Cryptococcal meningitis (CM), a life-threatening fungal infection of the central nervous system, faces therapeutic challenges due to poor blood‒brain barrier (BBB) penetration of amphotericin B. This study investigates the efficacy of low-intensity pulsed ultrasound (LIPUS) combined with microbubbles in enhancing BBB permeability and improving prognosis in a murine CM model. Our findings suggest that LIPUS combined with microbubbles treatment significantly increased BBB permeability, leading to elevated cerebral concentrations of amphotericin B and improved fungicidal activity against Cryptococcus neoformans in the brain. Mechanistic investigations revealed that LIPUS-microbubble treatment transiently upregulated vascular endothelial growth factor (VEGF) expression levels in cerebral tissues. Notably, these protein expression alterations and the associated BBB permeability enhancement completely normalized within 6 hours post-treatment. Pharmacological inhibition of VEGF abolished the ultrasound-induced BBB permeability increase, indicating that VEGF may serve as a pivotal upstream regulator mediating this transient barrier modulation. Compared with amphotericin B monotherapy, the combined regimen of LIPUS plus microbubbles and amphotericin B achieved a greater reduction in cerebral cryptococcal burden. The India ink staining revealed reduced cryptococcal capsule thickness and smaller yeast cell diameters in treated mice. Furthermore, the intervention ameliorated CM-associated clinical manifestations, including weight loss and neurological deficits, while prolonging survival time. These results suggest the potential of LIPUS-microbubble-mediated BBB modulation as a promising adjunctive strategy to optimize amphotericin B delivery and improve therapeutic efficacy in CM, offering new insights into overcoming the limitations of conventional treatments for neurotropic fungal infections.

Background/Objectives: Post-infectious inflammatory response syndrome (PIIRS) is a rare complication of cryptococcal meningitis. The objective of this study was to identify predictors that can be used to identify patients at risk of PIIRS before its onset. Methods: A total of 149 patients with cryptococcal meningitis who did not develop PIIRS (controls, n = 84) and developed PIIRS (cases, n = 65) were included in the study. Clinical presentation data, treatment data, and laboratory data at admission were collected and compared between the two groups using univariate and multivariable analyses. Inflamed areas within T2 FLAIR MRI scans were manually annotated, and a total of 110 radiomic features were extracted per patient. Data were split into training, test, and validation sets, and multiple machine learning models integrating radiomic, spatial, and clinical features were developed and evaluated using area under the curve (AUC) and related performance metrics. Results: Ventriculoperitoneal shunt (odds ratio: 4.64 [1.84–12.46]; p-value = 0.001), complement component 3 (C3) (odds ratio: 5.78 [1.55–24.42]; p-value = 0.012), and lumbar puncture opening pressure (odds ratio: 1.01 [1.00–1.01]; p-value = 0.008) were independent risk factors associated with PIIRS development. All four radiomics models performed very well in predicting PIIRS, with the final model (region of interest + location + C3) achieving the best overall performance set (test set AUC: 0.948 [0.840–1.000], validation set AUC: 0.943 [0.814–1.000]). Conclusions: Radiomics-based classification models demonstrated good performance for predicting PIIRS. These findings should be considered hypothesis-generating given the small sample size and require validation in larger multicenter studies before clinical implementation.

To characterize the distinct clinical phenotype of late‑onset (onset age ≥ 50 years) adult autoimmune glial fibrillary acidic protein astrocytopathy (A‑GFAP‑A). This single-center retrospective study included 104 adult patients diagnosed with A-GFAP-A, who were stratified into the late-onset group (LOG, n = 31) and the early-onset group (EOG, n = 73). Demographic, clinical, cerebrospinal fluid (CSF), neuroimaging, and short-term outcome data were compared. Multivariable logistic regression and hierarchical cluster analysis were performed. Compared with EOG, LOG showed a higher prevalence of hypertension (19.4

