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Magnetic resonance imaging study of cryptococcal neuroradiological lesions in HIV-negative cryptococcal meningitis

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Abstract

Magnetic resonance (MR) scanning has become an important diagnostic and management tool in cryptococcal meningitis (CM). However, there are only isolated case reports documenting neuroradiological findings in human immunodeficiency virus (HIV)-negative patients with CM and none has clearly addressed the relationship between cerebral lesions on magnetic resonance imaging (MRI) and prognosis. The MR brain images available from 114 HIV-negative patients with CM were retrospectively analysed. Patients were divided into Group I with one or more CM-related lesions and Group II without CM-related lesions. Initial clinical and biochemical markers and prognosis were collected and compared between the two groups. In the present study, the most common pattern of CM-related lesions by MRI was radiological meningitis, following by Virchow–Robin (VR) dilatation, hydrocephalus, intracerebral nodules and pseudocysts, which was different from previous studies reporting that the main MR findings of cerebral cryptococcosis in HIV-infected patients include dilated VR spaces, masses and pseudocysts. Compared to the patients without CM-related lesions, patients with CM-related lesions presented with a higher percentage of male patients, a higher frequency of altered mental status, a higher positive rate of Cryptococcus culture in cerebrospinal fluid (CSF) and a lower ratio of CSF glucose/blood glucose. Poor outcomes were more frequent in patients with presence of CM-related lesions compared to patients without CM-related lesions. In conclusion, the main pattern of cryptococcosis-related lesions on MR scanning differ between non-HIV- and HIV-positive patients with CM. The presence of CM-related lesions was significantly associated with predictors for poor outcome. Neuroimaging on MR scanning is a useful tool to evaluate the initial severity and prognosis of CM without HIV infection.

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Acknowledgements

This study was supported by the National Natural Science Foundation of China (grant nos. 81371260 and 30971026).

Authors’ contributions

W-XZ and F-HP participated in the design of the study. Y-HZ drafted the manuscript. ZZ and F-HP participated in collecting the clinical data. X-BF participated in the statistical analysis. All authors edited the manuscript and read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Neurology, The First Affiliated Hospital of Sun Yat-Sen University, No. 58, Zhongshan Road II, Guangzhou, Guangdong Province, 510080, People’s Republic of China

    Y. Zhong, Z. Zhou, X. Fang & W. Zhang

  2. Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Guangzhou, Guangdong Province, People’s Republic of China

    F. Peng

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  1. Y. Zhong
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Correspondence to F. Peng or W. Zhang.

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Ethical approval was provided by the Third Affiliated Hospital of Sun Yat-Sen University.

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Zhong, Y., Zhou, Z., Fang, X. et al. Magnetic resonance imaging study of cryptococcal neuroradiological lesions in HIV-negative cryptococcal meningitis. Eur J Clin Microbiol Infect Dis 36, 1367–1372 (2017). https://doi.org/10.1007/s10096-017-2941-8

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  • DOI: https://doi.org/10.1007/s10096-017-2941-8

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