PMID- 24371542
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211021
IS  - 2155-6113 (Print)
IS  - 2155-6113 (Electronic)
VI  - Suppl 3
IP  - 3
DP  - 2013 Apr 29
TI  - Diagnosis and Management of Cryptococcal Relapse.
LID - S3-003 [pii]
AB  - Despite improvements in the antifungal regimens and the roll out of 
      antiretroviral therapy (ART) in sub-Saharan Africa, mortality due to cryptococcal 
      meningitis remains high. Relapse of an initially successfully treated infection 
      contributes to this mortality and is often a clinical dilemma in differentiating 
      between paradoxical immune reconstitution inflammatory syndrome (IRIS) and 
      culture-positive relapse or treatment failure. Herein, we present a clinical case 
      scenario and review the case definitions, differential diagnosis, and management 
      of relapse with an emphasis on the current diagnostic and management strategies. 
      We also highlight the challenges of resistance testing and management of 
      refractory relapse cases. The risk of relapse is influenced by: 1) the choice of 
      induction therapy, with higher mortality risk with fluconazole monotherapy which 
      can select for resistance; 2) non-adherence to or lack of secondary prophylaxis; 
      3) failure of linkage-to-care or retention-in-care of HIV ART programs.
FAU - Musubire, Abdu K
AU  - Musubire AK
AD  - Infectious Disease Institute, Makerere University, Kampala, Uganda.
FAU - Boulware, David R
AU  - Boulware DR
AD  - University of Minnesota, Minneapolis, MN, USA.
FAU - Meya, David B
AU  - Meya DB
AD  - Infectious Disease Institute, Makerere University, Kampala, Uganda ; University 
      of Minnesota, Minneapolis, MN, USA.
FAU - Rhein, Joshua
AU  - Rhein J
AD  - University of Minnesota, Minneapolis, MN, USA.
LA  - eng
GR  - U01 AI089244/AI/NIAID NIH HHS/United States
GR  - R21 NS065713/NS/NINDS NIH HHS/United States
GR  - T32 AI055433/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  - Journal Article
PL  - United States
TA  - J AIDS Clin Res
JT  - Journal of AIDS & clinical research
JID - 101550222
PMC - PMC3870901
MID - NIHMS519620
OTO - NOTNLM
OT  - Cryptococcal meningitis
OT  - Cryptococcus
OT  - Drug resistance
OT  - HIV
OT  - Relapse
EDAT- 2013/12/29 06:00
MHDA- 2013/12/29 06:01
PMCR- 2013/12/24
CRDT- 2013/12/28 06:00
PHST- 2013/12/28 06:00 [entrez]
PHST- 2013/12/29 06:00 [pubmed]
PHST- 2013/12/29 06:01 [medline]
PHST- 2013/12/24 00:00 [pmc-release]
AID - S3-003 [pii]
AID - 10.4172/2155-6113.s3-003 [doi]
PST - ppublish
SO  - J AIDS Clin Res. 2013 Apr 29;Suppl 3(3):S3-003. doi: 10.4172/2155-6113.s3-003.