Humanized mouse models can mimic the human immune system, making them useful for investigating the pathogenesis of autoimmune diseases and developing therapeutic strategies. These models bridge the gap between murine and human immunology, providing critical preclinical insights into disease mechanisms. This review comprehensively surveys the methodologies used to generate humanized mouse models of multiple systemic autoimmune diseases, including systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, and Sjögren’s syndrome, as well as of various neurological and non-neurological organ-specific autoimmune diseases. We also delineate the models’ immunological, pathological, and molecular manifestations and discuss their limitations and potential remedies. We advocate for the continuous refinement of these models to enhance their longevity and fidelity and emphasize the importance of humanized mouse models in clarifying the complexities of autoimmune diseases and developing targeted therapies.

BACKGROUND:Cryptococcal meningitis (CM) in HIV-negative individuals is increasing, yet the role of vitamin D remains unclear. This study investigates serum 25-hydroxyvitamin D [25(OH)D] levels and their clinical implications in HIV-negative CM patients. METHODS:We conducted a retrospective case-control study of 93 HIV-negative CM patients and 191 healthy controls (HCs). Serum 25(OH)D levels, cerebrospinal fluid (CSF) fungal burden, cytokine profiles, the incidence of postinfectious inflammatory response syndrome (PIIRS), and one-year mortality were assessed. Bivariate logistic regression models identified predictors of mortality. RESULTS:CM patients had significantly lower serum 25(OH)D levels than HCs (18.33 vs. 23.69 ng/mL, p < 0.001), with a higher rate of deficiency (<20 ng/mL) in the CM group (59.14% vs. 34.03%, p < 0.001). Lower 25(OH)D levels were associated with elevated CSF levels of IL-6 and IL-8 (p < 0.05). Deficiency was linked to increased PIIRS incidence (43.64% vs. 21.05%, p = 0.028). Bivariate logistic regression showed a protective trend for 25(OH)D levels (OR 0.939, 95% CI 0.877-1.006, p = 0.075), although deficiency was not associated with higher mortality. CONCLUSIONS:Serum 25(OH)D deficiency is prevalent in HIV-negative CM patients and linked to neuroinflammation and increased risk of PIIRS. Serum 25(OH)D levels may serve as a useful prognostic marker, although further research is needed.

BACKGROUND:Autoimmune glial fibrillary acidic protein astrocytopathy (GFAPA) is a recently recognized autoimmune disorder of the central nervous system. While many patients respond to conventional immunotherapies, a subset exhibits suboptimal responses, highlighting the need for alternative treatment strategies. OBJECTIVE:To report real-world clinical experience with efgartigimod in GFAPA patients, providing preliminary data on its safety and effectiveness. DESIGN:This retrospective case-control study was conducted at a single center in China and included patients with GFAPA who received efgartigimod, with a minimum follow-up of 8 weeks. METHODS:We analyzed data from 36 patients diagnosed with GFAPA between January 2021 and July 2024. Patients were categorized into two groups: those treated with efgartigimod (n = 16) and those who were not (control group, n = 20). Clinical outcomes were evaluated using the modified Rankin Scale, Clinical Assessment Scale in Autoimmune Encephalitis (CASE), Glasgow Coma Scale (GCS), and assessment of clinical symptoms. Additionally, we monitored treatment-emergent adverse events (TEAEs), changes in cerebrospinal fluid (CSF) parameters (total protein, leukocyte count, anti-GFAP antibody titers), and serum immunoglobulin G (IgG) levels. RESULTS:Compared to the control group, patients receiving efgartigimod demonstrated greater clinical improvement, as reflected by borderline significant reductions in CASE scores at discharge (p = 0.04). Improvements in GCS scores were also observed at both time points. The efgartigimod group showed significant decreases in CSF total protein, leukocyte count, anti-GFAP antibody titers, and serum IgG levels. The most common TEAEs were mild to moderate infections; no serious safety concerns were identified. CONCLUSION:Efgartigimod appears to be safe and potentially effective in patients with GFAPA, and may be associated with improvements in clinical symptoms and neurological function. However, larger prospective, randomized controlled trials are warranted to confirm these findings and establish its role in the treatment algorithm.

