Clinical presentation and aetiologies of acute or complicated headache among HIV‐seropositive patients in a Ugandan clinic

Abstract

BackgroundWe set out to define the relative prevalence and common presentations of the various aetiologies of headache within an ambulant HIV-seropositive adult population in Kampala, Uganda.MethodsWe conducted a prospective study of adult HIV-1-seropositive ambulatory patients consecutively presenting with new onset headaches. Patients were classified as focal-febrile, focal-afebrile, non-focal-febrile or non-focal-afebrile, depending on presence or absence of fever and localizing neurological signs. Further management followed along a pre-defined diagnostic algorithm to an endpoint of a diagnosis. We assessed outcomes during four months of follow up.ResultsOne hundred and eighty patients were enrolled (72% women). Most subjects presented at WHO clinical stages III and IV of HIV disease, with a median Karnofsky performance rating of 70% (IQR 60-80).The most common diagnoses were cryptococcal meningitis (28%, n = 50) and bacterial sinusitis (31%, n = 56). Less frequent diagnoses included cerebral toxoplasmosis (4%, n = 7), and tuberculous meningitis (4%, n = 7). Thirty-two (18%) had other diagnoses (malaria, bacteraemia, etc.). No aetiology could be elucidated in 28 persons (15%). Overall mortality was 13.3% (24 of 180) after four months of follow up. Those without an established headache aetiology had good clinical outcomes, with only one death (4% mortality), and 86% were ambulatory at four months.ConclusionIn an African HIV-infected ambulatory population presenting with new onset headache, aetiology was found in at least 70%. Cryptococcal meningitis and sinusitis accounted for more than half of the cases.

Pain Among Ambulatory HIV/AIDS Patients: Multicenter Study of Prevalence, Intensity, Associated Factors, and Effect

“…Our sample was similar to previous HIV/AIDS samples in the African settings in terms of its sociodemographic characteristics. 32,42,66 A proportion (47%) experienced pain in the 7 days prior to the survey. This period of prevalence of pain, while not as high as other reports for people living with HIV in Southern Africa 27, [43][44][45] (possibly due to prior use of untested tools, measurement among advanced populations, and use of long periods of time), is still higher than the 17% found in a sample of 839 HIV-negative adults attending an urban clinic for sexually transmitted diseases in Malawi, 48 the 33% reported in a community sample in a resource-poor area of Cape Town, South Africa, whose HIV status was unknown, 29 and the 24% reported in a Norwegian general population.…”

“…31 Patients are rated on a scale of 0 to 100, with 0 corresponding to no functioning ability (ie, death) and 100 corresponding to complete, independent functioning. The KPS scale is a validated tool that has been widely used in patients with terminal illnesses, 31,32,42 In this study, patients' functional performance was rated by health workers who have been trained in using the KPS to classify patients according to their functional impairment using the KPS definitions rating (%) criteria. 31 …”

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

“…In fact, evidence shows that in an ambulatory African HIV-infected population presenting with new onset of headache, the diagnosis of CM is second to bacterial sinusitis as a cause in 28% of patients. [23]…”

Cerebro-meningeal infections in HIV-infected patients: a study of 116 cases in Libreville, Gabon

“…However, in AIDS, CSF changes are sometimes atypical and non-specific,making the diagnosis of any neurological infection troublesome 2 . We diagnosed 15 cases of cryptococcal neuromeningitis, representing 12.9% of aetiologies and the second cause of CNS opportunistic infection in this population, similar to that found in other regions of sub-Saharan Africa 5 , 29,30 . Other neuromeningeal manifestations may be attributable to cytomegalovirus, herpes virus or JC virus.…”

“…In this study the median CD4 count was 68/mm 3 with a minimum count of 1/mm 3 , which is concordant with other studies showing equally advanced stages of immunocompromise in CNS disease 2,27,28 . Cryptococcal neuromeningitis is another very common cause of neurological disease in HIV positive patients 5,29 . The diagnosis rests on identification of the fungus in the CSF by either india ink staining, the detection of the polysaccharide antigen or culture.…”