Aetiology of meningitis in HIV-infected patients in a referral hospital in Phnom Penh, Cambodia

Senya, Chhin; Rozycki, G; Pugatch, David; Harwell, Joseph I.

doi:10.1258/095646204322637263

Cited by 18 publications

(15 citation statements)

References 3 publications

(3 reference statements)

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“…[20] In our study, the case fatality rate of 52%, though high it was in line with findings of other studies. [222728] This high fatality rate could be related first to the natural history of CM and secondly to the inappropriate management issues in our milieu, which need to be addressed. [29] During our study period, the only available treatment (and until date) was generic fluconazole, whose availability was not sustained.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal meningoencephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome in douala, cameroon: A cross sectional study

et al. 2013

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Background:Cryptococcal meningoencephalitis (CM) kills about half a million human immunodeficiency virus (HIV) patients per year, mostly in Africa.Aim:The aim of this study was to determine the prevalence, clinical presentation and in-hospital outcome of CM among HIV-infected patients in Douala.Materials and Methods:A cross-sectional clinical note review of 672 HIV-1 patients’ files admitted from January 1 st 2004 to December 31 st 2009 at the Internal Medicine unit of the Douala General Hospital, Cameroon was performed. Only patients diagnosed of CM by microscopy of Indian ink stained cerebrospinal fluid (CSF) were studied.Results:The prevalence of CM in the study was 11.2%. Mean age of patients was 36.9 ΁ 12.7 years. Median cluster of differentiation 4 (CD4) cell count was 23 cells/μL, (interquartile range [IQR]: 10-61) and 62.7% of CD4 cell counts were >50 cells/μL. The most prevalent symptom was headache in 97.3% of patients. In CSF, median proteins was 0.9 g/L (IQR: 0.6-1); median glucose 0.2 g/L (IQR: 0.1-0.3) and median leucocyte count 54 cells/μL (IQR: 34-76) mostly of mixed cellularity. The case fatality rate was 52% and low CD4 cell count was strongly associated with death, odd ratio 4.6 (95% confidence interval: 2.6-8.0, P > 0.001).Conclusion:The high case fatality of CM in Douala warrants adequate diagnostic measures and optimization of standardized treatment to reduce mortality.

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Section: Discussionmentioning

confidence: 99%

Cryptococcal meningoencephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome in douala, cameroon: A cross sectional study

et al. 2013

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“…Entamoeba histolytica) or helminths (e.g. Gnathostoma spinigerum) and the management of such situations 5 .…”

Section: Cmentioning

confidence: 99%

Case histories of infectious disease management in developing countries: Phnom Penh and Kabul

Pilsczek

2009

Rev. Soc. Bras. Med. Trop.

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Healthcare in developing countries is affected by severe poverty, political instability and diseases that may be of lesser importance in industrialized countries. The aim of this paper was to present two cases and histories of physicians working in hospitals in developing countries and to discuss the opportunities for clinical investigation and collaboration. Cases of patients in Phnom Penh, Cambodia, with histoplasmosis, cryptococcal meningitis, crusted scabies, cerebral lesions and human immunodeficiency virus and of patients in Kabul, Afghanistan, with liver cirrhosis, nephrotic syndrome and facial ulcer are discussed. Greater developmental support is required from industrialized nations, and mutually beneficial cooperation is possible since similar clinical problems exist on both sides (e.g. opportunistic cardiovascular infections). Examples for possible support of hospital medicine include physician interchange visits with defined objectives (e.g. infection control or echocardiography training) and collaboration with clinical investigations and projects developed locally (e.g. epidemiology of cardiovascular diseases or nosocomial bloodborne infections). Key-words:Developing countries. Infectious diseases. Collaboration. Cambodia. Afghanistan. RESUMOA assistência à saúde em países em desenvolvimento é afetada pela pobreza extrema, instabilidade política e doenças que podem ter menor importância em países industrializados. O objetivo deste trabalho foi apresentar dois casos e histórias de médicos que trabalham em hospitais de países em desenvolvimento e discutir as oportunidades de investigação clínica e cooperação. São discutidos casos de pacientes em Phnom Penh, no Camboja, com histoplasmose, meningite criptocócica, sarna, lesões cerebrais e vírus da imunodeficiência humana, e de pacientes em Kabul, no Afeganistão, com cirrose hepática, síndrome nefrótica e úlcera facial. Maior apoio ao desenvolvimento por parte dos países desenvolvidos é essencial, e uma cooperação mutuamente benéfica é possível, visto que problemas clínicos similares existem em ambos os lados (p. ex. infecções cardiovasculares oportunistas). Exemplos para possível apoio à medicina hospitalar incluem intercâmbio de médicos para visitas com objetivos definidos (p. ex. controle de infecção ou treinamento em ecocardiografia) e colaboração com investigações clínicas e projetos desenvolvidos localmente (p. ex. epidemiologia de doenças cardiovasculares ou infecções hospitalares causadas por via sanguínea). Palavras-chaves:Países em desenvolvimento. Doenças infecciosas. Colaboração. Camboja. Afeganistão.