Background:Reports of cryptococcosis among patients without human immunodeficiency virus (HIV) infection are increasing. However, there is still a lack of data regarding the mortality characteristics in this population. Method:The clinical, laboratory, imaging data from 743 HIV-negative patients with cryptococcosis were analyzed. Kaplan-Meier analysis was used to estimate all-cause mortality at 2-week, 10-week, and 1-year, with comparisons between groups using log-rank tests. Risk factor analysis was conducted using Cox models. Additionally, a meta-analysis was conducted on four recent large-scale cohort studies to investigate the differences in 2-week mortality of HIV-negative cryptococcosis across different regions. Statistical analyses were performed using R. Result:The 2-week, 10-week, and 1-year mortality rates were 1.4% (95% confidence interval [CI] 0.5-2.2%), 8.4% (95% CI 6.3-10.4%), and 12.2% (95% CI 9.7-14.7%), respectively. Old age, higher baseline modified Rankin Scale scores, altered mental status, elevated total bilirubin levels, increased peripheral white blood cell counts, reduced serum albumin levels, elevated creatinine levels were associated with the mortality of cryptococcosis patients. For investigating the difference in 2-week mortality between Western and Chinese HIV-negative cryptococcosis, meta-analysis identified solid organ transplant and malignancy as risk factors (RR = 1.50, 95% CI 1.08-2.07, P = .02), while meta-regression indicated that older age in HIV-negative patients in Western countries increased risk (RR = 1.15, 95% CI 1.09-1.22, P < .001). Conclusions:The mortality rate of HIV-negative cryptococcosis patients is relatively low and primarily occurs within 2 to 10 weeks. The characteristics contributing to a lower 2-week mortality rate differ significantly from those in the Western countries, mainly because of the differences in age and underlying risk populations.

Prognostic prediction and identification of key factors are essential in managing autoimmune glial fibrillary acidic protein astrocytopathy (A-GFAP-A), a rare, recently identified inflammatory neurological disorder. However, prognostic factors for functional outcomes remain unclear. This retrospective study of A-GFAP-A patients was conducted between 2021 and 2024. Based on 1-month modified Rankin scale score (mRS) after admission, patients were divided into good outcome group (mRS 0–2) and poor outcome group (mRS 3–6). Demographic variables, clinical data, brain MRI, and mRS scores were examined as predictors of prognosis in logistic regression and least absolute shrinkage and selection operator (LASSO) models, respectively. Multiple machine learning classification models were evaluated to select the optimal model, followed by the development of a logistic regression-based nomogram and Shapley Additive exPlanations (SHAP) interpretation for personalized risk assessment. 107 patients (73.8

To evaluate the efficacy and safety of four antifungal regimens in treating non-HIV and non-transplant (NHNT) cryptococcal meningitis (CM) patients with high cryptococcal count (≥ 10,000/ml). A retrospective analysis was conducted on 135 NHNT CM patients with high cryptococcal count who were admitted to the Third Affiliated Hospital of Sun Yat-sen University from 2008 to 2023. Patients were categorized into four groups based on the antifungal regimen used during the induction period (Group1: Amphotericin B-deoxycholate (AmB-d) + 5-flucytosine (5-FC) + Voriconazole (VOR); Group2: AmB-d + 5-FC + Fluconazole (FLU); Group3: AmB-d + 5-FC; Group4: 5-FC + FLU). Treatment outcomes were assessed by comparing responses at 10 weeks. Baseline characteristics were comparable across the four groups. After 2 weeks of follow-up, the positive rate of Cryptococcus culture in cerebrospinal fluid (CSF) of Group1 (1/30; 3.3

