Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures
Objectives: To assess impact of serial lumbar punctures on association between cerebrospinal fluid (CSF) opening pressure and prognosis in HIV-associated cryptococcal meningitis; to explore time course and relationship of opening pressure with neurological findings, CSF fungal burden, immune respons...
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th-mahidol.277272018-09-13T14:03:27Z Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures Tihana Bicanic Annemarie E. Brouwer Graeme Meintjes Kevin Rebe Direk Limmathurotsakur Wirongrong Chierakul Praprit Teparrakkul Angela Loyse Nicholas J. White Robin Wood Shabbar Jaffar Thomas Harrison University of Cape Town St George's University of London GF Jooste Hospital Mahidol University Sappasitthiprasong Hospital Nuffield Department of Clinical Medicine Radboud University Nijmegen London School of Hygiene & Tropical Medicine Immunology and Microbiology Medicine Objectives: To assess impact of serial lumbar punctures on association between cerebrospinal fluid (CSF) opening pressure and prognosis in HIV-associated cryptococcal meningitis; to explore time course and relationship of opening pressure with neurological findings, CSF fungal burden, immune response, and CD4 cell count. Design: Evaluation of 163 HIV-positive ART-naive patients enrolled in three trials of amphotericin B-based therapy for cryptococcal meningitis in Thailand and South Africa. Methods: Study protocols required four lumbar punctures with measurements of opening pressure over the first 2 weeks of treatment and additional lumbar punctures if opening pressure raised. Fungal burden and clearance, CSF immune parameters, CD4 cell count, neurological symptoms and signs, and outcome at 2 and 10 weeks were compared between groups categorized by opening pressure at cryptococcal meningitis diagnosis. Results: Patients with higher baseline fungal burden had higher baseline opening pressure. High fungal burden appeared necessary but not sufficient for development of high pressure. Baseline opening pressure was not associated with CD4 cell count, CSF pro-inflammatory cytokines, or altered mental status. Day 14 opening pressure was associated with day 14 fungal burden. Overall mortality was 12% (20/162) at 2 weeks and 26% (42/160) at 10 weeks, with no significant differences between opening pressure groups. Conclusion: Studies are needed to define factors, in addition to fungal burden, associated with raised opening pressure. Aggressive management of raised opening pressure through repeated CSF drainage appeared to prevent any adverse impact of raised opening pressure on outcome in patients with cryptococcal meningitis. The results support increasing access to manometers in resource-poor settings and routine management of opening pressure in patients with cryptococcal meningitis. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins. 2018-09-13T06:44:02Z 2018-09-13T06:44:02Z 2009-03-27 Article AIDS. Vol.23, No.6 (2009), 701-706 10.1097/QAD.0b013e32832605fe 02699370 2-s2.0-64549108540 https://repository.li.mahidol.ac.th/handle/123456789/27727 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=64549108540&origin=inward |
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Immunology and Microbiology Medicine Tihana Bicanic Annemarie E. Brouwer Graeme Meintjes Kevin Rebe Direk Limmathurotsakur Wirongrong Chierakul Praprit Teparrakkul Angela Loyse Nicholas J. White Robin Wood Shabbar Jaffar Thomas Harrison Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures |
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Objectives: To assess impact of serial lumbar punctures on association between cerebrospinal fluid (CSF) opening pressure and prognosis in HIV-associated cryptococcal meningitis; to explore time course and relationship of opening pressure with neurological findings, CSF fungal burden, immune response, and CD4 cell count. Design: Evaluation of 163 HIV-positive ART-naive patients enrolled in three trials of amphotericin B-based therapy for cryptococcal meningitis in Thailand and South Africa. Methods: Study protocols required four lumbar punctures with measurements of opening pressure over the first 2 weeks of treatment and additional lumbar punctures if opening pressure raised. Fungal burden and clearance, CSF immune parameters, CD4 cell count, neurological symptoms and signs, and outcome at 2 and 10 weeks were compared between groups categorized by opening pressure at cryptococcal meningitis diagnosis. Results: Patients with higher baseline fungal burden had higher baseline opening pressure. High fungal burden appeared necessary but not sufficient for development of high pressure. Baseline opening pressure was not associated with CD4 cell count, CSF pro-inflammatory cytokines, or altered mental status. Day 14 opening pressure was associated with day 14 fungal burden. Overall mortality was 12% (20/162) at 2 weeks and 26% (42/160) at 10 weeks, with no significant differences between opening pressure groups. Conclusion: Studies are needed to define factors, in addition to fungal burden, associated with raised opening pressure. Aggressive management of raised opening pressure through repeated CSF drainage appeared to prevent any adverse impact of raised opening pressure on outcome in patients with cryptococcal meningitis. The results support increasing access to manometers in resource-poor settings and routine management of opening pressure in patients with cryptococcal meningitis. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins. |
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University of Cape Town |
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University of Cape Town Tihana Bicanic Annemarie E. Brouwer Graeme Meintjes Kevin Rebe Direk Limmathurotsakur Wirongrong Chierakul Praprit Teparrakkul Angela Loyse Nicholas J. White Robin Wood Shabbar Jaffar Thomas Harrison |
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Article |
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Tihana Bicanic Annemarie E. Brouwer Graeme Meintjes Kevin Rebe Direk Limmathurotsakur Wirongrong Chierakul Praprit Teparrakkul Angela Loyse Nicholas J. White Robin Wood Shabbar Jaffar Thomas Harrison |
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Tihana Bicanic |
title |
Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures |
title_short |
Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures |
title_full |
Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures |
title_fullStr |
Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures |
title_full_unstemmed |
Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures |
title_sort |
relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures |
publishDate |
2018 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/27727 |
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1763490456386142208 |