Choroid Plexitis and Ependymitis by Magnetic Resonance Imaging are Biomarkers of Neuronal Damage and Inflammation in HIV-negative Cryptococcal Meningoencephalitis
- Resource Type
- Authors
- John E. Bennett; Anil A. Panackal; Bibi Bielakova; Dima A. Hammoud; Virginia Sheikh; Irini Sereti; Eman Mahdi; Peter R. Williamson; Paul Wakim
- Source
- Scientific Reports, Vol 7, Iss 1, Pp 1-8 (2017)
Scientific Reports
- Subject
- Adult
Male
0301 basic medicine
Pathology
medicine.medical_specialty
Science
030106 microbiology
Human immunodeficiency virus (HIV)
Inflammation
Meningitis, Cryptococcal
medicine.disease_cause
Article
03 medical and health sciences
Therapeutic approach
0302 clinical medicine
Meningoencephalitis
Ependyma
medicine
Humans
Neurons
Multidisciplinary
medicine.diagnostic_test
business.industry
Brain
virus diseases
Magnetic resonance imaging
Cryptococcal meningoencephalitis
Middle Aged
medicine.disease
Magnetic Resonance Imaging
3. Good health
medicine.anatomical_structure
Choroid Plexus
Cryptococcosis
Medicine
Female
Choroid
medicine.symptom
business
Meningitis
Biomarkers
030217 neurology & neurosurgery
- Language
- English
- ISSN
- 2045-2322
CNS cryptococcal meningoencephalitis in both HIV positive (HIV+) and HIV negative (HIV−) subjects is associated with high morbidity and mortality despite optimal antifungal therapy. We thus conducted a detailed analysis of the MR imaging findings in 45 HIV− and 11 HIV+ patients to identify imaging findings associated with refractory disease. Ventricular abnormalities, namely ependymitis and choroid plexitis were seen in HIV− but not in HIV+ subjects. We then correlated the imaging findings in a subset of HIV− subjects (n = 17) to CSF levels of neurofilament light chain (NFL), reflective of axonal damage and sCD27, known to best predict the presence of intrathecal T-cell mediated inflammation. We found that ependymitis on brain MRI was the best predictor of higher log(sCD27) levels and choroid plexitis was the best predictor of higher log(NFL) levels. The availability of predictive imaging biomarkers of inflammation and neurological damage in HIV− subjects with CNS cryptococcosis may help gauge disease severity and guide the therapeutic approach in those patients.