Recognition And Treatment Of Cryptococcal Meningitis Associated Immune Reconstruction Inflammatory Syndrome

Objectives To probe into the identification and treatment of Cryptococcal Meningitis(CM)and CM related Immune Reconstruction Inflammatory Syndrome(CM-IRIS).Methods we retrospectively analyzed 100 patients with CM,then,we divided them into four group,group1: patients developed CM-IRIS;group2: patients didn't develpop CM–IRIS;group3: patients didn't treated with glucocorticoid during CM-IRIS developed;group4: patients treated with glucocorticoid during CM-IRIS developed;to compare baseline data respectively.Among them,Only 26(26%)developed cryptococcosis Meningitis associated immune reconstitution inflammatory syndrome.Moreover,we collected these 26 CM-IRIS cases with whole CSF pressure,the CSF and serum biochemical criterion value,MRI,clinical data,to recognize CM-IRIS furthermore.At the same time,we divided all patients with CM into 2 groups,one CM-IRIS developed and the other not,then to compare the effect with different antifungal drugs.Moreover,they were into 3 groups: group1: patients didn't treated with glucocorticoid before CM-IRIS developed;group2: patients didn't treated with glucocorticoid during CM-IRIS developed;group3: patients treated with glucocorticoid for two weeks during CM-IRIS developed.In addition,we divided all patients with CM into 2 groups,one treated with glucocorticoid and the other not,then calculating the incidence of IRIS in eatch group.Finally,we calculated the average time of CM-IRIS developed.Results The difference of baseline data(gender,age,average hospitalization days)in four group was unsignificant(p>0.05).Under unreappearing,The difference between group of CM-IRIS developed and group of CM-IRIS undeveloped wassignifican(p<0.05).Also,the difference of the effect with different antifungal drugs in CM-IRIS developed and group of CM-IRIS undeveloped was unsignifican(p >0.05).The group 2 presented a significantly higher CSF pressure,lower CSF protein and leucocyte count together with more increased lymphocyte proportion by comparison to the other groups(P<0.05).Given the glucocorticoid,it was obvious that CSF pressure in group 3 was lower than group 2,and the incidence of IRIS was higher in CM patients using glucocorticoid,the difference was Significant(P<0.05);The average time of CM-IRIS developed was 47.50±28.44.Conclusion Those CM patients,who had a great improvement in clinical symptoms and cerebrospinal fluid examination after treatment,showed a deterioration of clinical condition again with raised CSF pressure,unaltered total leucocyte count,increased lymphocyte proportion and patchy cerebral white matter lesions detected on MRI,then can be diagnosed as cerebral CM related immune reconstruction inflammatory syndrome(CM-IRIS).Significant improvements can be observed in clinical symptoms,CSF pressure and imaging findings in cerebral CM-IRIS group patients after glucocorticoid treatment.On the basis of 6-week effective antifungal therapy,glucocorticoid treatment might reduce the incidence rate of cerebral CM-IRIS.