Recurrence of HIV-Related Cryptococcal Meningitis: Sorting Out the Symptoms

In a Ugandan study, patients with primary CM and relapse had lower CSF white blood cell counts and were more likely to have positive CSF cultures than those with IRIS.

After initial treatment, patients with cryptococcal meningitis (CM) may experience reappearance of symptoms due to recurrence of primary disease, relapse of initial infection, or paradoxical immune reconstitution inflammatory syndrome (IRIS). To sort out these and other etiologies, researchers in Uganda prospectively enrolled 724 patients with suspected CM between August 2013 and November 2020. Among participants, 84% had primary infection, 11% had relapse, 4% had IRIS, and 1% had persistent symptoms without evidence of either infection or IRIS.

The general characteristics distinguishing primary infection from relapse and IRIS included shorter time between HIV diagnosis and presentation, not being on antiretroviral therapy, lower CD4 cell co…

Reviewing Author

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Recurrence of HIV-Related Cryptococcal Meningitis: Sorting Out the Symptoms

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Reviewing Author