PMID- 23056032
OWN - NLM
STAT- MEDLINE
DCOM- 20130117
LR  - 20211021
IS  - 1729-0503 (Electronic)
IS  - 1680-6905 (Print)
IS  - 1680-6905 (Linking)
VI  - 12
IP  - 2
DP  - 2012 Jun
TI  - Challenges in diagnosis and management of Cryptococcal immune reconstitution 
      inflammatory syndrome (IRIS) in resource limited settings.
PG  - 226-30
LID - 10.4314/ahs.v12i2.23 [doi]
AB  - In many resource-limited settings, cryptococcal meningitis (CM) contributes up to 
      20% of all deaths with further complications due to Immune Reconstitution 
      Inflammatory Syndrome (IRIS). We present a case report on a patient who developed 
      CM-IRIS and then subsequent CM-relapse with a fluconazole-resistant organism and 
      then later CM-IRIS once again, manifesting as cystic cryptococcomas, 
      hydrocephalus, and sterile CSF. In this case we, demonstrate that CM-IRIS and 
      persistent low level cryptococcal infection are not mutually exclusive phenomena. 
      The management of IRIS with corticosteroids may increase the risk of culture 
      positive CM-relapse which may further increase the risk of recurrent IRIS and 
      resulting complications including death. We also highlight the role of imaging 
      and fluconazole resistance testing in patients with recurrent meningitis and the 
      importance of CSF cultures in guiding treatment decisions.
FAU - Musubire, A K
AU  - Musubire AK
AD  - Infectious Disease Institute, College of Health Sciences, Makerere University, 
      Kampala, Uganda. amusubire@yahoo.com
FAU - Meya, B D
AU  - Meya BD
FAU - Mayanja-Kizza, H
AU  - Mayanja-Kizza H
FAU - Lukande, R
AU  - Lukande R
FAU - Wiesner, L D
AU  - Wiesner LD
FAU - Bohjanen, P
AU  - Bohjanen P
FAU - R Boulware, R D
AU  - R Boulware RD
LA  - eng
GR  - U01 AI089244/AI/NIAID NIH HHS/United States
GR  - K23AI073192/AI/NIAID NIH HHS/United States
GR  - L30 AI066779/AI/NIAID NIH HHS/United States
GR  - K24 AI096925/AI/NIAID NIH HHS/United States
GR  - L30AI066779/AI/NIAID NIH HHS/United States
GR  - U01AI089244/AI/NIAID NIH HHS/United States
GR  - K23 AI073192/AI/NIAID NIH HHS/United States
GR  - R25 TW009345/TW/FIC NIH HHS/United States
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - Uganda
TA  - Afr Health Sci
JT  - African health sciences
JID - 101149451
RN  - 0 (Anti-HIV Agents)
RN  - 0 (Antifungal Agents)
RN  - 7XU7A7DROE (Amphotericin B)
RN  - 8VZV102JFY (Fluconazole)
SB  - IM
MH  - AIDS-Related Opportunistic Infections/complications/*diagnosis/drug therapy
MH  - Adult
MH  - Amphotericin B/therapeutic use
MH  - Anti-HIV Agents/therapeutic use
MH  - Antifungal Agents/therapeutic use
MH  - Cryptococcus neoformans/*isolation & purification
MH  - Disease Management
MH  - Fatal Outcome
MH  - Fluconazole/therapeutic use
MH  - HIV Infections/*complications/diagnosis/drug therapy
MH  - Health Resources
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/complications/*diagnosis/drug therapy
MH  - Male
MH  - Meningitis, Cryptococcal/cerebrospinal fluid/complications/*diagnosis/drug 
      therapy
MH  - Recurrence
MH  - Uganda
PMC - PMC3462548
OTO - NOTNLM
OT  - AIDS
OT  - Cryptococcal Meningitis
OT  - HIV
OT  - Immune reconstitution inflammatory Syndrome
OT  - antiretroviral therapy
EDAT- 2012/10/12 06:00
MHDA- 2013/01/18 06:00
PMCR- 2012/06/01
CRDT- 2012/10/12 06:00
PHST- 2012/10/12 06:00 [entrez]
PHST- 2012/10/12 06:00 [pubmed]
PHST- 2013/01/18 06:00 [medline]
PHST- 2012/06/01 00:00 [pmc-release]
AID - jAFHS.v12.i2.pg226 [pii]
AID - 10.4314/ahs.v12i2.23 [doi]
PST - ppublish
SO  - Afr Health Sci. 2012 Jun;12(2):226-30. doi: 10.4314/ahs.v12i2.23.