Novel Treatment of Cryptococcal Meningitis via Neurapheresis Therapy.

Journal Article (Journal Article)

Cryptococcal meningitis (CM) has emerged as the most common life-threatening fungal meningitis worldwide. Current management involves a sequential, longitudinal regimen of antifungals; despite a significant improvement in survival compared with uniform mortality without treatment, this drug paradigm has not led to a consistent cure. Neurapheresis therapy, extracorporeal filtration of yeasts from cerebrospinal fluid (CSF) in infected hosts, is presented here as a novel, one-time therapy for CM. In vitro filtration of CSF through this platform yielded a 5-log reduction in concentration of the yeast and a 1-log reduction in its polysaccharide antigen over 24 hours. Additionally, an analogous closed-loop system achieved 97% clearance of yeasts from the subarachnoid space in a rabbit model over 4-6 hours. This is the first publication demonstrating the direct ability to rapidly clear, both in vitro and in vivo, the otherwise slowly removed fungal pathogen that directly contributes to the morbidity and mortality seen in CM.

Full Text

Duke Authors

Cited Authors

  • Smilnak, GJ; Charalambous, LT; Cutshaw, D; Premji, AM; Giamberardino, CD; Ballard, CG; Bartuska, AP; Ejikeme, TU; Sheng, H; Verbick, LZ; Hedstrom, BA; Pagadala, PC; McCabe, AR; Perfect, JR; Lad, SP

Published Date

  • August 24, 2018

Published In

Volume / Issue

  • 218 / 7

Start / End Page

  • 1147 - 1154

PubMed ID

  • 29788431

Pubmed Central ID

  • PMC6107745

Electronic International Standard Serial Number (EISSN)

  • 1537-6613

Digital Object Identifier (DOI)

  • 10.1093/infdis/jiy286


  • eng

Conference Location

  • United States