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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
A Prospective Longitudinal Study of the Clinical Outcomes from Cryptococcal Meningitis following Treatment Induction with 800 mg Oral Fluconazole in Blantyre, Malawi
PLoS ONE, Volume 8, No. 6, Article e67311, Year 2013
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Description
Introduction:Cryptococcal meningitis is the most common neurological infection in HIV infected patients in Sub Saharan Africa, where gold standard treatment with intravenous amphotericin B and 5 flucytosine is often unavailable or difficult to administer. Fluconazole monotherapy is frequently recommended in national guidelines but is a fungistatic drug compromised by uncertainty over optimal dosing and a paucity of clinical end-point outcome data.Methods:From July 2010 until March 2011, HIV infected adults with a first episode of cryptococcal meningitis were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. Patients were treated with oral fluconazole monotherapy 800 mg daily, as per national guidelines. ART was started at 4 weeks. Outcomes and factors associated with treatment failure were assessed 4, 10 and 52 weeks after fluconazole initiation.Results:Sixty patients were recruited. 26/60 (43%) died by 4 weeks. 35/60 (58.0%) and 43/56 (77%) died or failed treatment by 10 or 52 weeks respectively. Reduced consciousness (Glasgow Coma Score <14 of 15), moderate/severe neurological disability (modified Rankin Score >3 of 5) and confusion (Abbreviated Mental Test Score <8 of 10) were all common at baseline and associated with death or treatment failure. ART prior to recruitment was not associated with better outcomes.Conclusions:Mortality and treatment failure from cryptococcal meningitis following initiation of treatment with 800 mg oral fluconazole is unacceptably high. To improve outcomes, there is an urgent need for better therapeutic strategies and point-of-care diagnostics, allowing earlier diagnosis before development of neurological deficit. © 2013 Rothe et al.
Authors & Co-Authors
Rothe, Camilla
Malawi, Zomba
University of Malawi
Sloan, D. J.
Malawi, Zomba
University of Malawi
United Kingdom, Liverpool
University of Liverpool
Malawi, Blantyre
Queen Elizabeth Central Hospital Malawi
Goodson, Patrick
Malawi, Blantyre
Queen Elizabeth Central Hospital Malawi
Chikafa, Jean
Malawi, Zomba
University of Malawi
Mukaka, Mavuto F.J.
Malawi, Zomba
University of Malawi
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Denis, Brigitte B.
Malawi, Zomba
University of Malawi
Harrison, Thomas Stephen
United Kingdom, London
St George’s, University of London
van Oosterhout, Joep J.G.
Malawi, Zomba
University of Malawi
Heyderman, Robert Simon
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Malawi, Zomba
University of Malawi
Lalloo, David G.
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Allain, Theresa Jane
Malawi, Zomba
University of Malawi
Feasey, Nicholas A.
Malawi, Zomba
University of Malawi
United Kingdom, Liverpool
University of Liverpool
Statistics
Citations: 76
Authors: 12
Affiliations: 5
Identifiers
Doi:
10.1371/journal.pone.0067311
e-ISSN:
19326203
Research Areas
Disability
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Malawi