Guidelines for the prevention, diagnosis and management of cryptococcal meningitis and disseminated cryptococcosis in HIV-infected patients

McCarthy, Kerrigan; Meintjes, Graeme; Arthington-Skaggs, Beth A.; Bicanic, Tihana; Cotton, Mark F.; Chiller, Tom; Govender, Nelesh P.; Harrison, Thomas S.; Karstaed, Alan; Maartens, Gary; Varavia, Ebrahim; Venter, François; Vismer, H. F.

doi:10.4102/sajhivmed.v8i3.617

Cited by 30 publications

(41 citation statements)

References 21 publications

(25 reference statements)

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“…This educational intervention focused on the problem areas identified in the prior audit, especially the importance of adhering to the national treatment guidelines. 11 It was reinforced by posters and handouts describing the CM treatment guidelines. The audit team also liaised with local hospital management to ensure the procurement of spinal manometers, and with the ART clinic staff to ensure the speedy attendance to CM patients.…”

Section: Settingmentioning

confidence: 99%

“…The integrated care pathway is based on the South African HIV Clinician Society guidelines, and the recently published 2010 Infectious Diseases Society of America (IDSA) CM management guidelines. 11,21 This integrated care pathway comprises a CM management flowchart, as well as a two-week in-patient calendar which should be part of the patient's clinical notes. This calendar prompts the clinical team (doctors, nurses and ART councillors) to perform evidence-based actions in the three key areas of the in-patient treatment phase: CSF manometry and management of raised ICP, amphotericin B treatment, and ART counselling and referral.…”

Section: Recommendationsmentioning

confidence: 99%

“…11 CM patients are treated in the district and regional hospitals of the Cape Winelands (East) district. The clinical outcomes of these patients were perceived as poor by the treating team.…”

Section: Introductionmentioning

confidence: 99%

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A medical audit of the management of cryptococcal meningitis in HIV-positive patients in the Cape Winelands (East) district, Western Cape

Pressentin¹,

Conradie

Mash

2012

South African Family Practice

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. 8 The key concerns were management of CMassociated raised intracranial pressure (ICP), general CM management uncertainties, and follow-up challenges regarding ART and long-term fluconazole adherence. The key recommendations included addressing resource needs (manometers), paying attention to the diagnosis and management of raised ICP, and addressing the need to develop a local CM treatment guideline. AbstractBackground: Cryptococcal meningitis (CM) has become the most common type of community-acquired meningitis. CM has a poor outcome if the initial in-hospital treatment does not adhere to standard guidelines. The aim of this audit was to improve the quality of the care of human immunodeficiency virus (HIV) positive patients with CM in the Cape Winelands District.Method: Following an initial audit in 2008, the researchers and a new audit team introduced interventions, and planned a second audit cycle. The folders of 25 HIV-positive adults (admitted to three district hospitals, one regional hospital, and one tuberculosis hospital) were audited.Results: Spinal manometry was performed more consistently in the regional hospital, than in the district hospitals. Reasons for failing to reach the 14-day amphotericin B target were in-patient deaths, drug stock problems, and renal impairment. The renal monitoring of amphotericin B treatment was suboptimal. The quality of care at district hospitals appeared to be comparable to that found at the regional hospital. The in-patient referral for antiretroviral treatment (ART) counselling was better in the district hospital setting. However, both levels of care had difficulty in achieving the four-week target between the onset of amphotericin B and onset of ART. Conclusion:Deficiencies in the quality of care remained. Between the prior and current audit cycles, there was no consistent improvement in care at the regional hospital. An integrated care pathway document has been developed, and adopted as policy in the Cape Winelands district. Its impact on the quality of care will be evaluated by a dedicated audit team in the future.Peer reviewed.

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Section: Settingmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

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A medical audit of the management of cryptococcal meningitis in HIV-positive patients in the Cape Winelands (East) district, Western Cape

Pressentin¹,

Conradie

Mash

2012

South African Family Practice

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“…Patients with a positive lumbar puncture for cryptococcal meningitis will be treated according to South African cryptococcal disease guidelines (amphotericin B-based induction treatment for 2 weeks, followed by fluconazole 400 mg daily for 8 weeks, followed by secondary prophylaxis, 200 mg until the CD4+ T-lymphocyte count >200 cells/ µl for six months on ART). 17,18 For patients without symptoms of meningitis or symptomatic patients with a negative lumbar puncture, treatment with fluconazole (400 mg for 8 weeks and then 200 mg until CD4+ T-lymphocyte count >200 cells/µl for 6 months on ART) is recommended.…”

Section: Training and Clinical Managementmentioning

confidence: 99%

“…1). 10,16,17 For patients testing CrAg-positive, clinicians will first evaluate patients for symptoms and signs of meningitis (including headache for longer than 24 hours, fever, confusion or reduced level of consciousness, blurred vision, or neck stiffness). The clinician will also evaluate patients for any special situations (previous history of cryptococcal meningitis, pregnancy, liver disease, nevirapine use and age <18 years).…”

Section: Training and Clinical Managementmentioning

confidence: 99%

Phased implementation of screening for cryptococcal disease in South Africa

et al. 2012

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Cryptococcus neoformans is the most common cause of laboratoryconfirmed meningitis in South Africa.1 Despite the increased coverage of antiretroviral treatment (ART), the country' s incidence of cryptococcal meningitis remains high, and in routine care settings, the disease has a case-fatality ratio of >50% at 12 weeks post-diagnosis.2-4 Screening and pre-emptive antifungal treatment is desirable to prevent the development of cryptococcal meningitis and associated deaths.

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Management of Cryptococcal Meningitis in Sub-Saharan Africa

Jackson

Hosseinipour

2010

Curr HIV/AIDS Rep

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Cryptococcal meningitis (CM) is a common form of meningitis in sub-Saharan Africa due to the high prevalence of HIV/AIDS. This report outlines the management of CM with a focus on resource-limited settings. Sections covered include epidemiology and diagnosis, pharmacotherapy, management of complications, timing of antiretrovirals, and primary and secondary prevention of CM. Emphasis has been given to recent articles and landmark trials, and opinion is given from the authors' own experiences.

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Guidelines for the prevention, diagnosis and management of cryptococcal meningitis and disseminated cryptococcosis in HIV-infected patients

Abstract: No abstract available.

Cited by 30 publications

References 21 publications

A medical audit of the management of cryptococcal meningitis in HIV-positive patients in the Cape Winelands (East) district, Western Cape

A medical audit of the management of cryptococcal meningitis in HIV-positive patients in the Cape Winelands (East) district, Western Cape

Phased implementation of screening for cryptococcal disease in South Africa

Management of Cryptococcal Meningitis in Sub-Saharan Africa

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