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Cryptococcal meningitis

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https://www.readbyqxmd.com/read/29028998/high-cryptococcal-antigen-titers-in-blood-are-predictive-of-subclinical-cryptococcal-meningitis-among-hiv-infected-patients
#1
Rachel M Wake, Erika Britz, Charlotte Sriruttan, Ivy Rukasha, Tanvier Omar, David C Spencer, Jeremy S Nel, Sello Mashamaite, Adeboye Adelekan, Tom M Chiller, Joseph N Jarvis, Thomas S Harrison, Nelesh P Govender
Background: High mortality rates among asymptomatic cryptococcal antigen (CrAg)-positive patients identified through CrAg screening, despite pre-emptive fluconazole, may be due to undiagnosed cryptococcal meningitis. Methods: Symptoms were reviewed in CrAg-positive patients identified through screening 19,233 individuals with CD4 cell counts < 100 cells/µL at 17 clinics and 3 hospitals in Johannesburg from September 2012 until September 2015, and 2 of these hospitals until June 2016...
October 5, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29028957/long-term-mortality-and-disability-in-cryptococcal-meningitis-a-systematic-literature-review
#2
Estelle Pasquier, John Kunda, Pierre De Beaudrap, Angela Loyse, Elvis Temfack, Síle F Molloy, Thomas S Harrison, Olivier Lortholary
Cryptococcal meningitis (CM) is the primary cause of meningitis in HIV-infected adults and an emerging disease in HIV-seronegative individuals. No literature review has studied the long-term outcome of CM. We performed a systematic review on the long-term (≥3 months) impact of CM (C. neoformans and C. gattii) on mortality and disability in HIV-infected and non-HIV-infected adults. Though the quality of current evidence is limited, the long-term impact of CM on survival and disability appears to be high. One-year mortality ranged from 13% in an Australian non-HIV C...
October 4, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29021643/cryptococcal-cerebellitis-in-no-vih-patient
#3
Fabricio Andres Lasso, Tomas Omar Zamora Bastidas, Jorge Andrés Potosí García, Bairon Díaz Idrobo
INTRODUCTION: Cryptococcosis is an opportunistic fungal infection whose etiology is Cryptococcus neofromans / C. gattii, complex which affects immunocompromised patients mainly. Meningeal infection is one of the most common presentations, but cerebellar affection is rare. CASE DESCRIPTION: Male patient with 65 old years, from an area of subtropical climate with chronic exposure to poultry, without pathological antecedents, who presented clinical picture consistent with headache, fever, seizures and altered mental status...
June 30, 2017: Colombia Médica: CM
https://www.readbyqxmd.com/read/29020172/high-dose-fluconazole-monotherapy-is-inadequate-for-csf-cryptococcal-antigen-positive-hiv-infected-persons-in-an-ethiopian-crag-screening-program
#4
Tafese Beyene, Anteneh G Zewde, Abera Balcha, Belda Hirpo, Tadele Yitbarik, Teshome Gebissa, Radha Rajasingham, David R Boulware
817 HIV-infected Ethiopians with CD4 <=150/mcL underwent lab-based reflex cryptococcal antigen(CrAg) screening, using remaining plasma after CD4 testing. Of participants with plasma CrAg titers >=1:640, 96% (27/28) had cryptococcal meningitis (CSF CrAg+). When treated with fluconazole 1200mg monotherapy, 68% (23/34) of CSF CrAg+ died within three months.
July 17, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28992308/relationship-between-intracranial-pressure-and-antifungal-agents-levels-in-the-csf-of-patients-with-cryptococcal-meningitis
#5
Fernanda Wirth, Maria Isabel de Azevedo, Carmen Pilla, Valério Rodrigues Aquino, Gustavo Wissmann Neto, Luciano Zubaran Goldani
The purpose of this study was to evaluate the influence of intracranial hypertension in the cerebrospinal fluid (CSF) levels of amphotericin B and fluconazole levels of patients with cryptococcal meningitis. CSF samples and intracranial pressure were obtained by means of routine punctures performed at days 1, 7, and 14 of therapy, respectively. Amphotericin B and fluconazole CSF levels were measured by HPLC method as previously described. The minimum inhibitory concentration for amphotericin B, fluconazole, 5΄flucytosine, and voriconazole of each Cryptococcus isolate was performed according to CLSI...
