Determinants of Mortality in a Combined Cohort of 501 Patients With HIV-Associated Cryptococcal Meningitis: Implications for Improving Outcomes

Abstract

Cerebrospinal fluid fungal burden, altered mental status, and rate of clearance of infection predict acute mortality in HIV-associated cryptococcal meningitis. The identification of factors associated with mortality informs strategies to improve outcomes.

Rapid Diagnosis of Cryptococcal Meningitis by Use of Lateral Flow Assay on Cerebrospinal Fluid Samples: Influence of the High-Dose “Hook” Effect

“…It is the main cause of adult meningitis in sub-Saharan Africa (SSA) (3)(4)(5) and is a major cause of HIV-related mortality, accounting for between 13 and 44% of deaths in HIV-infected cohorts in resource-limited countries (3). Case fatality rates remain unacceptably high.…”

“…Key factors influencing survival are the fungal burden at presentation and the rate of sterilization of cerebrospinal fluid (CSF) with combination treatment (6,8,9,11,12). The rapid and accurate laboratory diagnosis of CM is thus important to enable the timely use of appropriate medication and prevent diagnostic delays contributing to increased CSF fungal loads and poor clinical outcomes (6,11,13,14).…”

Management of HIV-associated cryptococcal disease in South Africa

“…Previously, most study protocols for clinical trials in SA, Uganda, Malawi and Thailand advocated ART initiation 2 -6 weeks after starting antifungal therapy. [29] There have been four randomised trials that have tried to answer the question of optimal ART timing.…”

Treatment Principles for Candida and Cryptococcus

“…1) (Perfect et al 2010). Daily therapeutic lumbar punctures, up to a maximum of 20 -30 mL CSF, for those with persistently raised OP .25 cm H 2 O, provide immediate symptom relief as well as possibly abrogating the adverse impact of raised ICP on survival (Jarvis et al 2014). Those with refractory high CSF OPand progressive visual or other neurological impairment should be considered for a temporary lumbar drain (Perfect et al 2010).…”