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A prospective longitudinal study of the clinical outcomes from cryptococcal meningitis following treatment induction with 800 mg oral fluconazole in Blantyre, Malawi

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Date
28/06/2013
Author
Rothe, Camilla
Sloan, Derek J.
Goodson, Patrick
Chikafa, Jean
Mukaka, Mavuto
Denis, Brigitte
Harrison, Tom
van Oosterhout, Joep J.
Heyderman, Robert S.
Lalloo, David G.
Allain, Theresa
Feasey, Nicholas A.
Keywords
RA0421 Public health. Hygiene. Preventive Medicine
Agricultural and Biological Sciences(all)
Biochemistry, Genetics and Molecular Biology(all)
Medicine(all)
SDG 3 - Good Health and Well-being
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Abstract
Introduction:Cryptococcal 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.Methods:From 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.Results:Sixty 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 3 of 5) and confusion (Abbreviated Mental Test Score
Citation
Rothe , C , Sloan , D J , Goodson , P , Chikafa , J , Mukaka , M , Denis , B , Harrison , T , van Oosterhout , J J , Heyderman , R S , Lalloo , D G , Allain , T & Feasey , N A 2013 , ' A prospective longitudinal study of the clinical outcomes from cryptococcal meningitis following treatment induction with 800 mg oral fluconazole in Blantyre, Malawi ' , PLoS One , vol. 8 , no. 6 , e67311 . https://doi.org/10.1371/journal.pone.0067311
Publication
PLoS One
Status
Peer reviewed
DOI
https://doi.org/10.1371/journal.pone.0067311
ISSN
1932-6203
Type
Journal article
Rights
© 2013 Rothe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Description
Dr. Feasey was supported by a Wellcome Research Training Fellowship and MLW is funded by a Wellcome Trust Major Overseas Project Grant (award number 084679/Z/08/Z).
Collections
  • University of St Andrews Research
URI
http://hdl.handle.net/10023/13032

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