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Background. Though peripheral blood is a crucial sample to study immunology, it is unclear whether the immune environment in the peripheral vasculature correlates with that at the end-organ site of infection. Using cryptococcal meningitis as a model, we investigated the correlation between serum and cerebrospinal fluid biomarkers over time. Methods. We analyzed the cerebrospinal fluid and serum of 160 subjects presenting with first episode cryptococcal meningitis for soluble cytokines and chemokines measured by Luminex assay. Specimens were collected at meningitis diagnosis, 1-week, and 2-week post cryptococcal diagnosis. We compared paired samples by Spearman's correlation and the p value was set at <0.01. Results. Of the 21 analytes tested at baseline, there was no correlation detected between nearly all analytes. A weak negative correlation was found between serum and cerebrospinal fluid levels of interferon-gamma (Rho = − 0.214 ; p =.007) and interleukin-4 (Rho = − 0.232 ; p =.003). There was no correlation at 1-week post cryptococcal diagnosis. However, at 2-week post cryptococcal diagnosis, there was a weak positive correlation of granulocyte-macrophage colony-stimulating factor levels (Rho = 0.25 ; p =.007) in serum and cerebrospinal fluid. No cytokine or chemokine showed consistent correlation overtime. Conclusion. Based on our analysis of 21 biomarkers, serum and cerebrospinal fluid immune responses do not correlate. There appears to be a distinct immune environment in terms of soluble biomarkers in the vasculature versus end-organ site of infection. While this is a model of HIV-related cryptococcal meningitis, we postulate that assuming the blood compartment is representative of the immune function at the end-organ site of infection may not be appropriate. [ABSTRACT FROM AUTHOR]

Summary: Background: Cryptococcal meningitis accounts for 15% of all AIDS mortality globally. Most cases in low‐ and middle‐income countries are treated with fluconazole monotherapy, which is associated with a high mortality. New available therapies are needed. Short‐course amphotericin B has been shown to be a safe and efficient therapeutic option. Sertraline has in vitro fungicidal activity against Cryptococcus and bi‐directional synergy with fluconazole. Methods: We conducted an open‐label clinical trial to assess the safety and efficacy of sertraline 400 mg/day and fluconazole 1200 mg/day (n = 28) vs sertraline, fluconazole and additional 5 days of amphotericin B deoxycholate 0.7‐1 mg/kg (n = 18) for cryptococcal meningitis. Results: Two‐week survival was 64% (18/28) without amphotericin and 89% (16/18) with amphotericin, and 10‐week survival was 21% (6/28) vs 61% (11/18), respectively (P = .012). The cerebrospinal fluid (CSF) Cryptococcus clearance rate was 0.264 log10 colony‐forming units (CFU)/mL of CSF/day (95% CI: 0.112‐0.416) without amphotericin and 0.473 log10 CFU/mL/day (95% CI: 0.344‐0.60) with short‐course amphotericin (P = .03). Sertraline was discontinued in one participant due to side effects. Four participants receiving amphotericin B experienced hypokalemia <2.4 mEq/L. Conclusions: Short‐course amphotericin substantially increased CSF clearance and 10‐week survival. Adjunctive sertraline improved 2‐week CSF fungal clearance but did not improve 10‐week mortality compared with published data using fluconazole 1200 mg/day monotherapy (early fungicidal activity 0.15 log10 CFU/mL/day). [ABSTRACT FROM AUTHOR]