OBJECTIVES: To determine the prevalence, clinical features, risk factors and outcomes associated with cryptococcal meningitis (CM) in human immunodeficiency virus (HIV) positive patients at two referral hospitals in Nairobi, Kenya. DESIGN: Prospective, observational study. SETTING: Kenyatta National Hospital (KNH) and Mbagathi District Hospital (MDH), Nairobi, Kenya. SUBJECTS: Three hundred and forty HIV patients presenting with suspected CM. RESULTS: Of three hundred and forty suspected CM patients, 111 (33%) were diagnosed with CM by CrAg. Among CM patients, in-hospital mortality was 36% (38/106), median age was 35 years (range, 19-60 years) and median CD4 count was 41 cells/microL (n = 89, range 2-720 cells/microL). Common clinical manifestations among CM patients included headache 103 (93%), neck stiffness 76 (69%) and weight loss 53 (48%). Factors independently associated with CM were male sex, headache, blurred vision and previous antifungal drug use. Night sweats and current use of anti-retroviral therapy were associated with reduced risk for CM. CONCLUSIONS: There is a high prevalence of CM and CM-associated mortality in HIV patients at KNH and MDH despite treatment with antifungal and anti-retroviral drugs. This study demonstrates the need to address the existing inadequacies of CM patient outcomes in Kenya.
OBJECTIVES: To determine the prevalence, clinical features, risk factors and outcomes associated with cryptococcal meningitis (CM) in human immunodeficiency virus (HIV) positivepatients at two referral hospitals in Nairobi, Kenya. DESIGN: Prospective, observational study. SETTING: Kenyatta National Hospital (KNH) and Mbagathi District Hospital (MDH), Nairobi, Kenya. SUBJECTS: Three hundred and forty HIVpatients presenting with suspected CM. RESULTS: Of three hundred and forty suspected CMpatients, 111 (33%) were diagnosed with CM by CrAg. Among CMpatients, in-hospital mortality was 36% (38/106), median age was 35 years (range, 19-60 years) and median CD4 count was 41 cells/microL (n = 89, range 2-720 cells/microL). Common clinical manifestations among CMpatients included headache 103 (93%), neck stiffness 76 (69%) and weight loss 53 (48%). Factors independently associated with CM were male sex, headache, blurred vision and previous antifungal drug use. Night sweats and current use of anti-retroviral therapy were associated with reduced risk for CM. CONCLUSIONS: There is a high prevalence of CM and CM-associated mortality in HIVpatients at KNH and MDH despite treatment with antifungal and anti-retroviral drugs. This study demonstrates the need to address the existing inadequacies of CMpatient outcomes in Kenya.
Authors: J G Hakim; I T Gangaidzo; R S Heyderman; J Mielke; E Mushangi; A Taziwa; V J Robertson; P Musvaire; P R Mason Journal: AIDS Date: 2000-07-07 Impact factor: 4.177
Authors: M S Saag; R J Graybill; R A Larsen; P G Pappas; J R Perfect; W G Powderly; J D Sobel; W E Dismukes Journal: Clin Infect Dis Date: 2000-04-20 Impact factor: 9.079
Authors: R S Heyderman; I T Gangaidzo; J G Hakim; J Mielke; A Taziwa; P Musvaire; V J Robertson; P R Mason Journal: Clin Infect Dis Date: 1998-02 Impact factor: 9.079
Authors: Kerrigan M McCarthy; Juliette Morgan; Kathleen A Wannemuehler; Sara A Mirza; Susan M Gould; Ntombi Mhlongo; Portia Moeng; Bonnie R Maloba; Heather H Crewe-Brown; Mary E Brandt; Rana A Hajjeh Journal: AIDS Date: 2006-11-14 Impact factor: 4.177
Authors: Maureen J Donlin; Anthony Zunica; Ashlyn Lipnicky; Aswin K Garimallaprabhakaran; Alex J Berkowitz; Alexandre Grigoryan; Marvin J Meyers; John E Tavis; Ryan P Murelli Journal: Antimicrob Agents Chemother Date: 2017-03-24 Impact factor: 5.191
Authors: Maureen J Donlin; Thomas R Lane; Olga Riabova; Alexander Lepioshkin; Evan Xu; Jeffrey Lin; Vadim Makarov; Sean Ekins Journal: ACS Med Chem Lett Date: 2021-04-07 Impact factor: 4.345
Authors: Maureen J Donlin; Rajendra Upadhya; Kimberly J Gerik; Woei Lam; Laura G VanArendonk; Charles A Specht; Neil K Sharma; Jennifer K Lodge Journal: mBio Date: 2014-08-12 Impact factor: 7.867