consecutive HIV-negative patients with CM who presented at one of three emergency hospitals in Japan from April 2001 to March 2018 were enrolled. For all patients, we retrospectively assessed the relationships between clinical and laboratory information and the presence of WMLs. RESULTS: At presentation, 6 patients had WMLs on magnetic resonance imaging (MRI). The cerebrospinal fluid immunoglobulin G (CSF IgG) index was significantly higher in the patients with WMLs than in those without WMLs (mean, 1.34 vs. 0.70, p=0.017). The time from the symptom onset to initial neuroimaging was also significantly longer in the patients with WMLs than in those without WMLs (median, 31.5 vs. 7.0 days; p=0.008). The clinical outcome was comparable among the patients with and without WMLs. CONCLUSION: In HIV-negative patients with CM, a persistent, aberrant immune response to Cryptococcus, such as intrathecal IgG synthesis, may induce WML formation. The Japanese Society of Internal Medicine 2019-06-27 2019-11-01 /pmc/articles/PMC6875458/ /pubmed/31243232 http://dx.doi.org/10.2169/internalmedicine.2338-18 Text en Copyright © 2019 by The Japanese Society of Internal Medicine https://creativecommons.org/licenses/by-nc-nd/4.0/ The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Ohyagi, Masaki
Irioka, Takashi
Ohkubo, Takuya
Ishibashi, Satoru
Takahashi, Yuko K
Amano, Eiichiro
Machida, Akira
Kuwahara, Hiroya
Yokota, Takanori
Intrathecal IgG Synthesis and Persistent Inflammation Are Associated with White Matter Lesions in HIV-negative Patients with Cryptococcal Meningoencephalitis
title Intrathecal IgG Synthesis and Persistent Inflammation Are Associated with White Matter Lesions in HIV-negative Patients with Cryptococcal Meningoencephalitis
title_full Intrathecal IgG Synthesis and Persistent Inflammation Are Associated with White Matter Lesions in HIV-negative Patients with Cryptococcal Meningoencephalitis
title_fullStr Intrathecal IgG Synthesis and Persistent Inflammation Are Associated with White Matter Lesions in HIV-negative Patients with Cryptococcal Meningoencephalitis
title_full_unstemmed Intrathecal IgG Synthesis and Persistent Inflammation Are Associated with White Matter Lesions in HIV-negative Patients with Cryptococcal Meningoencephalitis
title_short Intrathecal IgG Synthesis and Persistent Inflammation Are Associated with White Matter Lesions in HIV-negative Patients with Cryptococcal Meningoencephalitis
title_sort intrathecal igg synthesis and persistent inflammation are associated with white matter lesions in hiv-negative patients with cryptococcal meningoencephalitis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875458/
https://www.ncbi.nlm.nih.gov/pubmed/31243232
http://dx.doi.org/10.2169/internalmedicine.2338-18
work_keys_str_mv AT ohyagimasaki intrathecaliggsynthesisandpersistentinflammationareassociatedwithwhitematterlesionsinhivnegativepatientswithcryptococcalmeningoencephalitis
AT iriokatakashi intrathecaliggsynthesisandpersistentinflammationareassociatedwithwhitematterlesionsinhivnegativepatientswithcryptococcalmeningoencephalitis
AT ohkubotakuya intrathecaliggsynthesisandpersistentinflammationareassociatedwithwhitematterlesionsinhivnegativepatientswithcryptococcalmeningoencephalitis
AT ishibashisatoru intrathecaliggsynthesisandpersistentinflammationareassociatedwithwhitematterlesionsinhivnegativepatientswithcryptococcalmeningoencephalitis
AT takahashiyukok intrathecaliggsynthesisandpersistentinflammationareassociatedwithwhitematterlesionsinhivnegativepatientswithcryptococcalmeningoencephalitis
AT amanoeiichiro intrathecaliggsynthesisandpersistentinflammationareassociatedwithwhitematterlesionsinhivnegativepatientswithcryptococcalmeningoencephalitis
AT machidaakira intrathecaliggsynthesisandpersistentinflammationareassociatedwithwhitematterlesionsinhivnegativepatientswithcryptococcalmeningoencephalitis
AT kuwaharahiroya intrathecaliggsynthesisandpersistentinflammationareassociatedwithwhitematterlesionsinhivnegativepatientswithcryptococcalmeningoencephalitis
AT yokotatakanori intrathecaliggsynthesisandpersistentinflammationareassociatedwithwhitematterlesionsinhivnegativepatientswithcryptococcalmeningoencephalitis