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Peripheral blood CD4+ T-lymphocyte count influences cerebrospinal fluid cellular response in patients with HIV-related cryptococcal meningitis

Purpose of the study

Cerebrospinal fluid (CSF) leukocyte count in asymptomatic HIV-infected patients without central nervous system (CNS) opportunistic diseases has a positive correlation with peripheral blood CD4+ T-lymphocyte count. However, previous communications showed that this correlation is lost in patients with CNS opportunistic infections. This fact has been attributed to the low CD4 T-cell counts found in this population. These studies were undertaken in a low number of patients with different CNS opportunistic infections (cerebral toxoplasmosis, cryptococcal meningitis, Cytomegalovirus encephalitis, progressive multifocal leukoencephalopathy, tuberculous meningitis) considered altogether for the analysis. To date, no study has evaluated correlation between CSF leukocyte count and peripheral CD4+ T-lymphocyte count in a cohort of patients with a single CNS opportunistic infection. The objective of this study was to address this issue in patients with cryptococcal meningitis.

Methods

We prospectively collected pretreatment CSF and blood samples from antiretroviral naive HIV-positive patients with culture-confirmed cryptococcal meningitis attending at the Infectious Diseases Hospital "Francisco Muñiz", Buenos Aires, Argentina (period 2004–2006). CSF characteristics were analyzed. Peripheral blood CD4+ T-lymphocyte count was determined by flow cytometry (Ortho Diagnostic Systems). Software: Statistix (linear regression analysis).

Summary of results

A total of 31 cases were included. Median CD4 T-cell count: 24/uL (range: 0–143). Median CSF leukocyte count: 10 cells/mm3 (range: 1–715); 97% with mononuclear predominance. A positive correlation was found between peripheral blood CD4+ T-lymphocyte count and the absolute CSF leukocyte count (r = 0.44; p = 0.0123) in the statistical analysis. A strong correlation was found between peripheral CD4+ T-lymphocyte count and the CSF leukocyte count in patients with cryptococcal meningitis.

Conclusion

This result suggests that, despite the advanced level of immunodeficiency observed in these patients, the peripheral blood CD4+ T-lymphocyte count has a major influence on the development of an inflammatory response in the CSF in patients with meningitis by Cryptococcus neoformans.

References

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Cecchini, D., Cañizal, A., Rojas, H. et al. Peripheral blood CD4+ T-lymphocyte count influences cerebrospinal fluid cellular response in patients with HIV-related cryptococcal meningitis. JIAS 11, P252 (2008). https://doi.org/10.1186/1758-2652-11-S1-P252

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  • DOI: https://doi.org/10.1186/1758-2652-11-S1-P252

Keywords

  • Toxoplasmosis
  • Cryptococcal Meningitis
  • Progressive Multifocal Leukoencephalopathy
  • Tuberculous Meningitis
  • Cerebral Toxoplasmosis