Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures

Abstract

Studies are needed to define factors, in addition to fungal burden, associated with raised opening pressure. Aggressive management of raised opening pressure through repeated CSF drainage appeared to prevent any adverse impact of raised opening pressure on outcome in patients with cryptococcal meningitis. The results support increasing access to manometers in resource-poor settings and routine management of opening pressure in patients with cryptococcal meningitis.

Visual evoked potentials show strong positive association with intracranial pressure in patients with cryptococcal meningitis

“…The frequency of ICH detected at first assessment or during follow-up in the CM patients was similar to those reported in other case series 1,3,4 . The predominance of male and HIV seropositive individuals in the investigated population reflects the current epidemiological profile of neurocryptococcosis 1,6,21,22,23 .…”

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

“…These negative predictive factors regarding mortality risk have been described in the literature as high CSF fungal burden, raised ICP, low CD4 count, and other co-morbid factors. 17 The constant turnover of junior doctors in the hospitals may have limited the impact of the initial educational intervention, and the regional hospital did not display the guidelines as a wall poster.…”

Treatment Principles for Candida and Cryptococcus

“…Raised ICP (defined as CSF opening pressure .20 cm H 2 O) is extremely common in CM, occurring in 60% -80% of patients in the context of high fungal burden (Graybill et al 2000;Bicanic et al 2009b) causing CSF outflow obstruction and a communicating hydrocephalus, and is associated with mortality (Graybill et al 2000;de Vedia et al 2013). Associated morbidities of visual and hearing loss are sometimes profound and irreversible (Rex et al 1993;Graybill et al 2000).…”

“…Factors causing slow response to induction therapy of CM include use of drugs that are slow to sterilize the CSF, such as fluconazole-based regimens or poor adherence to consolidation or maintenance therapy, and raised ICP, which can develop on therapy and persist even beyond the point of CSF sterilization (Bicanic et al 2009b).…”