Neuroinfektioner
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http://www.infmed.dk/neuroinfektion#diagnostik_og_behandling_af_lyme_neuroborreliose_2021.pdf
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http://www.infmed.dk/neuroinfektion#viral_meningitis_(2018).pdf
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http://www.infmed.dk/neuroinfektion#akut_bakteriel_meningitis_(2018).pdf
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http://www.infmed.dk/neuroinfektion#borrelia_klaringsrapport_(2._udgave_2014).pdf
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Links 1 Tværregional vejledning vedrørende akut bakteriel (purulent) meningitis hos voksne
2 Vejledning om forebyggelse ved tilfælde af Meningokoksygdom
Nye artikler 1 BACTERIAL MENINGITIS IN PATIENTS WITH MULTIPLE MYELOMA: A PROSPECTIVE NATIONWIDE COHORT STUDY AND REVIEW OF THE LITERATURE Fereshte Sheybani, Matthijs C. Brouwer, Diederik van de Beek International Journal of Infectious Diseases, 24.06.2022 Tilføjet 24.06.2022 2 Caution when using 1,3, β-D-glucan in the CSF as a biomarker of Candida albicans meningitis Laura Barbolini, Arnaud Riat, Christian Van Delden, Jacques Schrenzel International Journal of Infectious Diseases, 24.06.2022 Tilføjet 24.06.2022 Fungal meningitis is typically diagnosed by culture, sometimes by molecular diagnosis or histology. However, cultures lack sensitivity and require several days to grow. A sensitive biomarker that could rapidly identify a fungal central nervous system (CNS) infection could be one step among several towards improving diagnosis and treatment. Læs mere Tjek på PubMed3 Access to flucytosine for the treatment of HIV-associated cryptococcal meningitis in Africa Elvis Temfack, Olivier Lortholary Lancet Infectious Diseases, 22.06.2022 Tilføjet 22.06.2022 Cryptococcal meningitis, a major cause of meningitis in adults living with HIV infection, accounts for 15% of global HIV-associated mortality.1 Treatment of cryptococcal meningitis involves three phases: induction, consolidation, and maintenance. The induction phase, which aims at reducing cerebral and meningeal fungal burden crucial for early survival, requires combination antifungal therapy and management of increased cerebrospinal fluid intracranial pressure. WHO in 2018 recommended at induction either 1-week amphotericin B deoxycholate plus flucytosine followed by high-dose fluconazole or 2-week oral fluconazole plus flucytosine. Læs mere Tjek på PubMed4 Outcomes of flucytosine-containing combination treatment for cryptococcal meningitis in a South African national access programme: a cross-sectional observational study Rudzani C Mashau, Susan T Meiring, Vanessa C Quan, Jeremy Nel, Greg S Greene, Andrea Garcia, Colin Menezes, Denasha L Reddy, Michelle Venter, Sarah Stacey, Matamela Madua, Lia Boretti, Thomas S Harrison, Graeme Meintjes, Amir Shroufi, Laura Trivino-Duran, John Black, Nelesh P Govender, GERMS-SA Lancet Infectious Diseases, 22.06.2022 Tilføjet 22.06.2022 In-hospital mortality among patients treated with a flucytosine-containing regimen was comparable to reduced mortality reported in patients receiving a flucytosine-containing regimen in a recent multicentre African clinical trial. Flucytosine-based treatment can be delivered in routine care in a middle-income country with a substantial survival benefit. Læs mere Tjek på PubMed5 The clinical impact of multiplex PCR panel diagnostics in paediatric meningitis/ encephalitis: a bicenter cohort study Infection, 22.06.2022 Tilføjet 23.06.2022 Abstract
Purpose In infections of the Central Nervous System (iCNS), rapid identification of causing pathogens is crucial for survival and to avoid long-term sequelae. Targeted therapy may reduce side effects and development of antibiotic resistance. New molecular-based syndromic tests such as the “meningitis/encephalitis panel” (MEP) allow accelerated pathogen identification from cerebrospinal fluid. We conducted a clinical study to evaluate the MEP’s efficacy in paediatric patients.
