Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America

Vidal, José Ernesto; Oliveira, Augusto César Penalva de; Dauar, Rafi F.; Boulware, David R.

doi:10.1016/j.bjid.2012.10.020

Cited by 60 publications

(69 citation statements)

References 71 publications

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“…It should be noted that, because of the low seroprevalence of specific IgG antibodies to Toxoplasma gondii in China (21), the incidence of TE ranges from 0.6% to 10.5% among HIV-infected patients in China (22), which is quite different from TE incidences in other countries (23,24). Although no differences were found between the incidences of ADC or cryptococcal meningitis among the patients who survived versus those who expired, new considerations for treatment should include higher cut-offs of CD4+ T-cell counts (cells/μL) in the eligibility criteria for ART and preemptive fluconazole treatment for patients who screened positive for cryptococcal antigens (25). In our study, 7.8% of patients (11/141) had hepatitis B and 2.1% of patients (3/141) had hepatitis C; these incidence rates were similar to those in the general population of China.…”

Section: Discussionmentioning

confidence: 99%

Baseline Factors Associated with Mortality within Six Months after Admission among Hospitalized HIV-1 Patients in Shenyang, China

et al. 2014

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Objective Short-term mortality rates remain high among critically ill human immunodeficiency virus-1 (HIV-1) patients though long-term mortality rates have dropped. Baseline risk factors for short-term mortality have not yet been determined in China. In this paper, we herein describe clinical characteristics, laboratory findings, causes of clinical deterioration, and risk factors associated with mortality among HIV-1 patients within six months after hospital admission. Methods We carried out a prospective study of hospitalized patients in advanced stages of HIV infection. These patients started antiretroviral therapy three or four weeks after admission. Follow-up was conducted for a period of six months. We used a multivariate logistic-regression analysis to identify risk factors associated with mortality. Results A total of 141 patients met our inclusion criteria. The mean age was 41 years. Fever and weight loss were the most common clinical manifestations of advanced HIV disease. Oral candidiasis, tuberculosis, cytomegaloviremia, and pneumocystis pneumonia were the most common opportunistic infections. Significantly decreased CD4+ T-cell counts, hypoalbuminemia, anemia, hyponatremia, as well as elevated C-reactive protein (CRP) and glutamic alanine transaminase levels were common laboratory test abnormalities. The mortality rate was 21.3%. The patients who died were more likely than the survivors to have low CD4+ Tcell counts as well as low creatinine, hemoglobin, albumin, and serum sodium levels while also having longer intervals of fever and higher CRP levels. A multivariate analysis demonstrated that the independent risk factors for mortality were active tuberculosis [odds ratio (OR): 2.681; 95% confidence interval (CI), p=0.049], hyponatremia (OR: 3.027; 95% CI, p=0.015), and being at clinical stage 4 (as defined by the World Health Organization) (OR: 9.492; 95% CI, 1.200-75.065; p=0.033) within the first six months of admission. Conclusion Special consideration should be given to patients who have active tuberculosis, are at clinical stage 4, and present with hyponatremia upon admission as these were found to be important factors associated with mortality within six months of hospital admission in HIV-1 patients.

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Section: Discussionmentioning

confidence: 99%

Baseline Factors Associated with Mortality within Six Months after Admission among Hospitalized HIV-1 Patients in Shenyang, China

et al. 2014

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“…6,9,30,31 Despite ART availability in public health services in Brazil since 1997, the prevalence of cryptococcosis is 6-12% and the associated mortality rate is currently 55%. [32][33][34] This mycosis was considered the second most important cause of mortality among systemic mycoses according to Brazilian study based on public health registers. 4 This figure is similar to that of Latin American countries where most HIV-infected patients are also severely immunocompromised when they start the ART or discover their HIV status and/or are hospitalized.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil

Torres

Etchebehere

Adad

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Cryptococcosis occurs in acquired immunodeficiency syndrome (AIDS) patients with poor compliance to antiretroviral therapy or unaware of their human immunodeficiency virus status who present severe immunosuppression at admission. Consequently, high mortality rates are observed due to disseminated fungal infection. This report presents clinical and postmortem data of AIDS patients with cryptococcosis in a teaching hospital in Brazil. Retrospectively, medical and necropsy records of AIDS patients with cryptococcosis clinically confirmed and/or postmortem verified were reviewed. Clinical data were compared with those of patients presenting a good outcome to evaluate disseminated fungal infection and the agreement between clinical and postmortem diagnosis. At admission, most of the 45 patients with cryptococcal meningitis who died, presented more altered consciousness (P = 0.0047), intracranial increased pressure (P = 0.047), and severe malnutrition (P = 0.0006) than the survivors. Of 29 (64.4%) patients with cryptococcal meningitis, 23 died before week 2 on antifungal therapy, and the other six during the next 3 months. The remaining 16 (35.6%) cases had other diagnoses and died soon after. At necropsy, 31 (68.9%) presented disseminated infection involving two or more organs, whereas 14 (31.1%) cases had meningeal or pulmonary localized infection. The agreement of 64.4% between clinical and postmortem diagnosis was similar to some studies. However, other reports have shown figures ranging from 34% to 95%. Currently, a progressive worldwide decrease of autopsies is worrying because the role of postmortem examination is pivotal to verify or identify the death causes, which contributes to improve the quality of clinical diagnosis and medical training.

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“…6 Additionally, this fungal infection in the central nervous system leads to severe neurological complications. In this way, its successful treatment depends on rapid and accurate identification of the causative agent.…”

Section: Discussionmentioning

confidence: 99%

“…4,7 However, until today, cryptococcal meningitis remains a common complication in Brazil and other Latin American countries as it represents the primary cause of opportunistic meningitis and the second-most frequent neurologic opportunistic infection in HIV-infected patients. 6,7 Patients with cryptococcal meningitis usually present severe neurological manifestations, particularly secondary to intracranial hypertension. [7][8][9] A rapid laboratorial diagnosis is extremely important to identify Cryptococcus species.…”

Section: Introductionmentioning

confidence: 99%

Molecular diagnosis of cryptococcal meningitis in cerebrospinal fluid: comparison of primer sets for Cryptococcus neoformans and Cryptococcus gattii species complex

Martins

Brighente

Matos

et al. 2015

The Brazilian Journal of Infectious Diseases

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Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America

Cited by 60 publications

References 71 publications

Baseline Factors Associated with Mortality within Six Months after Admission among Hospitalized HIV-1 Patients in Shenyang, China

Baseline Factors Associated with Mortality within Six Months after Admission among Hospitalized HIV-1 Patients in Shenyang, China

Cryptococcosis in Acquired Immunodeficiency Syndrome Patients Clinically Confirmed and/or Diagnosed at Necropsy in a Teaching Hospital in Brazil

Molecular diagnosis of cryptococcal meningitis in cerebrospinal fluid: comparison of primer sets for Cryptococcus neoformans and Cryptococcus gattii species complex

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