Simple jQuery Dropdowns
Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/27727
Title: Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures
Authors: Tihana Bicanic
Annemarie E. Brouwer
Graeme Meintjes
Kevin Rebe
Direk Limmathurotsakur
Wirongrong Chierakul
Praprit Teparrakkul
Angela Loyse
Nicholas J. White
Robin Wood
Shabbar Jaffar
Thomas Harrison
University of Cape Town
St George's University of London
GF Jooste Hospital
Mahidol University
Sappasitthiprasong Hospital
Nuffield Department of Clinical Medicine
Radboud University Nijmegen
London School of Hygiene & Tropical Medicine
Keywords: Immunology and Microbiology;Medicine
Issue Date: 27-Mar-2009
Citation: AIDS. Vol.23, No.6 (2009), 701-706
Abstract: Objectives: To assess impact of serial lumbar punctures on association between cerebrospinal fluid (CSF) opening pressure and prognosis in HIV-associated cryptococcal meningitis; to explore time course and relationship of opening pressure with neurological findings, CSF fungal burden, immune response, and CD4 cell count. Design: Evaluation of 163 HIV-positive ART-naive patients enrolled in three trials of amphotericin B-based therapy for cryptococcal meningitis in Thailand and South Africa. Methods: Study protocols required four lumbar punctures with measurements of opening pressure over the first 2 weeks of treatment and additional lumbar punctures if opening pressure raised. Fungal burden and clearance, CSF immune parameters, CD4 cell count, neurological symptoms and signs, and outcome at 2 and 10 weeks were compared between groups categorized by opening pressure at cryptococcal meningitis diagnosis. Results: Patients with higher baseline fungal burden had higher baseline opening pressure. High fungal burden appeared necessary but not sufficient for development of high pressure. Baseline opening pressure was not associated with CD4 cell count, CSF pro-inflammatory cytokines, or altered mental status. Day 14 opening pressure was associated with day 14 fungal burden. Overall mortality was 12% (20/162) at 2 weeks and 26% (42/160) at 10 weeks, with no significant differences between opening pressure groups. Conclusion: Studies are needed to define factors, in addition to fungal burden, associated with raised opening pressure. Aggressive management of raised opening pressure through repeated CSF drainage appeared to prevent any adverse impact of raised opening pressure on outcome in patients with cryptococcal meningitis. The results support increasing access to manometers in resource-poor settings and routine management of opening pressure in patients with cryptococcal meningitis. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
URI: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=64549108540&origin=inward
http://repository.li.mahidol.ac.th/dspace/handle/123456789/27727
ISSN: 02699370
Appears in Collections:Scopus 2006-2010

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.