ArticlePloS one2014
A prospective study of mortality from cryptococcal meningitis following treatment induction with 1200 mg oral fluconazole in Blantyre, Malawi.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 3 of them syntheses that pooled it.
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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
47 citing papers in PubMed, 3 syntheses or guidelines pooled it, 69 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
- Prevalence of cryptococcal meningitis among people living with human immuno-deficiency virus and predictors of mortality in adults on induction therapy in Africa: A systematic review and meta-analysis.Frontiers in medicine · 2022Pooled it
- Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis.Journal of the International AIDS Society · 2020Pooled it
- Trial
- Trial
- 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
- Increased Antifungal Drug Resistance in Clinical Isolates of Cryptococcus neoformans in Uganda.Antimicrobial agents and chemotherapy · 2015Trial
- Article
- Investigating the therapeutic potential of the antibacterial drug nitroxoline in combating cryptococcal infection.PLoS neglected tropical diseases · 2026Article
- Review of Risk Factors and Factors Influencing Outcomes of Cryptococcal Meningitis in Persons Living with HIV.Infection and drug resistance · 2026Review
- Induction Treatment for HIV-Associated Cryptococcal Meningitis: Where Have We Been and Where Are We Going?Microorganisms · 2025Review
- Article
- 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
- Emerging and re-emerging fungal threats in Africa.Parasite immunology · 2023Review
- 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
- Article
- Management of long-term cryptococcal meningitis neoformans in a surviving patient: A case report.Frontiers in medicine · 2022Article
Corrections and comments
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Authors and funding
11 authors at 5 institutions in 2 countries.
Funding
Abstract
objectiveWe have previously reported high ten-week mortality from cryptococcal meningitis in Malawian adults following treatment-induction with 800 mg oral fluconazole (57% [33/58]). National guidelines in Malawi and other African countries now advocate an increased induction dose of 1200 mg. We assessed whether this has improved outcomes.
designThis was a prospective observational study of HIV-infected adults with cryptococcal meningitis confirmed by diagnostic lumbar puncture. Treatment was with fluconazole 1200 mg/day for two weeks then 400mg/day for 8 weeks. Mortality within the first 10 weeks was the study end-point, and current results were compared with data from our prior patient cohort who started on fluconazole 800 mg/day.
results47 participants received fluconazole monotherapy. Despite a treatment-induction dose of 1200 mg, ten-week mortality remained 55% (26/47). This was no better than our previous study (Hazard Ratio [HR] of death on 1200 mg vs. 800 mg fluconazole: 1.29 (95% CI: 0.77-2.16, p = 0.332)). There was some evidence for improved survival in patients who had repeat lumbar punctures during early therapy to lower intracranial pressure (HR: 0.27 [95% CI: 0.07-1.03, p = 0.055]).
conclusionThere remains an urgent need to identify more effective, affordable and deliverable regimens for cryptococcal meningitis.
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Registered trials
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