Outcomes of HIV-associated pneumocystis pneumonia at a South African referral hospital

Abstract

Background: Although tuberculous meningitis (TM) represents near 1% of the cases of tuberculosis disease, it is the most severe form of tuberculosis, with high mortality rate.Purpose: Description of tuberculosis meningitis cases and evaluation of infection outcome.Methods & Materials: Retrospective observational study in adults diagnosed with tuberculous meningitis at Centro Hospitalar do Porto, between January 2009 and October 2016.Results: During that period, 21 patients had a diagnosis of tuberculous meningitis, 81% (n = 17) were males and the mean age was 52,6 years-old (min 22; max 84). More prevalent risk factors identified were: chronic alcoholism (>60 g/day) in 23,8% (n = 5), drug use in 14,3% (n = 3) and iatrogenic immunosuppression in 14,3%. HIV infection was present in 28,6% (n = 6) On hospital admission, 23,8% (n = 5) patients had a stage III on BMRC score (British Medical Research Council). Regarding the cerebrospinal fluid (CSF), the mean protein level was 2,06 g/L (min. 0,30; max 4,53) and mean glucose de 0,34 g/L (min. 0,06; max. 0,81), mean pleocitosis of 233 cels/uL (mín. 0; máx. 911) with predominance of mononuclear cells (mean 140/uL; min. 0; max. 594). Microbiological diagnosis was based in PCR-assay (47,4%, n = 9), followed by culture (38,9%, n = 7).There was concomitant pulmonary tuberculosis in 19,0% (n = 4) of patients and 19,0% with disseminated disease. Tuberculostatic drugs were started in 20 patients (one died early) and 89,5% of them with adjunctive corticosteroids. External ventricular drain was needed in 42,9% (n = 9). Ischemic stroke (28,6%; n = 6) was the most common complication.Mortality rate at two-years was 47,6% (n = 10), with 6 deaths during hospitalization, 5 of them TM-related. At discharge, 9 of surviving patients had neurological sequelae with loss of autonomy.Conclusion: Even though it was a rare diagnosis in hospitalized patients, TM had a high mortality rate with significant loss of autonomy.

Causes and outcomes of hospitalizations among people living with HIV in Georgia’s referral institution, 2012–2017

“…While studies from resource-rich countries indicate decreases in mortality, [24][25][26] studies from low-and middleincome countries report high rates of mortality in recent years, ranging between 17.3% and 31.5%. [27][28][29] The high mortality from PCP in our settings is beyond the scope of the present article but warrants further analyses, including analysis of requirement of intensive care unit admission or mechanical ventilation, as well as prior use of PCP prophylaxis. In addition to very late presentation to care, it is possible that the patients who died from PCP in our study also had other undiagnosed coinfections, particularly TB, which is known to be adversely impact the outcome.…”

“…In addition to very late presentation to care, it is possible that the patients who died from PCP in our study also had other undiagnosed coinfections, particularly TB, which is known to be adversely impact the outcome. 27 High mortality from CM is well-documented both in resource-rich and resource-limited settings, even in patients treated with amphotericin B and flucytosine, 30,31 while in Georgia, neither of the recommended first-line treatment options is available, and treatment is limited to fluconazole.…”