August 2, 2017: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
https://www.readbyqxmd.com/read/28991888/commonly-prescribed-antiretroviral-therapy-regimens-and-incidence-of-aids-defining-neurological-conditions
#6
Ellen C Caniglia, Andrew Phillips, Kholoud Porter, Caroline A Sabin, Alan Winston, Roger Logan, John Gill, Marie-Anne Vandenhende, Diana Barger, Sara Lodi, Santiago Moreno, José Ramón Arribas, Antonio Pacheco, Sandra W Cardoso, George Chrysos, Charalabos Gogos, Sophie Abgrall, Dominique Costagliola, Laurence Meyer, Remonie Seng, Ard van Sighem, Peter Reiss, Roberto Muga, Santiago Pérez Hoyos, Dominique Braun, Christoph Hauser, Pilar Barrufet, Maria Leyes, Janet Tate, Amy Justice, Miguel A Hernán
BACKGROUND: The differential effects of commonly prescribed combined antiretroviral therapy (cART) regimens on AIDS-defining neurological conditions (neuroAIDS) remain unknown. SETTING: Prospective cohort studies of HIV-positive individuals from Europe and the Americas included in the HIV-CAUSAL Collaboration. METHODS: Individuals who initiated a first-line cART regimen in 2004 or later containing a nucleoside reverse transcriptase inhibitor (NRTI) backbone and either atazanavir, lopinavir, darunavir, or efavirenz were followed from cART initiation until death, lost to follow-up, pregnancy, the cohort-specific administrative end of follow-up, or the event of interest, whichever occurred earliest...
October 4, 2017: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/28934415/first-report-of-urease-activity-in-the-novel-systemic-fungal-pathogen-emergomyces-africanus-a-comparison-with-the-neurotrope-cryptococcus-neoformans
#7
Barbra Lerm, Chris Kenyon, Ilan S Schwartz, Heinrich Kroukamp, Riaan de Witt, Nelesh P Govender, G Sybren de Hoog, Alfred Botha
Cryptococcus neoformans is an opportunistic pathogen responsible for the AIDS-defining illness, cryptococcal meningitis. During the disease process, entry of cryptococcal cells into the brain is facilitated by virulence factors that include urease enzyme activity. A novel species of an Emmonsia-like fungus, recently named Emergomyces africanus, was identified as a cause of disseminated mycosis in HIV-infected persons in South Africa. However, in contrast to C. neoformans, the enzymes produced by this fungus, some of which may be involved in pathogenesis, have not been described...
November 1, 2017: FEMS Yeast Research
https://www.readbyqxmd.com/read/28928997/neurosyphilis-with-concomitant-cryptococcal-and-tuberculous-meningitis-in-a-patient-with-aids-report-of-a-unique-case
#8
Jose Armando Gonzales Zamora, Luis Alberto Espinoza, Rita N Nwanyanwu
Meningitis in individuals living with acquired immunodeficiency syndrome (AIDS) is most frequently infectious in origin and usually due to opportunistic infections. The most common pathogens are Cryptococcus neoformans and Mycobacterium tuberculosis. Treponema pallidum causes neurosyphilis and can complicate HIV infections at any time after the initial infection. Simultaneous infections of the central nervous system caused by these pathogens are very uncommon even in the setting of severe immunosuppression...
2017: Case Reports in Infectious Diseases
https://www.readbyqxmd.com/read/28919338/diagnostic-accuracy-of-xpert-mtb-rif-ultra-for-tuberculous-meningitis-in-hiv-infected-adults-a-prospective-cohort-study
#9
Nathan C Bahr, Edwin Nuwagira, Emily E Evans, Fiona V Cresswell, Philip V Bystrom, Adolf Byamukama, Sarah C Bridge, Ananta S Bangdiwala, David B Meya, Claudia M Denkinger, Conrad Muzoora, David R Boulware
BACKGROUND: WHO recommends Xpert MTB/RIF as initial diagnostic testing for tuberculous meningitis. However, diagnosis remains difficult, with Xpert sensitivity of about 50-70% and culture sensitivity of about 60%. We evaluated the diagnostic performance of the new Xpert MTB/RIF Ultra (Xpert Ultra) for tuberculous meningitis. METHODS: We prospectively obtained diagnostic cerebrospinal fluid (CSF) specimens during screening for a trial on the treatment of HIV-associated cryptococcal meningitis in Mbarara, Uganda...
September 14, 2017: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/28904453/hospital-based-retrospective-study-of-cryptococcal-meningitis-in-a-large-cohort-from-india
#10
Karkal Ravishankar Naik, Aralikatte Onkarappa Saroja, Darshan Kiran Doshi
BACKGROUND: Cryptococcal meningitis is an important and a fatal neuroinfection. Early diagnosis and treatment is of utmost importance in reducing morbidity and mortality. MATERIALS AND METHODS: Data of patients with laboratory-confirmed cryptococcal meningitis seen in tertiary care hospital were reviewed. Details of demographic profile, clinical data, laboratory parameters, complications, and in-hospital mortality were studied. RESULTS: Among 97 patients with cryptococcal meningitis (79 men, 18 women), 88 were HIV-positive, two were diabetic, and seven were sporadic...
