Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures

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dc.contributor.authorBicanic, Tihana
dc.contributor.authorBrouwer, Annemarie E
dc.contributor.authorMeintjes, Graeme
dc.contributor.authorRebe, Kevin
dc.contributor.authorLimmathurotsakul, Direk
dc.contributor.authorChierakul, Wirongrong
dc.contributor.authorTeparrakkul, Praprit
dc.contributor.authorLoyse, Angela
dc.contributor.authorWhite, Nicholas J
dc.contributor.authorWood, Robin
dc.contributor.authorJaffar, Shabbar
dc.contributor.authorHarrison, Thomas
dc.date.accessioned2018-05-08T13:28:55Z
dc.date.available2018-05-08T13:28:55Z
dc.date.issued2009
dc.date.updated2016-01-22T08:05:14Z
dc.description.abstractObjectives: To assess impact of serial lumbar punctures on association between cerebrospinal fluid (CSF) opening pressure and prognosis in HIV-associated cryptococcal meningitis; to explore time course and relationship of opening pressure with neurological findings, CSF fungal burden, immune response, and CD4 cell count. Design: Evaluation of 163 HIV-positive ART-naive patients enrolled in three trials of amphotericin B-based therapy for cryptococcal meningitis in Thailand and South Africa. Methods: Study protocols required four lumbar punctures with measurements of opening pressure over the first 2 weeks of treatment and additional lumbar punctures if opening pressure raised. Fungal burden and clearance, CSF immune parameters, CD4 cell count, neurological symptoms and signs, and outcome at 2 and 10 weeks were compared between groups categorized by opening pressure at cryptococcal meningitis diagnosis. Results: Patients with higher baseline fungal burden had higher baseline opening pressure. High fungal burden appeared necessary but not sufficient for development of high pressure. Baseline opening pressure was not associated with CD4 cell count, CSF pro-inflammatory cytokines, or altered mental status. Day 14 opening pressure was associated with day 14 fungal burden. Overall mortality was 12% (20/162) at 2 weeks and 26% (42/160) at 10 weeks, with no significant differences between opening pressure groups. Conclusion: Studies are needed to define factors, in addition to fungal burden, associated with raised opening pressure. Aggressive management of raised opening pressure through repeated CSF drainage appeared to prevent any adverse impact of raised opening pressure on outcome in patients with cryptococcal meningitis. The results support increasing access to manometers in resource-poor settings and routine management of opening pressure in patients with cryptococcal meningitis.
dc.identifierhttp://dx.doi.org/10.1097/QAD.0b013e32832605fe
dc.identifier.apacitationBicanic, T., Brouwer, A. E., Meintjes, G., Rebe, K., Limmathurotsakul, D., Chierakul, W., ... Harrison, T. (2009). Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures. <i>AIDS</i>, http://hdl.handle.net/11427/28012en_ZA
dc.identifier.chicagocitationBicanic, Tihana, Annemarie E Brouwer, Graeme Meintjes, Kevin Rebe, Direk Limmathurotsakul, Wirongrong Chierakul, Praprit Teparrakkul, et al "Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures." <i>AIDS</i> (2009) http://hdl.handle.net/11427/28012en_ZA
dc.identifier.citationBicanic, T., Brouwer, A. E., Meintjes, G., Rebe, K., Limmathurotsakul, D., Chierakul, W., ... & Harrison,T. (2009). Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures. Aids, 23(6), 701-706.
dc.identifier.ris TY - AU - Bicanic, Tihana AU - Brouwer, Annemarie E AU - Meintjes, Graeme AU - Rebe, Kevin AU - Limmathurotsakul, Direk AU - Chierakul, Wirongrong AU - Teparrakkul, Praprit AU - Loyse, Angela AU - White, Nicholas J AU - Wood, Robin AU - Jaffar, Shabbar AU - Harrison, Thomas AB - Objectives: To assess impact of serial lumbar punctures on association between cerebrospinal fluid (CSF) opening pressure and prognosis in HIV-associated cryptococcal meningitis; to explore time course and relationship of opening pressure with neurological findings, CSF fungal burden, immune response, and CD4 cell count. Design: Evaluation of 163 HIV-positive ART-naive patients enrolled in three trials of amphotericin B-based therapy for cryptococcal meningitis in Thailand and South Africa. Methods: Study protocols required four lumbar punctures with measurements of opening pressure over the first 2 weeks of treatment and additional lumbar punctures if opening pressure raised. Fungal burden and clearance, CSF immune parameters, CD4 cell count, neurological symptoms and signs, and outcome at 2 and 10 weeks were compared between groups categorized by opening pressure at cryptococcal meningitis diagnosis. Results: Patients with higher baseline fungal burden had higher baseline opening pressure. High fungal burden appeared necessary but not sufficient for development of high pressure. Baseline opening pressure was not associated with CD4 cell count, CSF pro-inflammatory cytokines, or altered mental status. Day 14 opening pressure was associated with day 14 fungal burden. Overall mortality was 12% (20/162) at 2 weeks and 26% (42/160) at 10 weeks, with no significant differences between opening pressure groups. Conclusion: Studies are needed to define factors, in addition to fungal burden, associated with raised opening pressure. Aggressive management of raised opening pressure through repeated CSF drainage appeared to prevent any adverse impact of raised opening pressure on outcome in patients with cryptococcal meningitis. The results support increasing access to manometers in resource-poor settings and routine management of opening pressure in patients with cryptococcal meningitis. DA - 2009 DB - OpenUCT DP - University of Cape Town J1 - AIDS LK - https://open.uct.ac.za PB - University of Cape Town PY - 2009 T1 - Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures TI - Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures UR - http://hdl.handle.net/11427/28012 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/28012
dc.identifier.vancouvercitationBicanic T, Brouwer AE, Meintjes G, Rebe K, Limmathurotsakul D, Chierakul W, et al. Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures. AIDS. 2009; http://hdl.handle.net/11427/28012.en_ZA
dc.language.isoeng
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.sourceAIDS
dc.source.urihttp://www.ovid.com/site/index.jsp
dc.subject.othercerebrospinal fluid pressure
dc.subject.othercryptococcal meningitis
dc.subject.otherCryptococcus
dc.subject.otherHIV
dc.subject.otherlumbar puncture
dc.subject.otherraised intracranial pressure
dc.titleRelationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures
dc.typeJournal Article
uct.type.filetypeText
uct.type.filetypeImage
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