Methods Cohort study in a unique clinical setting by comparing the outcome data of two neighbouring Children’s Hospitals in Germany which are comparable in size, catchment area and equipment but differ regarding availability of the MEP: study centre 1 (SC1): yes; SC2: no. The study population included 213 paediatric patients with a suspected iCNS (SC1: 106; SC2: 107), with comparable age, CRP at admission and frequency of intensive care. The primary outcome was total use of antibiotics.
Results Total antibiotic use per patient was numerically lower in SC1 than in SC2 (SC1: median 2.83 days; SC2 3.67 days; p = 0.671). Multiple linear regression analysis did not show a relevant association between MEP-availability and total antibiotic use (ß = 0.1, 95% confidence interval [−1.46; +1.67], p = 0.897). In the subcohort with suspected meningoencephalitis (SC1: 18, SC2: 17), duration of acyclovir treatment was shorter in SC1 than in SC2 (median 1.3 days vs. 2.7 days, descriptive p = 0.0397).
Conclusions The add-on use of the MEP in paediatric patients with suspected iCNS was associated with a non-significant reduction in total antibiotic use, and with a reduced exposure to acyclovir in treated patients. Læs mere Tjek på PubMed 6 The clinical impact of multiplex PCR panel diagnostics in paediatric meningitis/ encephalitis: a bicenter cohort study Infection, 22.06.2022 Tilføjet 25.06.2022 Abstract
Purpose In infections of the Central Nervous System (iCNS), rapid identification of causing pathogens is crucial for survival and to avoid long-term sequelae. Targeted therapy may reduce side effects and development of antibiotic resistance. New molecular-based syndromic tests such as the “meningitis/encephalitis panel” (MEP) allow accelerated pathogen identification from cerebrospinal fluid. We conducted a clinical study to evaluate the MEP’s efficacy in paediatric patients.
Methods Cohort study in a unique clinical setting by comparing the outcome data of two neighbouring Children’s Hospitals in Germany which are comparable in size, catchment area and equipment but differ regarding availability of the MEP: study centre 1 (SC1): yes; SC2: no. The study population included 213 paediatric patients with a suspected iCNS (SC1: 106; SC2: 107), with comparable age, CRP at admission and frequency of intensive care. The primary outcome was total use of antibiotics.
Results Total antibiotic use per patient was numerically lower in SC1 than in SC2 (SC1: median 2.83 days; SC2 3.67 days; p = 0.671). Multiple linear regression analysis did not show a relevant association between MEP-availability and total antibiotic use (ß = 0.1, 95% confidence interval [−1.46; +1.67], p = 0.897). In the subcohort with suspected meningoencephalitis (SC1: 18, SC2: 17), duration of acyclovir treatment was shorter in SC1 than in SC2 (median 1.3 days vs. 2.7 days, descriptive p = 0.0397).
Conclusions The add-on use of the MEP in paediatric patients with suspected iCNS was associated with a non-significant reduction in total antibiotic use, and with a reduced exposure to acyclovir in treated patients. Læs mere Tjek på PubMed 7 Long-term neuro-functional disability in adult patients with community-acquired bacterial meningitis Infection, 3.06.2022 Tilføjet 3.06.2022 Abstract
Purpose To investigate the prevalence of neuro-functional disability and its determinants 12 months after community-acquired bacterial meningitis (CABM) in adult patients.
Methods In a prospective multicenter cohort study (COMBAT), all consecutive cases of CABM were enrolled and followed up for 12 months. Neuro-functional disability at 12 months was evaluated using a combination of the Glasgow Outcome Scale (functional disability), and the modified Rankin Disability Scale (physical disability). Factors associated with neuro-functional disability were identified by multivariate logistic regression.
Results Among 281 patients, 84 (29.9%) patients exhibited neuro-functional disability at 12 months: 79 (28.1%) with functional disability and 51 (18.1%) with physical disability. Overall, 6 patients (2.1%) died during the follow-up. The most common pathogen identified was Streptococcus pneumoniae (131/272, 48.2%); 77/268 patients (28.7%) had a physical disability at hospital discharge. Factors independently associated with 12-month neuro-functional disability were a pneumococcal meningitis (adjusted OR = 2.8; 95% confidence interval (CI) = [1.3; 6.7]), the presence of a physical disability at hospital discharge (aOR = 2.3; 95%CI = [1.2; 4.4]) and the presence of behavioral disorders at hospital-discharge (aOR = 5.9; 95%CI = [1.6; 28.4]). Dexamethasone use was not significantly associated with neuro-functional disability (OR = 0.2; 95%CI = [< 0.1;1.3]).
