Evidence map›Paper›PMID 33258083›Full record

Observational studyMycopathologia2021

HIV-Associated Cryptococcal Meningitis Patients Treated with Amphotericin B Deoxycholate Plus Flucytosine under Routine Care Conditions in a Referral Center in São Paulo, Brazil.

José E Vidal, Camila de Albuquerque Moraes, Renata Elisie Barbalho de Siqueira, Nathalya Fernanda Brito Miranda, Rosa Marcusso, David R Boulware, Augusto C Penalva de Oliveira

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Mycopathologia, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.7field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 7 citations in OpenAlex.

  1. Observational
  2. Article
  3. Cryptococcal meningitis.Nature reviews. Disease primers · 2023
    Review
  4. Synergistic antifungal interaction ofFrontiers in microbiology · 2023
    Article
  5. Searching for new antifungals for the treatment of cryptococcosis.Revista da Sociedade Brasileira de Medicina Tropical · 2023
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 2 countries.

José E VidalDepartment of Neurology, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil. josevibe@gmail.com.ORCID http://orcid.org/0000-0001-7830-8716
Camila de Albuquerque MoraesDepartment of Infectious Diseases, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
Renata Elisie Barbalho de SiqueiraDepartment of Infectious Diseases, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
Nathalya Fernanda Brito MirandaDepartment of Infectious Diseases, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
Rosa MarcussoDepartment of Neurology, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
David R BoulwareDivision of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, USA.
Augusto C Penalva de OliveiraDepartment of Neurology, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
Instituto de Infectologia Emílio Ribas · BRUniversity of Minnesota · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCryptococcal meningitis remains a common cause of mortality in low- and middle-income countries, where amphotericin B deoxycholate (amphotericin) plus fluconazole is the most common treatment. Flucytosine is almost uniformly absent as is outcome data on flucytosine use in routine care. The main goal of this study was identified the cumulative mortality at 2, 4, and 10 weeks after hospital admission.

methodsWe conducted a retrospective, observational cohort study among HIV-infected adults with cryptococcal meningitis receiving amphotericin plus flucytosine as induction therapy in Brazil. We assessed cumulative mortality at 2, 4, and 10 weeks and the cumulative proportion discontinuating amphotericin or flucytosine due to toxicity at 2 weeks. We performed multiple logistic regression to identify variables associated with in-hospital mortality.

resultsIn total, 77 individuals (n = 66 men) were included with median baseline CD4 of 29 (IQR, 9-68) cells/mcL. Twenty (26%) had at least one concurrent neurological disease diagnosed. Sixty (78%) patients received at least 14 days of amphotericin plus flucytosine. Cumulative mortality was 5% (4/77) at 2 weeks, 8% (6/77) at 4 weeks, and 19% (15/77) at 10 weeks. Cumulative proportion of patients that discontinuated amphotericin or flucytosine due to toxicity was 20% (16/77) at 2 weeks. In addition, in-hospital mortality was associated with receiving ≤ 10 days of induction therapy (odds ratio = 4.5, 95% CI 1.2-17.1, P = 0.028) or positive cerebrospinal fluid fungal culture after 2 weeks (odds ratio = 3.8, 95% CI 1.1-13.5, P = 0.035).

conclusionIn this "real-world" study, amphotericin plus flucytosine shows low early mortality of patients with HIV-associated cryptococcal meningitis. Early discontinuation due to adverse events was moderate. More effective and safe antifungals are needed in order to improve the outcome of cryptococcal meningitis.

Indexed as

HIV InfectionsMeningitis, CryptococcalAdultAmphotericin BAntifungal AgentsBrazilDeoxycholic AcidDrug CombinationsDrug Therapy, CombinationFluconazoleFlucytosineHumansMaleReferral and ConsultationRetrospective StudiesAmphotericin Bamphotericin B, deoxycholate drug combinationAntifungal AgentsDeoxycholic AcidDrug CombinationsFluconazoleFlucytosineAcquired immunodeficiency syndromeBrazilCryptococcal meningitisCryptococcosisFlucytosineTreatment

Identifiers

PMID33258083
OpenAlexW3107203187

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.