Role of quantitative CSF microscopy to predict culture status and outcome in HIV-associated cryptococcal meningitis in a Brazilian cohort.

Diagnostic Microbiology and Infectious Disease
José E VidalDavid R Boulware

Abstract

This retrospective study aimed to evaluate the clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococcal cell counts for associations with in-hospital outcomes of HIV-infected patients with cryptococcal meningitis. Ninety-eight HIV-infected adult patients with CSF culture-proven cryptococcal meningitis were admitted between January 2006 and June 2008 at a referral center in Sao Paulo, Brazil. Cryptococcal meningitis was the first AIDS-defining illness in 69%, of whom 97% (95/98) had known prior HIV infection. The median CD4+ T-cell count was 39 cells/μL (interquartile range 17-87 cells/μL). Prior antiretroviral therapy was reported in 50%. Failure to sterilize the CSF by 7-14 days was associated with baseline fungal burden of ≥ 10 yeasts/μL by quantitative CSF microscopy (odds ratio [OR] = 15.3, 95% confidence interval [CI] 4.1-56.7; P < 0.001) and positive blood cultures (OR = 11.5, 95% CI 1.2-109; P = 0.034). At 7-14 days, ≥ 10 yeasts/μL CSF was associated with positive CSF cultures in 98% versus 36% with <10 yeasts/μL CSF (P < 0.001). In-hospital mortality was 30% and was associated with symptoms duration for >14 days, altered mental status (P < 0.001), CSF white blood cell counts <5 cells/μL (P = 0.027),...Continue Reading

References

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Citations

May 15, 2013·The Brazilian Journal of Infectious Diseases : an Official Publication of the Brazilian Society of Infectious Diseases·Jose E VidalDavid R Boulware
Oct 25, 2016·Tropical Medicine & International Health : TM & IH·José E VidalDavid R Boulware
Oct 31, 2015·Journal of Neurosurgery·Jacob CherianShankar P Gopinath
Dec 13, 2016·Expert Review of Molecular Diagnostics·Matthew William McCarthy, Thomas J Walsh
Jan 13, 2015·Clinical Chemistry and Laboratory Medicine : CCLM·Daniel Morell-GarciaIsabel Llompart
May 3, 2018·BMC Neurology·Jia LiuFu-Hua Peng
Sep 15, 2017·Journal of the Pediatric Infectious Diseases Society·Matthew W McCarthyThomas J Walsh
Apr 12, 2018·Memórias do Instituto Oswaldo Cruz·Carolina FiracativeUNKNOWN Latin American Cryptococcal Study Group
Apr 20, 2021·The Lancet Infectious Diseases·Katharine Elizabeth StottWilliam Hope

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