Immune mediators in cerebrospinal fluid during cryptococcosis are influenced by meningeal involvement and human immunodeficiency virus serostatus

Pro- and anti- inflammatory mediators (tumor necrosis factor [TNF]-alpha, interleukin [IL]- 6, IL- 8, IL- 10, and soluble TNF receptor II [sTNFR] II) were measured in cerebrospinal fluid (CSF) before treatment (day 0), and after 2 weeks and 3 months of antifungal therapy in 51 human immunodeficiency virus (HIV)- positive and 7 HIV- negative patients with culture-confirmed cryptococcosis. On day 0, all mediator concentrations, except IL- 10 in HIV- positive patients, were higher in patients with meningeal, rather than extrameningeal cryptococcosis or in control subjects (P < .05). For meningitis patients, all mediator levels, except sTNFR II, were higher in HIV- negative than HIV- positive patients (P < .05). Day 0 CSF IL- 8 levels were higher in HIV- positive patients receiving antiretroviral therapy than in untreated persons (P < .02). Day 0 sTNFR II levels were higher in HIV- positive survivors at 3 months, and elevated levels were sustained in HIV- positive patients with meningitis. Overall, these data support the idea that inflammatory responses are crucial to the eradication of cryptococcal infections in the central nervous system.