July 2017: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/28877182/cryptococcal-antigen-screening-by-lay-cadres-using-a-rapid-test-at-the-point-of-care-a-feasibility-study-in-rural-lesotho
#11
Fernanda Rick, Aline Aurore Niyibizi, Amir Shroufi, Kazumi Onami, Sarah-Jane Steele, Malehlohonolo Kuleile, Innocent Muleya, Tom Chiller, Tiffany Walker, Gilles Van Cutsem
INTRODUCTION: Cryptococcal meningitis is one of the leading causes of death among people with HIV in Africa, primarily due to delayed presentation, poor availability and high cost of treatment. Routine cryptococcal antigen (CrAg) screening of patients with a CD4 count less than 100 cells/mm3, followed by pre-emptive therapy if positive, might reduce mortality in high prevalence settings. Using the cryptococcal antigen (CrAg) lateral flow assay (LFA), screening is possible at the point of care (POC)...
2017: PloS One
https://www.readbyqxmd.com/read/28857298/cryptococcosis-in-patients-with-diabetes-mellitus-ii-in-mainland-china-1993-2015
#12
Yingfang Li, Wenjie Fang, Weiwei Jiang, Ferry Hagen, Jia Liu, Lei Zhang, Nan Hong, Yu Zhu, Xiaoguang Xu, Xia Lei, Danqi Deng, Jianping Xu, Wanqing Liao, Teun Boekhout, Min Chen, Weihua Pan
Diabetes mellitus II (DM II) is a newly defined independent factor contributing to the morbidity and mortality of cryptococcosis. This retrospective case analysis aims to explore the epidemiology, clinical profile and strain characteristics of cryptococcosis in Chinese DM II patients. This study included 30 cases of cryptococcosis with DM II occurring from 1993 to 2015 in mainland China. The hospital-based prevalence of cryptococcosis in DM II was 0.21%. The mean age of the patients was 56.1 years (95% confidence interval: 51...
August 30, 2017: Mycoses
https://www.readbyqxmd.com/read/28831193/tuberculosis-cryptococcosis-co-infection-in-china-between-1965-and-2016
#13
Wenjie Fang, Lei Zhang, Jia Liu, David W Denning, Ferry Hagen, Weiwei Jiang, Nan Hong, Shuwen Deng, Xia Lei, Danqi Deng, Wanqing Liao, Jianping Xu, Teun Boekhout, Min Chen, Weihua Pan
Cases of tuberculosis/cryptococcosis co-infection are rapidly increasing in China. However, most studies addressing this co-infection have been published in Chinese journals, and this publication strategy has obscured this disease trend for scientists in other parts of the world. Our investigation found that 62.9% of all co-infection cases worldwide were reported in the Chinese population (n=197) between 1965 and 2016, and 56.3% of these Chinese cases were reported after 2010. Nearly all cases originated from the warm and wet monsoon regions of China...
August 23, 2017: Emerging Microbes & Infections
https://www.readbyqxmd.com/read/28830348/evaluation-of-trypan-blue-stain-in-a-haemocytometer-for-rapid-detection-of-cerebrospinal-fluid-sterility-in-hiv-patients-with-cryptococcal-meningitis
#14
Richard Kwizera, Andrew Akampurira, Tadeo K Kandole, Kirsten Nielsen, Andrew Kambugu, David B Meya, David R Boulware, Joshua Rhein
BACKGROUND: Quantitative culture is the most common method to determine the fungal burden and sterility of cerebrospinal fluid (CSF) among persons with cryptococcal meningitis. A major drawback of cultures is a long turnaround-time. Recent evidence demonstrates that live and dead Cryptococcus yeasts can be distinguished using trypan blue staining. We hypothesized that trypan blue staining combined with haemocytometer counting may provide a rapid estimation of quantitative culture count and detection of CSF sterility...
August 22, 2017: BMC Microbiology
https://www.readbyqxmd.com/read/28820702/predictive-model-for-permanent-shunting-in-cryptococcal-meningitis
#15
Woralux Phusoongnern, Siriluck Anunnatsiri, Kittisak Sawanyawisuth, Amnat Kitkhuandee
Cryptococcal meningitis may have long-term morbidity and requires a permanent cerebrospinal fluid shunt. This study aimed to evaluate the risk factors and create a predictive model for permanent shunt treatment in cryptococcal meningitis patients. This was a retrospective analytical study conducted at Khon Kaen University. The study period was from January 2005 to December 2015. We enrolled all adult patients diagnosed with cryptococcal meningitis. Risk factors predictive for permanent shunting treatment were analyzed by multivariate logistic regression analysis...
