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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Low CD4 count plus coma predicts cryptococcal meningitis in Tanzania
BMC Infectious Diseases, Volume 7, Article 39, Year 2007
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Description
Background: Largely due to the lack of diagnostic reagents, the prevalence and clinical presentation of cryptococcal meningitis in Tanzania is poorly understood. This in turn is limiting the impact of increased fluconazole availability. Methods: We evaluated a cohort of 1 49 consecutive HIV-infected adult inpatients presenting with headache or altered mental status for clinical features, CD4 count, cryptococcal infection, and outcome. Cryptococcal meningitis was diagnosed via India ink and latex agglutination assay of CSF (n = 24 and 40 positive, respectively). Associations between cryptococcal meningitis and clinical features were evaluated by t-test. The sensitivity, specificity, and positive likelihood ratio of such features were determined. Results: Cryptococcal meningitis was associated with confusion, social withdrawal, seizures, fever, tachycardia, meningismus, oral candidiasis, and low Glasgow coma scales and CD4 count. CD4 count < 100/μl provided the highest sensitivity for the diagnosis (93%), coma (Glasgow coma scale ≤ 8) provided the highest specificity (84%), and the combination provided the highest positive likelihood ratio (3.8). All cryptococcal meningitis patients were initiated on 800 milligrams of fluconazole daily and 50% survived to discharge, however no clinical or laboratory findings correlated with prognosis. Conclusion: Cryptococcal meningitis is common among Tanzanian HIV inpatients presenting with headache or altered mental status. Purely clinical features are insensitive for establishing the diagnosis or prognosis. We advocate expanding laboratory capacity for cryptococcal antigen testing to maximize survival. © 2007 Kisenge et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Kısenge, Peter R.
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Hawkins, Alexander T.
United States, Charlottesville
University of Virginia
Maro, Venance Phillip
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Mchele, John P D
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Swai, Ndealilia S.
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Mueller, Andreas
Tanzania, Moshi
Kilimanjaro Christian Medical Centre
Germany, Wurzburg
Medical Mission Institute
Houpt, Eric R.
United States, Charlottesville
University of Virginia
Statistics
Citations: 74
Authors: 7
Affiliations: 3
Identifiers
Doi:
10.1186/1471-2334-7-39
e-ISSN:
14712334
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Tanzania