PMID- 20526411
OWN - NLM
STAT- MEDLINE
DCOM- 20100914
LR  - 20240516
IS  - 0256-9574 (Print)
IS  - 2078-5135 (Electronic)
VI  - 100
IP  - 6
DP  - 2010 Jun
TI  - Symptomatic relapse of HIV-associated cryptococcal meningitis in South Africa: 
      the role of inadequate secondary prophylaxis.
PG  - 378-82
AB  - OBJECTIVES: Cryptococcal meningitis is the commonest cause of adult meningitis in 
      Southern Africa. A sizeable proportion of this disease burden is thought to be 
      due to symptomatic relapse of previously treated infection. We carried out a 
      study to examine the contribution of inadequate secondary fluconazole prophylaxis 
      to symptomatic relapses of cryptococcal meningitis. DESIGN: A prospective 
      observational study of patients presenting with laboratory-confirmed symptomatic 
      relapse of HIV-associated cryptococcal meningitis between January 2007 and 
      December 2008 at GF Jooste Hospital, a public sector adult referral hospital in 
      Cape Town. OUTCOME MEASURES: Relapse episodes were categorized into 1) patients 
      not taking fluconazole prophylaxis, 2) immune reconstitution inflammatory 
      syndrome (IRIS) and 3) relapses occurring prior to ART in patients taking 
      fluconazole. In-hospital mortality was recorded. RESULTS: There were 69 relapse 
      episodes, accounting for 23% of all cases of cryptococcal meningitis. 43%(n=30) 
      of relapse episodes were in patients not taking fluconazole prophylaxis, 45%(31) 
      were due to IRIS and 12%(8) were in patients pre-ART taking fluconazole. Patients 
      developing relapse due to inadequate secondary prophylaxis had severe disease and 
      high in-hospital mortality (33%). Of the 30 patients not taking fluconazole, 47% 
      (14) had not been prescribed secondary prophylaxis by their healthcare providers. 
      Importantly, we documented no relapses due to fluconazole resistance in this 
      cohort of patients who has received amphotericin B as initial therapy. 
      CONCLUSIONS: Large numbers of relapses of cryptococcal meningitis are due to 
      failed prescription, dispensing, referral for or adherence to secondary 
      fluconazole prophylaxis. Interventions to improve the use of secondary 
      fluconazole prophylaxis are essential.
FAU - Jarvis, Joseph N
AU  - Jarvis JN
AD  - Infectious Diseases Unit, GF Jooste Hospital, Cape Town, South Africa. 
      joejarvis@doctors.net.uk
FAU - Meintjes, Graeme
AU  - Meintjes G
FAU - Williams, Zomzi
AU  - Williams Z
FAU - Rebe, Kevin
AU  - Rebe K
FAU - Harrison, Thomas S
AU  - Harrison TS
LA  - eng
GR  - WT_/Wellcome Trust/United Kingdom
GR  - 081794/WT_/Wellcome Trust/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - South Africa
TA  - S Afr Med J
JT  - South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
JID - 0404520
RN  - 0 (Antifungal Agents)
RN  - 8VZV102JFY (Fluconazole)
SB  - IM
MH  - Adult
MH  - Antifungal Agents/*therapeutic use
MH  - Female
MH  - Fluconazole/*therapeutic use
MH  - HIV Infections/*complications
MH  - Humans
MH  - Male
MH  - Meningitis, Cryptococcal/*prevention & control/*virology
MH  - Prospective Studies
MH  - Recurrence
MH  - South Africa
MH  - Treatment Failure
PMC - PMC2880446
MID - UKMS27726
OID - NLM: UKMS27726
EDAT- 2010/06/08 06:00
MHDA- 2010/09/15 06:00
PMCR- 2010/06/03
CRDT- 2010/06/08 06:00
PHST- 2010/06/08 06:00 [entrez]
PHST- 2010/06/08 06:00 [pubmed]
PHST- 2010/09/15 06:00 [medline]
PHST- 2010/06/03 00:00 [pmc-release]
AID - 10.7196/samj.3515 [doi]
PST - ppublish
SO  - S Afr Med J. 2010 Jun;100(6):378-82. doi: 10.7196/samj.3515.