Visual Disturbance in Patients with Cryptococcal Meningitis: The Road Ahead

Kuriakose, Cijoy K; Mishra, Ajay Kumar; Vanjare, Harshad Arvind; Raju, Ancy; Abraham, O C

doi:10.4103/0976-3147.193560

Cited by 16 publications

(15 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ophthalmic signs and symptoms were present in more than a quarter of our cohort of Ugandan adults with HIV-associated cryptococcal meningitis, consistent with previous literature reporting ophthalmic findings to be common in this population 1 , 2 , 8 , 16 , 17 , although heterogeneity in study design should is noted. The complexity of this patient group is demonstrated in the breadth of signs present, both those indicative of systemic disease and those representing concurrent ocular and neurological pathology.…”

Section: Discussionsupporting

confidence: 91%

“…This demonstrates the potential for identifying a large spectrum of systemic, ocular and neurological disease even in a low-resource setting. The absence of equipment such as Snellen charts in our study may partly explain the low incidence of reported visual disturbance in our population (4.6%), when compared to previously published case series 2 , 8 , 16 , 17 . The apparently low incidence of neurological signs (10.9%) is likely to be attributable in part to the effect of protocol-specified lumbar punctures on intracranial pressure.…”

Section: Discussioncontrasting

confidence: 65%

See 1 more Smart Citation

Ophthalmic signs in Ugandan adults with HIV-associated cryptococcal meningitis: A nested analysis of the ASTRO-CM cohort

et al. 2018

View full text Add to dashboard Cite

Cryptococcal meningitis is a leading cause of morbidity and mortality among HIV-infected persons, accounting for 15% of AIDS-related deaths. Visual disturbance is commonly reported, and a wide range of ophthalmic signs may be present on examination. There is limited published literature to date describing the range and incidence of ophthalmic signs in HIV-associated cryptococcal meningitis. Nested within the Adjunctive Sertraline for the Treatment of HIV-Associated Cryptococcal Meningitis (ASTRO-CM) trial (ClinicalTrials.gov number: NCT01802385), we conducted an observational study of 696 Ugandan adults with HIV-associated cryptococcal meningitis. Patients were screened for visual disturbance and external ophthalmic signs at initial presentation and at follow-up appointments over 18 weeks. Assessment comprised simple clinical history and basic examination and required no specialist equipment. More than a quarter of our cohort demonstrated ocular signs or symptoms, which were observed throughout the study period. A broad range of ocular signs were demonstrated: these included neurological signs (10.9%), localized ocular pathology (4.5%), and evidence of concurrent systemic disease (12.9%). The range of signs observed demonstrates the complexities of case management in patients with advanced HIV and cryptococcosis and also the importance of basic ocular examination in low resource settings. There remains an urgent need for studies conducting comprehensive ocular examination in patients with HIV-associated cryptococcal meningitis; these studies should include formal assessment of visual acuity, slit lamp examination and dilated indirect ophthalmoscopy. Prospective studies should investigate whether there is a correlation between reported visual disturbance and objective signs, in order to further clarify the underlying mechanisms and to guide effective diagnosis, follow-up and management.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 65%

Ophthalmic signs in Ugandan adults with HIV-associated cryptococcal meningitis: A nested analysis of the ASTRO-CM cohort

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Of the excluded studies, 16 concerned CM, [54][55][56][57][59][60][61][62][63][66][67][68][69]76,78,80 four TBM, 20,58,64,77 two bacterial meningitis, 70,71 one coccoidal meningitis, 8 and one included only cases of diagnostic uncertainty. 65 Two studies were published only in abstract form and did not present sufficient outcome data for inclusion.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…The reasons for exclusion from this review are as follows: Two studies included patients with multiple, undocumented modalities of CSF diversion; 54,55 one study provided a just single case report; 56 three studies reported just one or two cases of surgical intervention and no survival/outcome data; 57,60,61 one study included 44 patients who underwent VPS in the context of CM but no outcome data; 80 two studies were review articles; 58,66 eight reported no HIV-infected patients who underwent VPS; 20,59,[62][63][64][65]71,[76][77][78] in one study reporting <50% HIV-infected patients it was not possible to associate outcome with HIV status 8 and; no relevant measures of survival/outcome were studied in four. [67][68][69][70]…”

