Role of Quantitative CSF Microscopy to Predict Culture Status and Outcome in HIV-Associated Cryptococcal Meningitis in a Brazilian Cohort
| Autor: | David R. Boulware, Augusto César Penalva de Oliveira, Gilberto Silva Oliveira Filho, Rafi F. Dauar, Érique José F. Peixoto de Miranda, Juliana Gerhardt, José E. Vidal |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Microbiology (medical)
Adult Male medicine.medical_specialty Adolescent Colony Count Microbial Meningitis Cryptococcal Article Cohort Studies Young Adult Cerebrospinal fluid Interquartile range Internal medicine medicine Humans Survival analysis Intracranial pressure Cerebrospinal Fluid Retrospective Studies Microscopy AIDS-Related Opportunistic Infections business.industry Retrospective cohort study General Medicine Odds ratio Middle Aged medicine.disease Survival Analysis Infectious Diseases Treatment Outcome Cryptococcosis Immunology Female Drug Monitoring business Meningitis Brazil |
| Popis: | This retrospective study aimed to evaluate the clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococcal cell counts for associations with in-hospital outcomes of HIV-infected patients with cryptococcal meningitis. Ninety-eight HIV-infected adult patients with CSF culture-proven cryptococcal meningitis were admitted between January 2006 and June 2008 at a referral center in Sao Paulo, Brazil. Cryptococcal meningitis was the first AIDS-defining illness in 69%, of whom 97% (95/98) had known prior HIV infection. The median CD4+ T-cell count was 39 cells/μL (interquartile range 17-87 cells/μL). Prior antiretroviral therapy was reported in 50%. Failure to sterilize the CSF by 7-14 days was associated with baseline fungal burden of ≥ 10 yeasts/μL by quantitative CSF microscopy (odds ratio [OR] = 15.3, 95% confidence interval [CI] 4.1-56.7; P0.001) and positive blood cultures (OR = 11.5, 95% CI 1.2-109; P = 0.034). At 7-14 days, ≥ 10 yeasts/μL CSF was associated with positive CSF cultures in 98% versus 36% with10 yeasts/μL CSF (P0.001). In-hospital mortality was 30% and was associated with symptoms duration for14 days, altered mental status (P0.001), CSF white blood cell counts5 cells/μL (P = 0.027), intracranial hypertension (P = 0.011), viral loads50,000 copies/mL (P = 0.036), ≥ 10 yeasts/μL CSF at 7-14 days (P = 0.038), and intracranial pressure50 cmH(2)0 at 7-14 days (P = 0.007). In conclusion, most patients were aware of their HIV status. Fungal burden of ≥ 10 yeasts/μL by quantitative CSF microscopy predicted current CSF culture status and may be useful to customize the induction therapy. High uncontrolled intracranial pressure was associated with mortality. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|