This retrospective cohort study compared the efficacy and safety of lipid-based amphotericin B formulations (amphotericin B colloidal dispersion [ABCD] and liposomal amphotericin B [L-AmB]) versus conventional amphotericin B deoxycholate (AmB-d) for the treatment of non-human immunodeficiency virus (HIV)-associated cryptococcal meningitis (CM). Data from 199 patients were analyzed, divided into three groups based on induction therapy: AmB-d (n = 110), ABCD (n = 44), and L-AmB (n = 45). At baseline, a higher proportion of patients in the lipid-based groups presented with altered mental status. After 2 weeks, the ABCD and L-AmB groups showed significantly better clinical improvement (as measured by British Medical Research Council Stage 1) compared to the AmB-d group (63.6% and 77.8% vs. 35.5%; P < .001), and experienced substantially lower rates of renal impairment (54.5% and 53.3% vs. 79.1%; P = .001). Early fungicidal activity was similar across all groups. Multivariate analysis at 10 weeks indicated that both lipid-based formulations were associated with a lower risk of unsuccessful outcomes compared to AmB-d. Furthermore, 1-year survival analysis for clinical cure demonstrated a significantly higher cumulative incidence in the lipid-based AmB groups (Log-rank test, P = .016). In conclusion, induction regimens based on ABCD or L-AmB were associated with better outcomes than AmB-d for non-HIV-associated CM, offering better long-term outcomes and a more favorable safety profile, particularly regarding kidney toxicity.

Alzheimer's disease (AD) exhibits sex-specific molecular signatures that may improve diagnostic precision. We aimed to identify and validate male- and female-specific blood and brain gene expression biomarkers for AD prediction. We analyzed four GEO datasets (blood- and brain-derived) using limma and Fisher's meta-analysis to identify sex-specific differentially expressed genes, assessed age associations via linear regression, and constructed 10-fold cross-validated logistic regression models. After performing a meta-analysis, 74 differentially expressed genes were identified in the female cohort and 89 DEGs were screened in the male cohort. ERH and MRPS33 were identified as the most relevant genes in the male cohort, and NDUFA1 and NDUFS5 were screened in the female cohort. The identified genes were downregulated in AD samples compared to controls. Both male-specific and female-specific prediction models achieved an AUC of above 0.7 in two external validation blood-derived datasets as well entorhinal cortex dataset. Paradoxically, qPCR showed significant upregulation of all four genes in the AD group compared to the control group.

OBJECTIVES:The purpose of this study was to evaluate the efficacy of Efgartigimod (EFG) in anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis patients during acute attacks. METHODS:A case-control study was designed to compare 26 anti-NMDAR encephalitis patients who were treated with EFG, and 15 patients with intravenous immunoglobulin (IVIG), and 23 patients with immunoadsorption with staphylococcal protein A column (SPA-IA) treatment. RESULTS:At baseline, no significant differences in mRS scores were observed among the EFG, IVIG, and SPA-IA groups of anti-NMDAR encephalitis patients. When compared with the IVIG group, patients treated with EFG had significantly decreased serum IgG levels. Compared with the SPA-IA group, EFG-treated patients had lower CSF anti-NMDAR antibody titers at admission (p = 0.039) and higher post-treatment IgG levels (p = 0.002). When compared with the IVIG group, SPA-IA patients had higher CASE scores (p = 0.022) and baseline IgG levels (p = 0.023). All groups improved the symptoms of anti-NMDAR encephalitis patients after treatment during acute attacks, with significant decreases in mRS and CASE scores from admission to discharge (p < 0.01). In the EFG and SPA-IA groups, there was a significant reduction in anti-NMDAR antibody titers in both CSF and serum (p < 0.01), while no remarkable decrease was found in the IVIG group. Additionally, serum IgG levels significantly decreased in both the EFG and SPA-IA groups post treatment and during the 1-month follow-up. By the 3-month of follow-up, IgG levels in the blood of both groups remained below the baseline levels. CONCLUSION:EFG could be an elegant alternative to both IVIG and SPA-IA therapies for anti-NMDAR encephalitis during acute attacks. It has a better effect on reducing antibody titers than IVIG and is comparable to SPA-IA therapy, and no serious adverse events were observed during infusion.

