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Dean O, Anjum S, Scott T, Ham L, Traino K, Wang J, Hunsberger S, Powers JH, Marr KA, Snow J, Williamson PR. Quality of life of HIV-negative, previously healthy individuals following cryptococcal meningoencephalitis. Sci Rep 2021; 11:3673. [PMID: 33574462 PMCID: PMC7878796 DOI: 10.1038/s41598-021-83176-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/13/2021] [Indexed: 11/08/2022] Open
Abstract
The morbidity and mortality of cryptococcal meningoencephalitis (CM) in previously healthy, HIV-negative individuals is increasingly recognized. We administered a healthcare associated quality of life (QOL) survey to the largest longitudinally followed cohort of these patients in the United States. We identified moderate or severe self-reported impairment in at least one QOL domain in 61% of subjects at least one year following diagnosis. Self-reported cognitive impairment was noted in 52% and sleep disturbance was noted in 55%. This is the first comprehensive study of cross-sectional long-term QOL in previously healthy patients following cryptococcal infection.
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Affiliation(s)
- Owen Dean
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bld 10, Rm 11C208, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Seher Anjum
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bld 10, Rm 11C208, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Terri Scott
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bld 10, Rm 11C208, 9000 Rockville Pike, Bethesda, MD, 20892, USA
| | - Lillian Ham
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Katherine Traino
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Jing Wang
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Sally Hunsberger
- Biostatistics Research Branch, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - John H Powers
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Kieren A Marr
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph Snow
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Peter R Williamson
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bld 10, Rm 11C208, 9000 Rockville Pike, Bethesda, MD, 20892, USA.
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Traino K, Snow J, Ham L, Summers A, Segalà L, Shirazi T, Biassou N, Panackal A, Anjum S, Marr KA, Kreisl WC, Bennett JE, Williamson PR. HIV-Negative Cryptococcal Meningoencephalitis Results in a Persistent Frontal-Subcortical Syndrome. Sci Rep 2019; 9:18442. [PMID: 31804566 PMCID: PMC6895107 DOI: 10.1038/s41598-019-54876-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022] Open
Abstract
Twenty-seven previously healthy (of 36 consecutive eligible patients), HIV-negative cryptococcal meningoencephalitis (CM) patients underwent comprehensive neuropsychological evaluation during the late post-treatment period (1.3-4 years post diagnosis), assessing attention, language, learning, memory, visuospatial, executive function, information processing, psychomotor functioning, as well as mood symptoms. Seven of eight domains (all except attention) showed increased percentages of CM patients scoring in the less than 16th percentile range compared to standardized normative test averages, adjusted for education level and age. Comparison with a matched archival dataset of mild cognitive impairment/Alzheimer's disease patients showed that CM patients exhibited relative deficits in psychomotor and executive function with fewer deficits in memory and learning, consistent with a frontal-subcortical syndrome. MRI evaluation at the time of testing demonstrated an association of lower neuropsychological functioning with ventriculomegaly. These studies suggest that CM should be included in the list of treatable causes of dementia in neurological work ups. Future studies are needed to identify diagnostic and treatment regimens that may enhance neurological function after therapy.
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Affiliation(s)
- Katherine Traino
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Joseph Snow
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Lillian Ham
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Angela Summers
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Laura Segalà
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Talia Shirazi
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Nadia Biassou
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Anil Panackal
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Seher Anjum
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kieren A Marr
- Johns Hopkins University Department of Medicine, Baltimore, MD, USA
| | - William C Kreisl
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.,Columbia University, New York, NY, USA
| | - John E Bennett
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Peter R Williamson
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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