August 14, 2017: American Journal of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/28815430/clinical-evaluation-of-the-antifungal-effect-of-sertraline-in-the-treatment-of-cryptococcal-meningitis-in-hiv-patients-a-single-mexican-center-experience
#16
Hiram Villanueva-Lozano, Rogelio de J Treviño-Rangel, Gloria M González, Pedro A Hernández-Rodríguez, Adrián Camacho-Ortiz, Luis Castillo-Reyna, Sandra G Galindo-Alvarado, Michel F Martínez-Reséndez
PURPOSE: Cryptococcal meningitis is a potentially fatal fungal infection associated with a significant attributable morbidity and mortality, especially among HIV/AIDS patients. The first-line therapy for the treatment of this clinical entity is the combinatory therapy of amphotericin B plus flucytosine. However, the high cost, toxic effects, and limited repertoire of effective antifungal drugs have led to the investigation of novel molecules. This is a prospective, double-blinded, and randomized study performed in a Mexican tertiary care center to evaluate the antifungal activity of sertraline in the treatment of cryptococcal meningitis in HIV patients...
August 16, 2017: Infection
https://www.readbyqxmd.com/read/28807740/outcomes-of-hiv-positive-patients-with-cryptococcal-meningitis-in-the-americas
#17
B Crabtree Ramírez, Y Caro Vega, B E Shepherd, C Le, M Turner, C Frola, B Grinsztejn, C Cortes, D Padgett, T R Sterling, C C McGowan, A Person
BACKGROUND: Cryptococcal meningitis (CM) is associated with substantial mortality in HIV-infected patients. Optimal timing of antiretroviral therapy (ART) in persons with CM represents a clinical challenge, and the burden of CM in Latin America has not been well described. Studies suggest that early ART initiation is associated with higher mortality, but data from the Americas are scarce. METHODS: HIV-infected adults in care between 1985-2014 at participating sites in the Latin America (the Caribbean, Central and South America network (CCASAnet)) and the Vanderbilt Comprehensive Care Clinic (VCCC) and who had CM were included...
October 2017: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/28806629/aseptic-meningitis-in-adults-and-children-diagnostic-and-management-challenges
#18
Bhavarth Shukla, Elizabeth A Aguilera, Lucrecia Salazar, Susan H Wootton, Quanhathai Kaewpoowat, Rodrigo Hasbun
BACKGROUND: Aseptic meningitis represents a common diagnostic and management dilemma to clinicians. OBJECTIVES: To compare the clinical epidemiology, diagnostic evaluations, management, and outcomes between adults and children with aseptic meningitis. STUDY DESIGN: We conducted a retrospective study from January 2005 through September 2010 at 9 Memorial Hermann Hospitals in Houston, TX. Patients age≥2months who presented with community-acquired aseptic meningitis with a CSF white blood cell count >5cells/mm(3) and a negative Gram stain and cultures were enrolled...
September 2017: Journal of Clinical Virology: the Official Publication of the Pan American Society for Clinical Virology
https://www.readbyqxmd.com/read/28799299/a-comparative-study-of-csf-viral-rna-loads-between-hiv-positive-patients-with-neurological-manifestations-and-neurologically-asymptomatic-hiv-patients
#19
A D Mathur, S Devesh
INTRODUCTION: There are conflicting reports in literature about correlation of CSF viral RNA levels with neurological manifestations in HIV positive patients. Many studies in animals and human subjects have shown that CSF HIV-1 RNA can be useful as a specific marker of HIV induced neuropathology. To the contrary there are studies which show that neurological disease states can occur in absence of significant increase of CSF HIV RNA. MATERIALS AND METHODS: This was a prospective study conducted at Base hospital Delhi Cantt, New Delhi, a tertiary care hospitals for HIV patients...
August 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/28793057/noninvasive-intracranial-pressure-monitoring-for-hiv-associated-cryptococcal-meningitis
#20
V R Bollela, G Frigieri, F C Vilar, D L Spavieri, F J Tallarico, G M Tallarico, R A P Andrade, T M de Haes, O M Takayanagui, A M Catai, S Mascarenhas
Mortality and adverse neurologic sequelae from HIV-associated cryptococcal meningitis (HIV-CM) remains high due to raised intracranial pressure (ICP) complications. Cerebrospinal fluid (CSF) high opening pressure occurs in more than 50% of HIV-CM patients. Repeated lumbar puncture with CSF drainage and external lumbar drainage might be required in the management of these patients. Usually, there is a high grade of uncertainty and the basis for clinical decisions regarding ICP hypertension tends to be from clinical findings (headache, nausea and vomiting), a low Glasgow coma scale score, and/or fundoscopic papilledema...
August 7, 2017: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
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