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  • Open Access

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

  • 1,
  • 2,
  • 2,
  • 2,
  • 2,
  • 2 and
  • 2
Journal of the International AIDS Society200811 (Suppl 1) :P252

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

  • Published:

Keywords

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

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.

Authors’ Affiliations

(1)
Hospital Muñiz, (Helios Salud and Cosme Argerich Hospital), Buenos Aires, Argentina
(2)
Hospital Muñiz, Buenos Aires, Argentina

References

  1. Spudich S, et al: Cerebrospinal fluid HIV infection and pleocytosis: relation to systemic infection and antiretroviral treatment. BMC Infectious Diseases. 2005, 5: 98-10.1186/1471-2334-5-98.PubMedPubMed CentralView ArticleGoogle Scholar
  2. Claes M, et al: Cerebrospinal fluid mononuclear cell counts influence CSF HIV-1 RNA levels. J Aquir Immune Defic Syndr Hum Retrovirol. 1998, 17: 214-9.View ArticleGoogle Scholar

Copyright

© Cecchini et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

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