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Predictors of poor clinical outcome of cryptococcal meningitis in HIV-infected patients
The aim of this study was to identify baseline prognostic factors for poor clinical outcome of HIV-associated cryptococcal meningitis. We conducted a trial in Thailand and the USA comparing low- and high-dose concomitant use of amphotericin B and fluconazole for HIV-associated cryptococcal meningiti...
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Published in: | International journal of STD & AIDS 2011-11, Vol.22 (11), p.665-670 |
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container_title | International journal of STD & AIDS |
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creator | Anekthananon, T Manosuthi, W Chetchotisakd, P Kiertiburanakul, S Supparatpinyo, K Ratanasuwan, W Pappas, P G Filler, S G Kopetskie, H A Nolen, T L Kendrick, A S Larsen, R A |
description | The aim of this study was to identify baseline prognostic factors for poor clinical outcome of HIV-associated cryptococcal meningitis. We conducted a trial in Thailand and the USA comparing low- and high-dose concomitant use of amphotericin B and fluconazole for HIV-associated cryptococcal meningitis to amphotericin B followed by fluconazole. Subjects who were either alive and cerebrospinal fluid (CSF) culture-positive or dead were considered to have a poor outcome. At day 14, baseline characteristics associated with poor outcome included: low weight, high CSF cryptococcal antigen (CrAg) titre and low CSF white blood cell (WBC) count. At day 70, the associated baseline characteristics included: CSF CrAg titre >1:1024 and low Karnofsky performance status. Overall, consistent with published findings, low weight, high CSF CrAg titre and low CSF WBC counts at baseline were predictors for poor clinical outcome. In addition, we found that low Karnofsky performance status was predictive of poor outcome. Prompt management with appropriate antifungal therapy for this particular group of patients may improve the outcomes. |
doi_str_mv | 10.1258/ijsa.2011.010538 |
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We conducted a trial in Thailand and the USA comparing low- and high-dose concomitant use of amphotericin B and fluconazole for HIV-associated cryptococcal meningitis to amphotericin B followed by fluconazole. Subjects who were either alive and cerebrospinal fluid (CSF) culture-positive or dead were considered to have a poor outcome. At day 14, baseline characteristics associated with poor outcome included: low weight, high CSF cryptococcal antigen (CrAg) titre and low CSF white blood cell (WBC) count. At day 70, the associated baseline characteristics included: CSF CrAg titre >1:1024 and low Karnofsky performance status. Overall, consistent with published findings, low weight, high CSF CrAg titre and low CSF WBC counts at baseline were predictors for poor clinical outcome. In addition, we found that low Karnofsky performance status was predictive of poor outcome. Prompt management with appropriate antifungal therapy for this particular group of patients may improve the outcomes.</description><identifier>ISSN: 0956-4624</identifier><identifier>EISSN: 1758-1052</identifier><identifier>DOI: 10.1258/ijsa.2011.010538</identifier><identifier>PMID: 22096053</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>AIDS/HIV ; Amphotericin B - administration & dosage ; Antifungal Agents - administration & dosage ; Biological and medical sciences ; Cerebrospinal Fluid - microbiology ; Cryptococcus ; Fluconazole - administration & dosage ; General aspects ; HIV Infections - complications ; Human immunodeficiency virus ; Human mycoses ; Human viral diseases ; Humans ; Infectious diseases ; Medical sciences ; Meningitis, Cryptococcal - diagnosis ; Meningitis, Cryptococcal - drug therapy ; Meningitis, Cryptococcal - mortality ; Meningitis, Cryptococcal - pathology ; Miscellaneous mycoses ; Mycoses ; Prognosis ; Survival Analysis ; Thailand ; Treatment Outcome ; United States ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids</subject><ispartof>International journal of STD & AIDS, 2011-11, Vol.22 (11), p.665-670</ispartof><rights>2011 SAGE Publications</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c398t-a93358962a190cc2fa1208c31b6ef700af7974742ca735c01a57a8f0049aecf73</citedby><cites>FETCH-LOGICAL-c398t-a93358962a190cc2fa1208c31b6ef700af7974742ca735c01a57a8f0049aecf73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925,79364</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25286180$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22096053$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Anekthananon, T</creatorcontrib><creatorcontrib>Manosuthi, W</creatorcontrib><creatorcontrib>Chetchotisakd, P</creatorcontrib><creatorcontrib>Kiertiburanakul, S</creatorcontrib><creatorcontrib>Supparatpinyo, K</creatorcontrib><creatorcontrib>Ratanasuwan, W</creatorcontrib><creatorcontrib>Pappas, P