ArticlePloS one2013
A prospective longitudinal study of the clinical outcomes from cryptococcal meningitis following treatment induction with 800 mg oral fluconazole in Blantyre, Malawi.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
50 citing papers in PubMed, 3 syntheses or guidelines pooled it, 74 citations in OpenAlex.
- Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM.The Lancet. Infectious diseases · 2024Guideline
- Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis.Journal of the International AIDS Society · 2020Pooled it
- Treatment for HIV-associated cryptococcal meningitis.The Cochrane database of systematic reviews · 2018Pooled it
- Trial
- How Applicable Is the Single-Dose AMBITION Regimen for Human Immunodeficiency Virus-Associated Cryptococcal Meningitis to High-Income Settings?Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Trial
- One-year Mortality Outcomes From the Advancing Cryptococcal Meningitis Treatment for Africa Trial of Cryptococcal Meningitis Treatment in Malawi.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Trial
- Healthcare Costs and Life-years Gained From Treatments Within the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) Trial on Cryptococcal Meningitis: A Comparison of Antifungal Induction Strategies in Sub-Saharan Africa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019Trial
- Trial
- Investigating the therapeutic potential of the antibacterial drug nitroxoline in combating cryptococcal infection.PLoS neglected tropical diseases · 2026Article
- The Vacuolar Protein 8 (Vac8) Homolog inJournal of fungi (Basel, Switzerland) · 2025Article
- Article
- Lack of an atypical PDR transporter generates an immunogenicbioRxiv : the preprint server for biology · 2025Article
- Induction Treatment for HIV-Associated Cryptococcal Meningitis: Where Have We Been and Where Are We Going?Microorganisms · 2025Review
- Management and outcome of intracranial fungal infections in children and adults in Africa: a scoping review.BMC infectious diseases · 2024Article
- Pathways to care with HIV-associated cryptococcal meningitis in Botswana and Uganda: Findings from a qualitative methods study.SSM. Qualitative research in health · 2023Article
- Vaccination with aInfection and immunity · 2023Article
- Preemptive Therapy in Cryptococcosis Adjusted for Outcomes.Journal of fungi (Basel, Switzerland) · 2023Article
- The acceptability of the AMBITION-cm treatment regimen for HIV-associated cryptococcal meningitis: Findings from a qualitative methods study of participants and researchers in Botswana and Uganda.PLoS neglected tropical diseases · 2022Article
- Novel ABC Transporter Associated with Fluconazole Resistance in Aging ofJournal of fungi (Basel, Switzerland) · 2022Article
- Article
Corrections and comments
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Authors and funding
12 authors at 5 institutions in 2 countries.
Funding
Abstract
introductionCryptococcal meningitis is the most common neurological infection in HIV infected patients in Sub Saharan Africa, where gold standard treatment with intravenous amphotericin B and 5 flucytosine is often unavailable or difficult to administer. Fluconazole monotherapy is frequently recommended in national guidelines but is a fungistatic drug compromised by uncertainty over optimal dosing and a paucity of clinical end-point outcome data.
methodsFrom July 2010 until March 2011, HIV infected adults with a first episode of cryptococcal meningitis were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. Patients were treated with oral fluconazole monotherapy 800 mg daily, as per national guidelines. ART was started at 4 weeks. Outcomes and factors associated with treatment failure were assessed 4, 10 and 52 weeks after fluconazole initiation.
resultsSixty patients were recruited. 26/60 (43%) died by 4 weeks. 35/60 (58.0%) and 43/56 (77%) died or failed treatment by 10 or 52 weeks respectively. Reduced consciousness (Glasgow Coma Score <14 of 15), moderate/severe neurological disability (modified Rankin Score >3 of 5) and confusion (Abbreviated Mental Test Score <8 of 10) were all common at baseline and associated with death or treatment failure. ART prior to recruitment was not associated with better outcomes.
conclusionsMortality and treatment failure from cryptococcal meningitis following initiation of treatment with 800 mg oral fluconazole is unacceptably high. To improve outcomes, there is an urgent need for better therapeutic strategies and point-of-care diagnostics, allowing earlier diagnosis before development of neurological deficit.
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