Section: Description Of Studiesmentioning

confidence: 99%

Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis

Loan

Poon

Tominey

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Hydrocephalus is a common, life threatening complication of human immunodeficiency virus (HIV)-related central nervous system opportunistic infection which can be treated by insertion of a ventriculoperitoneal shunt (VPS). In HIV-infected patients there is concern that VPS might be associated with unacceptably high mortality. To identify prognostic indicators, we aimed to compare survival and clinical outcome following VPS placement between all studied causes of hydrocephalus in HIV infected patients.Methods The following electronic databases were searched: The Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), EMBASE, CINAHL Plus, LILACS, Research Registry, the metaRegister of Controlled Trials, ClinicalTrials.gov, African Journals Online, and the OpenGrey database. We included observational studies of HIV-infected patients treated with VPS which reported of survival or clinical outcome. Data was extracted using standardised proformas. Risk of bias was assessed using validated domain-based tools. Results 723 unique study records were screened. Nine observational studies were included. Three included a total of 75 patients with tuberculous meningitis (TBM) and six included a total of 49 patients with cryptococcal meningitis (CM). All of the CM and two of the TBM studies were of weak quality. One of the TBM studies was of moderate quality. One-month mortality ranged from 62.5-100% for CM and 33.3-61.9% for TBM. These pooled data were of low to very-low quality and was inadequate to support meta-analysis between aetiologies. Pooling of results from two studies with a total of 77 participants indicated that HIV-infected patients with TBM had higher risk of one-month mortality compared with HIV non-infected controls (odds ratio 3.03; 95% confidence-interval 1.13- 8.12; p=0.03). Conclusions The evidence base is currently inadequate to inform prognostication in VPS insertion in HIV-infected patients. A population-based prospective cohort study is required to address this, in the first instance.

show abstract

“…In an immunocompetent host, cryptococcal infection is subclinical and limited to lungs; however, in an immunocompromised state as in renal transplant recipient (RTR), central nervous system (CNS) is the most common site, followed by cutaneous, pulmonary, prostate and bone 4. Neurocryptococcosis usually present with focal neurological deficits like impaired cognition, seizures, cranial nerve deficits5 secondary to acute or chronic meningoencephalitis (CME) and cryptococcoma. Rarely, cerebral infarcts can occur secondary to cryptococcal vasculitis (incidence: 4%–8% of cryptococcal infections) and primarily affects basal ganglia, internal capsule, thalamus, frontal, temporal and parieto-occipital regions in the descending order 6.…”

Section: Introductionmentioning

confidence: 99%

Deceptively asymptomatic cryptococcaemia in a renal transplant recipient: the lull before a storm

et al. 2019

View full text Add to dashboard Cite

Cryptococcal infection constitutes around 3% of opportunistic infections in solid organ transplant recipients. Most common organ affected in renal transplant recipients (RTRs) is central nervous system and usually presents with chronic meningoencephalitis (CME). Ischaemic stroke as a consequence of cryptococcal meningoencephalitisis rare and possibly due to the involvement of intracranial vessel by exudates causing vasculitis-related thrombosis. In this context, we describe an unusual case of asymptomatic cryptococcaemia in an RTR, progressing on to acute ischaemic stroke secondary to acute CME with near complete neurological recovery following timely diagnosis, early and appropriate antifungal treatment. The index case attempts to re-emphasise the significance of mandatory screening required to exclude the possibility of dissemination of cryptococcaemia in RTRs besides highlighting the requirement of prolonged induction phase with combination therapy, particularly in presence of stroke.

show abstract

Visual Disturbance in Patients with Cryptococcal Meningitis: The Road Ahead

Cited by 16 publications

References 7 publications

Ophthalmic signs in Ugandan adults with HIV-associated cryptococcal meningitis: A nested analysis of the ASTRO-CM cohort

Ophthalmic signs in Ugandan adults with HIV-associated cryptococcal meningitis: A nested analysis of the ASTRO-CM cohort

Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis

Deceptively asymptomatic cryptococcaemia in a renal transplant recipient: the lull before a storm

Contact Info

Product

Resources

About