OBJECTIVE:Ofatumumab presents a potentially promising alternative to current second-line immunotherapy for refractory anti-N-methyl-D-aspartate receptor autoimmune encephalitis (NMDAR-AE). We aimed to evaluate the efficacy and safety of ofatumumab as a novel second-line immunotherapy for NMDAR-AE. METHODS:This prospective, multicenter, nested cohort study compared patients with NMDAR-AE from the CHina Autoimmune encephalitiS outcomE study registry (CHASE) recruited between October 2011 and February 2024, treated with and without ofatumumab. The primary outcome was the proportion reaching a favorable functional outcome (modified Rankin Scale [mRS] score ≤2) at the last follow-up. Secondary outcomes included mRS scores and Clinical Assessment Scale in Autoimmune Encephalitis (CASE) scores over the first 24-month follow-up and the proportion with further mRS score improvement after ofatumumab initiation. A propensity score matching was performed to balance major confounders. RESULTS:A total of 715 patients with AE were screened. Fifty-eight propensity score-matched patients with NMDAR-AE each in the ofatumumab group and non-ofatumumab group were analyzed. Fifty-four patients (93.1%) in the ofatumumab group achieved further mRS score improvement with a median time of 14 days from ofatumumab initiation, and 53 (91.4%) reached a favorable functional outcome at the last follow-up. For those who failed first-line immunotherapy, the ofatumumab group demonstrated a faster mRS score and CASE score improvement and more frequently reached a favorable functional outcome at the last follow-up compared with the non-ofatumumab group (87.9% vs. 64.7%, odds ratio [OR] 3.95; 95% confidence interval [CI] 1.12-13.94; p = 0.026). No serious adverse events associated with ofatumumab treatment were reported. INTERPRETATION:Ofatumumab showed substantial efficacy and safety, particularly in patients who failed first-line immunotherapy, warranting its consideration in NMDAR-AE management. ANN NEUROL 2025;98:80-92.

Introduction:Autoimmune glial fibrillary acidic protein astrocytopathy (A-GFAP-A) is an increasingly recognized neurological disorder with significant clinical management challenges, particularly in predicting the need for intensive care unit (ICU) admission. This study aimed to develop and validate predictive models to identify A-GFAP-A patients at increased risk for ICU admission. Methods:We retrospectively analyzed 107 patients (January 2021 - August 2024), randomly assigned to training and validation cohorts (7:3). Variable selection for model development was performed using random forest, least absolute shrinkage and selection operator (LASSO), and extreme gradient boosting (XGBoost). Logistic regression was used to construct a nomogram, and a decision tree was developed to facilitate rapid clinical decision-making. Model performance was assessed by area under the curve (AUC), calibration plots, and decision curve analysis (DCA). Results:Four key predictors of ICU admission were identified: Glasgow Coma Scale (GCS) score at admission, seizures, maximum body temperature, and C-reactive protein (CRP) levels. The nomogram demonstrated excellent predictive accuracy with AUCs of 0.923 (95% CI, 0.858-0.987) in training cohort, 0.922 (95% CI, 0.836-1.000) in validation cohort, and 0.93 (95% CI, 0.883-0.972) in bootstrap validation. The model showed excellent calibration, and DCA confirmed its clinical utility. The decision tree identified GCS <15, seizures, and temperature >39°C as the most relevant indicators for high-risk stratification. Discussion:This study presents the first validated nomogram and decision tree for ICU admission risk in A-GFAP-A, based on the largest reported cohort to date, providing a valuable tool for clinical decision-making and resource optimization.

