OBJECTIVE: To assess kinetic of cryptococci in the cerebrospinal fluid (CSF) and outcome of AIDS-associated cyptococcal meningitis after high-dose amphotericin B. PATIENTS AND METHODS: A prospective study involving Thai adults (n=106) with cryptococcal meningitis associated with AIDS was conducted to determine the kinetic of cryptococci in CSF and prognostic factors affecting survival after high-dose amphotericin B (0.7 mg/kg/day) followed by oral azole treatment. Cerebrospinal fluids were collected for cryptococcal count and culture at weekly intervals for at least 2 weeks or until CSF cultures were negative for cryptococci. All patients were followed monthly for 1 year or until death in order to detect relapse or occurrence of any other opportunistic infection. RESULTS: A total of 106 AIDS patients with cryptococcal meningitis were enrolled. The geometric mean (range) total and viable cryptococcal counts in CSF on admission were 430,000 (1000 to 3.4 x 10(7)) and 31,000 (10 to 1.4 x 10(7)) per ml, respectively. Both total and viable cryptococcal counts declined monoexponentially with an elimination half life of 4 days. The cumulative CSF yeast clearance rates were 38% and 56% at 2 and 4 weeks, respectively. Early death was associated significantly with previous history of weight loss [relative risk (RR)=2.2; 95% CI, 1.2-3.9], Glasgow Coma Score <13 (RR=2.33; 95% CI, 1.55-3.50), and hypoalbuminaemia (P<0.001). Later mortality was associated delayed CSF yeast clearance (RR=3.6; 95% CI, 1.9--6.4) and relapse (RR=3.9; 95% CI, 1.4-10.8). CONCLUSION: High-dose amphotericin B was not as effective as previously thought. Cumulative mortality at 2 weeks, 4 weeks and 1 year were 16%, 24% and 76%, respectively. Copyright 2001 The British Infection Society.
OBJECTIVE: To assess kinetic of cryptococci in the cerebrospinal fluid (CSF) and outcome of AIDS-associated cyptococcal meningitis after high-dose amphotericin B. PATIENTS AND METHODS: A prospective study involving Thai adults (n=106) with cryptococcal meningitis associated with AIDS was conducted to determine the kinetic of cryptococci in CSF and prognostic factors affecting survival after high-dose amphotericin B (0.7 mg/kg/day) followed by oral azole treatment. Cerebrospinal fluids were collected for cryptococcal count and culture at weekly intervals for at least 2 weeks or until CSF cultures were negative for cryptococci. All patients were followed monthly for 1 year or until death in order to detect relapse or occurrence of any other opportunistic infection. RESULTS: A total of 106 AIDSpatients with cryptococcal meningitis were enrolled. The geometric mean (range) total and viable cryptococcal counts in CSF on admission were 430,000 (1000 to 3.4 x 10(7)) and 31,000 (10 to 1.4 x 10(7)) per ml, respectively. Both total and viable cryptococcal counts declined monoexponentially with an elimination half life of 4 days. The cumulative CSF yeast clearance rates were 38% and 56% at 2 and 4 weeks, respectively. Early death was associated significantly with previous history of weight loss [relative risk (RR)=2.2; 95% CI, 1.2-3.9], Glasgow Coma Score <13 (RR=2.33; 95% CI, 1.55-3.50), and hypoalbuminaemia (P<0.001). Later mortality was associated delayed CSF yeast clearance (RR=3.6; 95% CI, 1.9--6.4) and relapse (RR=3.9; 95% CI, 1.4-10.8). CONCLUSION: High-dose amphotericin B was not as effective as previously thought. Cumulative mortality at 2 weeks, 4 weeks and 1 year were 16%, 24% and 76%, respectively. Copyright 2001 The British Infection Society.
Authors: David R Boulware; Shulamith C Bonham; David B Meya; Darin L Wiesner; Gregory S Park; Andrew Kambugu; Edward N Janoff; Paul R Bohjanen Journal: J Infect Dis Date: 2010-09-15 Impact factor: 5.226
Authors: R A Larsen; M Bauer; P Pitisuttithum; A Sanchez; S Tansuphaswadikul; V Wuthiekanun; S J Peacock; A J H Simpson; A W Fothergill; M G Rinaldi; B Bustamante; A M Thomas; R Altomstone; N P J Day; N J White Journal: Antimicrob Agents Chemother Date: 2011-09-26 Impact factor: 5.191
Authors: Robert A Larsen; Madeline Bauer; Ann M Thomas; Alejandro Sanchez; Diane Citron; Meri Rathbun; Thomas S Harrison Journal: Antimicrob Agents Chemother Date: 2005-08 Impact factor: 5.191
Authors: Y Liu; Y Jiang; A Wu; S Chen; Y Zhang; M Liu; X Ma; L Ma; X Chen Journal: Eur J Clin Microbiol Infect Dis Date: 2012-03-06 Impact factor: 3.267
Authors: Andrew Kambugu; David B Meya; Joshua Rhein; Meagan O'Brien; Edward N Janoff; Allan R Ronald; Moses R Kamya; Harriet Mayanja-Kizza; Merle A Sande; Paul R Bohjanen; David R Boulware Journal: Clin Infect Dis Date: 2008-06-01 Impact factor: 9.079
Authors: John R Perfect; William E Dismukes; Francoise Dromer; David L Goldman; John R Graybill; Richard J Hamill; Thomas S Harrison; Robert A Larsen; Olivier Lortholary; Minh-Hong Nguyen; Peter G Pappas; William G Powderly; Nina Singh; Jack D Sobel; Tania C Sorrell Journal: Clin Infect Dis Date: 2010-02-01 Impact factor: 9.079