Conclusion Neuro-functional disability is frequently reported 12 months after CABM. Detailed neurological examination at discharge is needed to improve the follow-up.
Trial registration NCT01730690. Læs mere Tjek på PubMed 8 Long-term neuro-functional disability in adult patients with community-acquired bacterial meningitis Infection, 3.06.2022 Tilføjet 5.06.2022 Abstract
Purpose To investigate the prevalence of neuro-functional disability and its determinants 12 months after community-acquired bacterial meningitis (CABM) in adult patients.
Methods In a prospective multicenter cohort study (COMBAT), all consecutive cases of CABM were enrolled and followed up for 12 months. Neuro-functional disability at 12 months was evaluated using a combination of the Glasgow Outcome Scale (functional disability), and the modified Rankin Disability Scale (physical disability). Factors associated with neuro-functional disability were identified by multivariate logistic regression.
Results Among 281 patients, 84 (29.9%) patients exhibited neuro-functional disability at 12 months: 79 (28.1%) with functional disability and 51 (18.1%) with physical disability. Overall, 6 patients (2.1%) died during the follow-up. The most common pathogen identified was Streptococcus pneumoniae (131/272, 48.2%); 77/268 patients (28.7%) had a physical disability at hospital discharge. Factors independently associated with 12-month neuro-functional disability were a pneumococcal meningitis (adjusted OR = 2.8; 95% confidence interval (CI) = [1.3; 6.7]), the presence of a physical disability at hospital discharge (aOR = 2.3; 95%CI = [1.2; 4.4]) and the presence of behavioral disorders at hospital-discharge (aOR = 5.9; 95%CI = [1.6; 28.4]). Dexamethasone use was not significantly associated with neuro-functional disability (OR = 0.2; 95%CI = [< 0.1;1.3]).
Conclusion Neuro-functional disability is frequently reported 12 months after CABM. Detailed neurological examination at discharge is needed to improve the follow-up.
Trial registration NCT01730690. Læs mere Tjek på PubMed 9 Etiology of meningitis among adults in three quaternary hospitals in Mozambique, 2016–2017: The role of HIV Aquino Albino Nhantumbo, Charlotte Elizabeth Comé, Plácida Iliany Maholela, Alcides Moniz Munguambe, Paulino da Costa, Mariana Mott, Gabriella Rosa Cunha, Lúcia Chambal, Cícero Dias, Vlademir Vicente Cantarelli, Eduardo Samo Gudo PLoS One Infectious Diseases, 11.05.2022 Tilføjet 11.05.2022 by Aquino Albino Nhantumbo, Charlotte Elizabeth Comé, Plácida Iliany Maholela, Alcides Moniz Munguambe, Paulino da Costa, Mariana Mott, Gabriella Rosa Cunha, Lúcia Chambal, Cícero Dias, Vlademir Vicente Cantarelli, Eduardo Samo Gudo Background Meningitis remains an important cause of morbi-mortality in adults in sub-Saharan Africa. Data on the etiological investigation of meningitis in adults in Mozambique is limited and most studies were conducted in southern Mozambique. Identification of the etiology of meningitis in adults are crucial to guide prevention and treatments strategies. In this study, we determine the burden of fungal and bacterial meningitis among adults at the three largest hospitals in Mozambique. Method We performed analysis of data from the routine sentinel surveillance system for meningitis in Mozambique from January 2016 to December 2017. Cerebrospinal fluid (CSF) samples were collected from eligible adults (≥18 years old) who met World Health Organization (WHO) case definition criteria for Meningitis. All samples were tested by cryptococcal antigen (CrAg) lateral flow assay (LFA), culture and triplex real-time polymerase chain reaction (qPCR) assay and all patients were tested for human immunodeficiency virus (HIV) using the national algorithm for HIV testing. Results Retrospective analysis of 1501 CSF samples from adults clinically suspected of meningitis revealed that 10.5% (158/1501) were positive for bacterial and fungal meningitis. Of these 158 confirmed cases, the proportion of Cryptococcal meningitis and pneumococcal meningitis was38.6% (95% CI: 31.0% to 46.7%) and 