BACKGROUND:Autoimmune encephalitis (AE) with concurrent triple neuronal/glial autoantibody positivity is exceptionally rare, and its correlation with thyroid carcinoma remains undocumented. We report for the first time a case of overlapping syndrome characterized by co-existence of anti-N-methyl-D-aspartate receptor (NMDAR), anti-glial fibrillary acidic protein (GFAP), and anti-metabotropic glutamate receptor 5 (mGluR5) antibodies, association with papillary thyroid carcinoma (PTC). CASE PRESENTATION:A 50-year-old Chinese Han woman presented with headache, mental behavioral abnormalities, and memory loss, which further developed with fever, involuntary movements, and impaired consciousness. Cerebrospinal fluid (CSF) examination revealed lymphocytic-predominant pleocytosis and elevated protein levels. CSF was positive for the three antibodies mentioned above. After treatment with methylprednisolone, rituximab, and immunoadsorption with staphylococcal protein A column (SPA-IA) treatment, her consciousness became clear and mental state returned to normal, except for memory loss during the onset of illness. Whole-body nuclear PET/CT detected thyroid tumor. She underwent radical thyroidectomy and resumed normal life without recurrence during an 18-month follow-up. CONCLUSION:This is the first reported case of this unique triad, highlighting the importance of considering underlying malignancy in patients with multiple neuronal/glial antibody co-existences.

OBJECTIVE:To investigate the epidemiology and in vitro susceptibility of Cryptococcus neoformans to fluconazole (FLU) in HIV-negative cryptococcal meningitis (CM) patients. METHODS:Demographic and laboratory data, minimum inhibiting concentrations (MICs) of FLU, and 1-year outcomes from 270 CM patients in Guangdong Province, China, between 2011 and 2022 were retrospectively collected. RESULTS:270 Cryptococcus neoformans isolates were analyzed, of which 49 (18.1%) were FLU-resistant isolates (MIC ≥8 μg/ml). The FLU MIC values and the proportion of FLU-resistant isolates showed no statistically significant temporal trend over the 12-year. However, the FLU MIC values (3.55 vs 2.84, p = 0.013) and the proportion of FLU-resistant isolates (23.9% vs 12.1%, p = 0.012) during the dry season (October to March) were higher than those during the rainy season (April to September). The 1-year mortality rates were 27.0% in the MIC ≥8 μg/ml group and 14.3% in the MIC < 8 μg/ml group. Kaplan-Meier curve showed a slight but non-significant divergence between the two groups (log-rank test p = 0.074). CONCLUSIONS:No significant temporal trend in FLU MIC was observed. Although the majority of Cryptococcus neoformans isolates are susceptible to FLU, surveillance for emerging resistance may be warranted on a national basis.

BACKGROUND:To evaluate the glymphatic dysfunction and its association with disease severity in autoimmune glial fibrillary acidic protein astrocytopathy (A-GFAP-A) patients, and to determine its clinical predictors. METHODS:A total of 20 A-GFAP-A patients and 20 healthy controls (HC) were included. All participants underwent magnetic resonance imaging, and glymphatic function was assessed using the diffusion tensor imaging along the perivascular space (DTI-ALPS) index. Modified Rankin Scale (mRS) scores were recorded at baseline and 4 weeks post-immunotherapy. Multiple linear regression analysis was conducted to identify independent predictors of short-term prognosis. RESULTS:The baseline DTI-ALPS index was significantly lower in A-GFAP-A patients compared to HC (mean ± SD: 1.50 ± 0.06 vs. 1.62 ± 0.04 [CI -0.16, -0.08], p = 0.003), after adjusting for confounding factors. Four weeks after immunotherapy, the DTI-ALPS index significantly increased (mean ± SD: 1.52 ± 0.14 vs. 1.59 ± 0.17 [CI 0.01, 0.14], p = 0.037). A significant negative correlation was observed between the residuals of the baseline DTI-ALPS index and the baseline mRS scores (r = -0.50 [CI -0.77, -0.07], p = 0.025). The baseline DTI-ALPS index was identified as an independent predictor of short-term prognosis (coefficient = -3.43 [CI -6.68, -0.04], p = 0.048). CONCLUSIONS:This study indicates that A-GFAP-A patients exhibit significant glymphatic dysfunction, as detected by the DTI-ALPS index, which is related to the severity of the disease. The DTI-ALPS index may serve as a biomarker for monitoring disease progression and as a predictor of short-term prognosis in A-GFAP-A patients.

