ArticleJournal of the International AIDS Society2011
Universal screening of Tanzanian HIV-infected adult inpatients with the serum cryptococcal antigen to improve diagnosis and reduce mortality: an operational study.
Article in Journal of the International AIDS Society, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.
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Who cites it
35 citing papers in PubMed, 1 synthesis or guideline pooled it, 53 citations in OpenAlex.
- Cryptococcal antigenemia and its predictors among HIV infected patients in resource limited settings: a systematic review.BMC infectious diseases · 2020Pooled it
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- Trial
- Article
- PDE4B deficiency aids macrophage differentiation and contributes to Cryptococcus neoformans brain infection.PLoS pathogens · 2026Article
- Assessment of Clinical Guideline Use in the Prevention, Diagnosis, and Treatment of Cryptococcal Meningitis Among Health Care Providers in Ethiopia.Open forum infectious diseases · 2025Article
- Article
- Uptake of lumbar puncture and mortality among patients with advanced human immunodeficiency virus disease who screened for serum cryptococcal-antigen in Africa.World journal of virology · 2025Article
- Article
- High Cryptococcal Antigenuria Prevalence in a Population of PLHIV with Neurological Symptoms Hospitalized in the Infectious Diseases Wards of the Centre Hospitalier Universitaire de Libreville, Gabon.Tropical medicine and infectious disease · 2024Article
- Invasive Fungal Diseases in Africa: A Critical Literature Review.Journal of fungi (Basel, Switzerland) · 2022Article
- Epidemiological characteristics of cryptococcal meningoencephalitis associated with Cryptococcus neoformans var. grubii from HIV-infected patients in Madagascar: A cross-sectional study.PLoS neglected tropical diseases · 2020Article
- Underlying Cryptococcal Diseases and the Correlation With Serum Cryptococcal Antigen Titers in Hospitalized HIV-Infected Patients Screened Positive for Cryptococcal Antigenemia.Frontiers in cellular and infection microbiology · 2020Article
- 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
- Neurological disorders in HIV in Africa: a review.African health sciences · 2019Review
- Laboratory-Reflex Cryptococcal Antigen Screening Is Associated With a Survival Benefit in Tanzania.Journal of acquired immune deficiency syndromes (1999) · 2019Article
- Disseminated cryptococcosis in a HIV-negative patient: Case report of a newly diagnosed hypertensive adult presenting with hemiparesis.Medical mycology case reports · 2018Article
- Article
- High Cryptococcal Antigen Titers in Blood Are Predictive of Subclinical Cryptococcal Meningitis Among Human Immunodeficiency Virus-Infected Patients.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Article
- Minimizing fungal disease deaths will allow the UNAIDS target of reducing annual AIDS deaths below 500 000 by 2020 to be realized.Philosophical transactions of the Royal Society of London. Series B, Biological sciences · 2016Review
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundCryptococcal meningitis is a leading cause of death among HIV-infected individuals in sub-Saharan Africa. Recent developments include the availability of intravenous fluconazole, cryptococcal antigen assays and new data to support fluconazole pre-emptive treatment. In this study, we describe the impact of screening HIV-positive adult inpatients with serum cryptococcal antigen (CRAG) at a Tanzanian referral hospital.
methodsAll adults admitted to the medical ward of Bugando Medical Centre are counseled and tested for HIV. In this prospective cohort study, we consecutively enrolled HIV-positive patients admitted between September 2009 and January 2010. All patients were interviewed, examined and screened with serum CRAG. Patients with positive serum CRAG or signs of meningitis underwent lumbar puncture. Patients were managed according to standard World Health Organization treatment guidelines. Discharge diagnoses and in-hospital mortality were recorded.
resultsOf 333 HIV-infected adults enrolled in our study, 15 (4.4%) had confirmed cryptococcal meningitis and 10 of these 15 (66%) died. All patients with cryptococcal meningitis had at least two of four classic symptoms and signs of meningitis: fever, headache, neck stiffness and altered mental status. Cryptococcal meningitis accounted for a quarter of all in-hospital deaths.
conclusionsDespite screening of all HIV-positive adult inpatients with the serum CRAG at the time of admission and prompt treatment with high-dose intravenous fluconazole in those with confirmed cryptococcal meningitis, the in-hospital mortality rate remained unacceptably high. Improved strategies for earlier diagnosis and treatment of HIV, implementation of fluconazole pre-emptive treatment for high-risk patients and acquisition of better resources for treatment of cryptococcal meningitis are needed.
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