Ambulatory induction phase treatment of cryptococcal meningitis in HIV integrated primary care clinics, Yangon, Myanmar

Abstract

Background Cryptococcal meningitis (CM) is a common HIV-associated opportunistic-infection worldwide. Existing literature focusses on hospital-based outcomes of induction treatment. This paper reviews outpatient management in integrated primary care clinics in Yangon. Method This retrospective case note review analyses a Myanmar HIV-positive patient cohort managed using ambulatory induction-phase treatment with intravenous amphotericin-B-deoxycholate (0.7–1.0 mg/kg) and oral fluconazole (800 mg orally/day). Results Seventy-six patients were diagnosed between 2010 and 2017. The median age of patients diagnosed was 35 years, 63% were male and 33 (45%) were on concurrent treatment for tuberculosis. The median CD4 count was 60 at the time of diagnosis. Amphotericin-B-deoxycholate infusions precipitated 56 episodes of toxicity, namely hypokalaemia, nephrotoxicity, anaemia, febrile reactions, phlebitis, observed in 44 patients (58%). One-year survival (86%) was higher than existing hospital-based treatment studies. Conclusion Ambulation of patients in this cohort saved 1029 hospital bed days and had better survival outcomes when compared to hospital-based studies in other resource constrained settings.

Palmitoylethanolamide shows limited efficacy in controlling cerebral cryptococcosisin vivo

“…The World Health Organization places cryptococcosis as a high priority mycosis and recommends a combination of amphotericin B (AmpB) and 5-flurocytosine (5-FC), followed by fluconazole as the therapeutic management of CME in severely immunosuppressed individuals (6). There are limitations to this treatment regimen, particularly with AmpB being highly toxic causing nephrotoxicity, phlebitis, hypokalaemia, and anaemia (7), often requiring hospitalization (8), and the high costs and limited accessibility of 5-FC (9). Various formulations of AmpB have been tested, such as single-dose liposomal AmpB (10), which has shown similar efficacy to conventional AmpB with fewer complications, and AmpB colloidal dispersion (11).…”