G</creatorcontrib><creatorcontrib>Filler, S G</creatorcontrib><creatorcontrib>Kopetskie, H A</creatorcontrib><creatorcontrib>Nolen, T L</creatorcontrib><creatorcontrib>Kendrick, A S</creatorcontrib><creatorcontrib>Larsen, R A</creatorcontrib><creatorcontrib>BAMSG 3-01 Study Team</creatorcontrib><creatorcontrib>The Bamsg 3-01 Study Team</creatorcontrib><title>Predictors of poor clinical outcome of cryptococcal meningitis in HIV-infected patients</title><title>International journal of STD & AIDS</title><addtitle>Int J STD AIDS</addtitle><description>The aim of this study was to identify baseline prognostic factors for poor clinical outcome of HIV-associated cryptococcal meningitis. We conducted a trial in Thailand and the USA comparing low- and high-dose concomitant use of amphotericin B and fluconazole for HIV-associated cryptococcal meningitis to amphotericin B followed by fluconazole. Subjects who were either alive and cerebrospinal fluid (CSF) culture-positive or dead were considered to have a poor outcome. At day 14, baseline characteristics associated with poor outcome included: low weight, high CSF cryptococcal antigen (CrAg) titre and low CSF white blood cell (WBC) count. At day 70, the associated baseline characteristics included: CSF CrAg titre >1:1024 and low Karnofsky performance status. Overall, consistent with published findings, low weight, high CSF CrAg titre and low CSF WBC counts at baseline were predictors for poor clinical outcome. In addition, we found that low Karnofsky performance status was predictive of poor outcome. Prompt management with appropriate antifungal therapy for this particular group of patients may improve the outcomes.</description><subject>AIDS/HIV</subject><subject>Amphotericin B - administration & dosage</subject><subject>Antifungal Agents - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Cerebrospinal Fluid - microbiology</subject><subject>Cryptococcus</subject><subject>Fluconazole - administration & dosage</subject><subject>General aspects</subject><subject>HIV Infections - complications</subject><subject>Human immunodeficiency virus</subject><subject>Human mycoses</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Medical sciences</subject><subject>Meningitis, Cryptococcal - diagnosis</subject><subject>Meningitis, Cryptococcal - drug therapy</subject><subject>Meningitis, Cryptococcal - mortality</subject><subject>Meningitis, Cryptococcal - pathology</subject><subject>Miscellaneous mycoses</subject><subject>Mycoses</subject><subject>Prognosis</subject><subject>Survival Analysis</subject><subject>Thailand</subject><subject>Treatment Outcome</subject><subject>United States</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. 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We conducted a trial in Thailand and the USA comparing low- and high-dose concomitant use of amphotericin B and fluconazole for HIV-associated cryptococcal meningitis to amphotericin B followed by fluconazole. Subjects who were either alive and cerebrospinal fluid (CSF) culture-positive or dead were considered to have a poor outcome. At day 14, baseline characteristics associated with poor outcome included: low weight, high CSF cryptococcal antigen (CrAg) titre and low CSF white blood cell (WBC) count. At day 70, the associated baseline characteristics included: CSF CrAg titre >1:1024 and low Karnofsky performance status. Overall, consistent with published findings, low weight, high CSF CrAg titre and low CSF WBC counts at baseline were predictors for poor clinical outcome. In addition, we found that low Karnofsky performance status was predictive of poor outcome. Prompt management with appropriate antifungal therapy for this particular group of patients may improve the outcomes.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>22096053</pmid><doi>10.1258/ijsa.2011.010538</doi><tpages>6</tpages></addata></record> |
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subjects | AIDS/HIV Amphotericin B - administration & dosage Antifungal Agents - administration & dosage Biological and medical sciences Cerebrospinal Fluid - microbiology Cryptococcus Fluconazole - administration & dosage General aspects HIV Infections - complications Human immunodeficiency virus Human mycoses Human viral diseases Humans Infectious diseases Medical sciences Meningitis, Cryptococcal - diagnosis Meningitis, Cryptococcal - drug therapy Meningitis, Cryptococcal - mortality Meningitis, Cryptococcal - pathology Miscellaneous mycoses Mycoses Prognosis Survival Analysis Thailand Treatment Outcome United States Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids |
title | Predictors of poor clinical outcome of cryptococcal meningitis in HIV-infected patients |
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