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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
The medical management of central nervous system infections in Uganda and the potential impact of an algorithm-based approach to improve outcomes
International Journal of Infectious Diseases, Volume 11, No. 6, Year 2007
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Description
Background: In sub-Saharan Africa, HIV has increased the spectrum of central nervous system (CNS) infections. The etiological diagnosis is often difficult. Mortality from CNS infections is higher in sub-Saharan Africa compared to Western countries. This study examines the medical management of CNS infections in Uganda. We also propose a clinical algorithm to manage CNS infections in an effective, systematic, and resource-efficient manner. Methods: We prospectively followed 100 consecutive adult patients who were admitted to Mulago Hospital with a suspected diagnosis of a CNS infection without any active participation in their management. From the clinical and outcome data, we created an algorithm to manage CNS infections, which was appropriate for this resource-limited, high HIV prevalence setting. Results: Only 32 patients had a laboratory confirmed diagnosis and 23 of these were diagnosed with cryptococcal meningitis. Overall mortality was 39%, and mortality trended upward when the diagnosis was delayed past 3 days. The initial diagnoses were made clinically without significant laboratory data in 92 of the 100 patients. Because HIV positive patients have a unique spectrum of CNS infections, we created an algorithm that identified HIV-positive patients and diagnosed those with cryptococcal meningitis. After cryptococcal infection was ruled out, previously published algorithms were used to assist in the early diagnosis and treatment of bacterial meningitis, tuberculous meningitis, and other common central nervous system infections. In retrospective comparison with current management, the CNS algorithm reduced overall time to diagnosis and initiate treatment of cryptococcal meningitis from 3.5 days to less than 1 day. Conclusions: CNS infections are complex and difficult to diagnose and treat in Uganda, and are associated with high in-hospital mortality. A clinical algorithm may significantly decrease the time to diagnose and treat CNS infections in a resource-limited setting. © 2007 International Society for Infectious Diseases.
Authors & Co-Authors
Trachtenberg, Joel D.
United States, Salt Lake City
The University of Utah
Kambugu, Andrew Ddungu
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
McKellar, Mehri S.
United States, Salt Lake City
The University of Utah
Semitala, Fred Collins
Uganda, Kampala
Mulago Hospital
Mayanja-Kizza, Harriet
Uganda, Kampala
School of Medicine, Makerere University College of Health Sciences
Samore, Matthew H.
United States, Salt Lake City
Va Salt Lake City Healthcare System
Ronald, Allan R.
Canada, Winnipeg
University of Manitoba
Sande, Merle A.
United States, Salt Lake City
The University of Utah
Statistics
Citations: 29
Authors: 8
Affiliations: 5
Identifiers
Doi:
10.1016/j.ijid.2007.01.014
ISSN:
12019712
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Uganda