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“…Prevention of this opportunistic infection is a very important public health issue in developing countries [8]. In Cambodia, cryptococcosis was the leading cause of mortality among hospitalized AIDS patients in the 1990s [9], [10]. In four recent studies involving severely immunosuppressed patients with CD4+ count <100 cells/µl initiating combination antiretroviral therapy (cART), the prevalence of positive serum cryptococcal antigen (CRAG) was 20.2% (57/282) in Cambodia in 2004, 13.0% (42/336) in South Africa from 2002 to 2005, 8.8% (26/295) in Uganda during 2004–2006 period, and 12.9% (11/85) in Thailand [11], [12], [13], [14].…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Primary Prophylaxis of AIDS Associated Cryptococcosis in Cambodia

Micol

Tajahmady²,

Lortholary

et al. 2010

PLoS ONE

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BackgroundCryptococcal infection is a frequent cause of mortality in Cambodian HIV-infected patients with CD4+ count ≤100 cells/µl. This study assessed the cost-effectiveness of three strategies for cryptococcosis prevention in HIV-infected patients.MethodsA Markov decision tree was used to compare the following strategies at the time of HIV diagnosis: no intervention, one time systematic serum cryptococcal antigen (CRAG) screening and treatment of positive patients, and systematic primary prophylaxis with fluconazole. The trajectory of a hypothetical cohort of HIV-infected patients with CD4+ count ≤100 cells/µl initiating care was simulated over a 1-year period (cotrimoxazole initiation at enrollment; antiretroviral therapy within 3 months). Natural history and cost data (US$ 2009) were from Cambodia. Efficacy data were from international literature.ResultsIn a population in which 81% of patients had a CD4+ count ≤50 cells/ µl and 19% a CD4+ count between 51–100 cells/µl, the proportion alive 1 year after enrolment was 61% (cost $ 472) with no intervention, 70% (cost $ 483) with screening, and 72% (cost $ 492) with prophylaxis. After one year of follow-up, the cost-effectiveness of screening vs. no intervention was US$ 180/life year gained (LYG). The cost-effectiveness of prophylaxis vs. screening was $ 511/LYG. The cost-effectiveness of prophylaxis vs. screening was estimated at $1538/LYG if the proportion of patients with CD4+ count ≤50 cells/µl decreased by 75%.ConclusionIn a high endemic area of cryptococcosis and HIV infection, serum CRAG screening and prophylaxis are two cost effective strategies to prevent AIDS associated cryptococcosis in patients with CD4+ count ≤100 cells/µl, at a short-term horizon, screening being more cost-effective but less effective than prophylaxis. Systematic primary prophylaxis may be preferred in patients with CD4+ below 50 cells/µl while systematic serum CRAG screening for early targeted treatment may be preferred in patients with CD4+ between 51–100 cells/µl.

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Aetiology of meningitis in HIV-infected patients in a referral hospital in Phnom Penh, Cambodia

Cited by 18 publications

References 3 publications

Cryptococcal meningoencephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome in douala, cameroon: A cross sectional study

Cryptococcal meningoencephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome in douala, cameroon: A cross sectional study

Case histories of infectious disease management in developing countries: Phnom Penh and Kabul

Cost-Effectiveness of Primary Prophylaxis of AIDS Associated Cryptococcosis in Cambodia

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