OBJECTIVES:This study aims to evaluate the diagnostic accuracy of cryptococcal antigen lateral flow assay (CrAg LFA) in HIV-negative populations. METHODS:The CrAg LFA results of 2918 paired serum and cerebrospinal fluid (CSF) from 1459 HIV-negative inpatients (including 354 cryptococcosis and 1105 non-cryptococcosis) who underwent both serum and CSF CrAg LFA tests were retrospectively collected. Time-series analysis of sensitivity values for CrAg LFA from 2019 to 2024 was performed using linear interpolation and Gaussian smoothing. The diagnostic capability of serum CrAg LFA for predicting cryptococcal meningitis (CM) was assessed by logistic regression. Spearman's rank correlation analysed the relationship between serum and CSF CrAg LFA titres. RESULTS:The sensitivity of serum CrAg LFA test for diagnosing cryptococcosis was 97.7% (95% CI: 96.2-99.3%), with a specificity of 99.1% (95% CI: 98.5-99.7%), positive predictive value of 97.2% (95% CI: 95.5-98.9%), and negative predictive value of 99.3% (95% CI: 98.8-99.8%). False-positive serum CrAg LFA were identified in ten patients without cryptococcosis. The sensitivity, specificity, positive predictive value, and negative predictive value of CSF CrAg LFA test for the diagnosis of CM were 100% (95% CI: 100-100%), 99.9% (95% CI: 99.7-100%), 99.7% (95% CI: 99.1-100%), and 100% (95% CI: 100-100%), respectively. One case with a false-positive CSF CrAg LFA was identified. The receiver operating characteristic curve demonstrated an area under the curve of 0.96 (95% CI: 0.959-0.963) for CM in serum CrAg LFA-positive patients with neurological symptoms. DISCUSSION:This study highlights the high sensitivity and specificity of the CrAg LFA test in HIV-negative patients. This test can be used as an effective tool for the first-line rapid diagnosis of cryptococcosis in HIV-negative populations, regardless of the determination of the CrAg LFA titre.

AIMS:The aim of our study was to evaluate the efficacy of efgartigimod and intravenous immunoglobulin (IVIG) on AQP4-IgG-positive neuromyelitis optica spectrum disorder (NMOSD) patients during acute attacks. METHODS:A retrospective case-control study was designed to compare the clinical outcomes of 13 NMOSD patients treated with efgartigimod (at a dose of 20 mg/kg in the first and fifth day) and 20 NMOSD patients treated with IVIG (at 0.4 g/kg/day for 5 days). Follow-up outcome information for patients is documented at 6 months postdischarge. RESULTS:Compared with IVIG, efgartigimod could improve NMOSD patients' symptoms during acute attacks, the mean Expanded Disability Status Scale score was significantly improved from 3.0 at admission to 2.5 at discharge (P < .001). The serum IgG levels were obviously decreased in NMOSD patients treated with efgartigimod (P < .001). Additionally, AQP4-IgG titres in 5 NMOSD patients were found to turn negative after efgartigimod treatment. CONCLUSION:The efficacy of efgartigimod is comparable to IVIG therapy in improving acute symptoms of AQP4-IgG-positive NMOSD. Efgartigimod could be an elegant alternative to IVIG therapy, and no serious adverse events were observed during infusion.