ArticleSouth African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde2010
Symptomatic relapse of HIV-associated cryptococcal meningitis in South Africa: the role of inadequate secondary prophylaxis.
Article in South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 51 citations in OpenAlex.
- Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis.Journal of the International AIDS Society · 2020Pooled it
- Evaluating the Use of Lower Dose Flucytosine for the Treatment of Cryptococcal Meningitis: A Clinical Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Trial
- The effect of therapeutic lumbar punctures on acute mortality from cryptococcal meningitis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2014Trial
- Poor long-term outcomes despite improved hospital survival for patients with cryptococcal meningitis in rural, Northern Uganda.PloS one · 2024Article
- Recurrent Cryptococcal Meningitis in a Late Presenter of HIV: A Rare Case Report and Review of Literature.The American journal of case reports · 2023Review
- Recurrence of Symptoms Following Cryptococcal Meningitis: Characterizing a Diagnostic Conundrum With Multiple Etiologies.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Clinical utility of antifungal susceptibility testing.JAC-antimicrobial resistance · 2022Review
- Treatment recommendations for non-HIV associated cryptococcal meningoencephalitis including management of post-infectious inflammatory response syndrome.Frontiers in neurology · 2022Review
- Risk Factors for Cryptococcal Meningitis Recurrence in Human Immunodeficiency Virus (HIV)-Infected Patients in a Large Chinese Acquired Immune Deficiency Syndrome (AIDS) Treatment Center.Medical science monitor : international medical journal of experimental and clinical research · 2021Article
- Cryptococcal meningitis: a review for emergency clinicians.Internal and emergency medicine · 2021Review
- Cost-effectiveness analysis of flucytosine as induction therapy in the treatment of cryptococcal meningitis in HIV-infected adults in South Africa.BMC health services research · 2021Article
- Potential Predictors and Survival Analysis of the Relapse of HIV-Associated Cryptococcal Meningitis: A Retrospective Study.Frontiers in medicine · 2021Article
- Cryptococcal antigenemia and associated risk factors among ART-naïve and ART-experienced HIV-infected peoples at selected health institutions of Mekelle, Northern Ethiopia.MicrobiologyOpen · 2019Article
- Southern African HIV Clinicians Society guideline for the prevention, diagnosis and management of cryptococcal disease among HIV-infected persons: 2019 update.Southern African journal of HIV medicine · 2019Article
- HIV-Associated Cryptococcal Disease in Resource-Limited Settings: A Case for "Prevention Is Better Than Cure"?Journal of fungi (Basel, Switzerland) · 2017Review
- Recent advances in AIDS-related cryptococcal meningitis treatment with an emphasis on resource limited settings.Expert review of anti-infective therapy · 2017Review
- Retrospective Study of Cryptococcal Meningitis With Elevated Minimum Inhibitory Concentration to Fluconazole in Immunocompromised Patients.Open forum infectious diseases · 2016Article
- Massive cerebral edema resulting in brain death as a complication of Cryptococcus neoformans meningitis.Journal of community hospital internal medicine perspectives · 2015Article
- Multilocus sequence typing of serially collected isolates of Cryptococcus from HIV-infected patients in South Africa.Journal of clinical microbiology · 2014Article
- Cryptococcal meningitis: epidemiology and therapeutic options.Clinical epidemiology · 2014Review
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
Abstract
objectivesCryptococcal meningitis is the commonest cause of adult meningitis in Southern Africa. A sizeable proportion of this disease burden is thought to be due to symptomatic relapse of previously treated infection. We carried out a study to examine the contribution of inadequate secondary fluconazole prophylaxis to symptomatic relapses of cryptococcal meningitis.
designA prospective observational study of patients presenting with laboratory-confirmed symptomatic relapse of HIV-associated cryptococcal meningitis between January 2007 and December 2008 at GF Jooste Hospital, a public sector adult referral hospital in Cape Town. OUTCOME MEASURES: Relapse episodes were categorized into 1) patients not taking fluconazole prophylaxis, 2) immune reconstitution inflammatory syndrome (IRIS) and 3) relapses occurring prior to ART in patients taking fluconazole. In-hospital mortality was recorded.
resultsThere were 69 relapse episodes, accounting for 23% of all cases of cryptococcal meningitis. 43%(n=30) of relapse episodes were in patients not taking fluconazole prophylaxis, 45%(31) were due to IRIS and 12%(8) were in patients pre-ART taking fluconazole. Patients developing relapse due to inadequate secondary prophylaxis had severe disease and high in-hospital mortality (33%). Of the 30 patients not taking fluconazole, 47% (14) had not been prescribed secondary prophylaxis by their healthcare providers. Importantly, we documented no relapses due to fluconazole resistance in this cohort of patients who has received amphotericin B as initial therapy.
conclusionsLarge numbers of relapses of cryptococcal meningitis are due to failed prescription, dispensing, referral for or adherence to secondary fluconazole prophylaxis. Interventions to improve the use of secondary fluconazole prophylaxis are essential.
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