دورية أكاديمية
Treatment of cryptococcal meningitis in KwaZulu-Natal, South Africa.
| العنوان: | Treatment of cryptococcal meningitis in KwaZulu-Natal, South Africa. |
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| المؤلفون: | Lightowler JV; Ngwelezane Hospital, Empangeni, KwaZulu-Natal, South Africa., Cooke GS, Mutevedzi P, Lessells RJ, Newell ML, Dedicoat M |
| المصدر: | PloS one [PLoS One] 2010 Jan 07; Vol. 5 (1), pp. e8630. Date of Electronic Publication: 2010 Jan 07. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: Electronic Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: San Francisco, CA : Public Library of Science |
| مواضيع طبية MeSH: | Amphotericin B/*therapeutic use , Antifungal Agents/*therapeutic use , Fluconazole/*therapeutic use , Meningitis, Cryptococcal/*drug therapy, Adult ; Female ; Humans ; Male ; Prospective Studies ; South Africa ; Survival Analysis |
| مستخلص: | Background: Cryptococcal meningitis (CM) remains a leading cause of death for HIV-infected individuals in sub-Saharan Africa. Improved treatment strategies are needed if individuals are to benefit from the increasing availability of antiretroviral therapy. We investigated the factors associated with mortality in routine care in KwaZulu-Natal, South Africa. Methodology/principal Findings: A prospective year long, single-center, consecutive case series of individuals diagnosed with cryptococcal meningitis 190 patients were diagnosed with culture positive cryptococcal meningitis, of whom 186 were included in the study. 52/186 (28.0%) patients died within 14 days of diagnosis and 60/186 (32.3%) had died by day 28. In multivariable cox regression analysis, focal neurology (aHR 11 95%C.I. 3.08-39.3, P<0.001), diastolic blood pressure<60 mmHg (aHR 2.37 95%C.I. 1.11-5.04, P=0.025), concurrent treatment for tuberculosis (aHR 2.11 95%C.I. 1.02-4.35, P=0.044) and use of fluconazole monotherapy (aHR 3.69 95% C.I. 1.74-7.85, P<0.001) were associated with increased mortality at 14 and 28 days. Conclusions: Even in a setting where amphotericin B is available, mortality from cryptococcal meningitis in this setting is high, particularly in the immediate period after diagnosis. This highlights the still unmet need not only for earlier diagnosis of HIV and timely access to treatment of opportunistic infections, but for better treatment strategies of cryptococcal meningitis. |
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| معلومات مُعتمدة: | United Kingdom WT_ Wellcome Trust; GR085957 United Kingdom WT_ Wellcome Trust |
| المشرفين على المادة: | 0 (Antifungal Agents) 7XU7A7DROE (Amphotericin B) 8VZV102JFY (Fluconazole) |
| تواريخ الأحداث: | Date Created: 20100112 Date Completed: 20100520 Latest Revision: 20220321 |
| رمز التحديث: | 20221213 |
| مُعرف محوري في PubMed: | PMC2799667 |
| DOI: | 10.1371/journal.pone.0008630 |
| PMID: | 20062814 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1932-6203 |
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| DOI: | 10.1371/journal.pone.0008630 |