Differences in immunologic factors among patients presenting with altered mental status during cryptococcal meningitis

Sarah Lofgren, Kathy H. Hullsiek, Bozena M. Morawski, Henry W. Nabeta, Reuben Kiggundu, Kabanda Taseera, Abdu Musubire, Charlotte Schutz, Mahsa Abassi, Nathan C. Bahr, Lillian Tugume, Conrad Muzoora, Darlisha A. Williams, Melissa A. Rolfes, Sruti S. Velamakanni, Radha Rajasingham, Graeme Meintjes, Joshua Rhein, David B. Meya, David R. Boulware

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Altered mental status in cryptococcal meningitis results in poorer survival, but underlying causes of altered mentation are poorly understood. Within two clinical trials, we assessed risk factors for altered mental status (GCS score<15) considering baseline clinical characteristics, CSF cytokines/chemokines, and antiretroviral therapy. Among 326 enrolled participants, 97 (30%) had GCS<15 and these patients had lower median CSF cryptococcal antigen titers (P = .042) and CCL2 (P = .005) but higher opening pressures (320 vs. 269 mm H2O; P = .016), IL-10 (P = .044), and CCL3 (P = .008) compared with persons with GCS=15. Altered mental status may be associated with host immune response rather than Cryptococcus burden.

Original languageEnglish (US)
Pages (from-to)693-697
Number of pages5
JournalJournal of Infectious Diseases
Issue number5
StatePublished - Mar 1 2017

Bibliographical note

Funding Information:
This work was supported by the National Institute of Neurologic Diseases and Stroke and the Fogarty International Center (grants R01NS086312 and R25TW009345) and by the National Institute of Allergy and Infectious Diseases (grants U01AI089244 and T32AI055433).

Publisher Copyright:
© The Author 2017.


  • Altered mental status
  • Cryptococcal meningitis
  • Cytokines
  • HIV
  • Immunology


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