36.7% (95% CI: 29.2% to 44.7%), respectively. The other bacterial agents of meningitis identified include Neisseria meningitidis (8.9%; 14/158), Escherichia coli (6.3%; 10/158), Haemophilus influenzae (5.1%; 8/158) and S. aureus (4.4%; 7/158), which represent (24.7%; 39/158) of the total confirmed cases. Conclusion Altogether, our findings show a high burden of Cryptococcal meningitis among adults in Mozambique, especially in people living with HIV, followed by pneumococcal meningitis. Our findings suggest that rollout of CrAg Lateral Flow Assay in the health system in Mozambique for early detection of cryptococcus neoformans is necessary to improve overall patient care. Læs mere Tjek på PubMed10 Escherichia coli community-acquired meningitis in adults: a case series of 29 patients in France Aurore Moussiegt, André Birgy, Aurélie Cointe, Xavier Duval, Philippe Bidet, Stéphane Bonacorsi Clinical Microbiology and Infection, 11.05.2022 Tilføjet 11.05.2022 Escherichia coli meningitis is frequent and has been widely described among newborns (1). The strains involved show an oligoclonal distribution within only a few sequence type complexes (STcs) and often harbor the K1 capsular antigen. Among adults, E. coli accounts for 0.5-3% of meningitis and has poor outcome, but data are scarce and genomic characteristics of responsible strains are often lacking (2). We conducted a multicentric retrospective study, including all cases referred for expertise to our national reference center between 2009 and 2020, and performed whole-genome sequencing to genetically characterize corresponding isolates as previously described (3). Læs mere Tjek på PubMed11 Efficacy assessment of a novel endolysin PlyAZ3aT for the treatment of ceftriaxone-resistant pneumococcal meningitis in an infant rat model Luca G. Valente, Ngoc Dung Le, Melissa Pitton, Gabriele Chiffi, Denis Grandgirard, Stephan M. Jakob, David R. Cameron, Grégory Resch, Yok-Ai Que, Stephen L. Leib PLoS One Infectious Diseases, 26.04.2022 Tilføjet 26.04.2022 by Luca G. Valente, Ngoc Dung Le, Melissa Pitton, Gabriele Chiffi, Denis Grandgirard, Stephan M. Jakob, David R. Cameron, Grégory Resch, Yok-Ai Que, Stephen L. Leib Background Treatment failure in pneumococcal meningitis due to antibiotic resistance is an increasing clinical challenge and alternatives to antibiotics warrant investigation. Phage-derived endolysins efficiently kill gram-positive bacteria including multi-drug resistant strains, making them attractive therapeutic candidates. The current study assessed the therapeutic potential of the novel endolysin PlyAZ3aT in an infant rat model of ceftriaxone-resistant pneumococcal meningitis. Methods Efficacy of PlyAZ3aT was assessed in a randomized, blinded and controlled experimental study in infant Wistar rats. Meningitis was induced by intracisternal infection with 5 x 107 CFU/ml of a ceftriaxone-resistant clinical strain of S. pneumoniae, serotype 19A. Seventeen hours post infection (hpi), animals were randomized into 3 treatment groups and received either (i) placebo (phosphate buffered saline [PBS], n = 8), (ii) 50 mg/kg vancomycin (n = 10) or (iii) 400 mg/kg PlyAZ3aT (n = 8) via intraperitoneal injection. Treatments were repeated after 12 h. Survival at 42 hpi was the primary outcome; bacterial loads in cerebrospinal fluid (CSF) and blood were secondary outcomes. Additionally, pharmacokinetics of PlyAZ3aT in serum and CSF was assessed. Results PlyAZ3aT did not improve survival compared to PBS, while survival for vancomycin treated animals was 70% which is a significant improvement when compared to PBS or PlyAZ3aT (p<0.05 each). PlyAZ3aT was not able to control the infection, reflected by the inability to reduce bacterial loads in the CSF, whereas Vancomycin sterilized the CSF and within 25 h. Pharmacokinetic studies indicated that PlyAZ3aT did not cross the blood brain barrier (BBB). In support, PlyAZ3aT showed a peak concentration of 785 μg/ml in serum 2 h after intraperitoneal injection but could not be detected in CSF. Conclusion In experimental pneumococcal meningitis, PlyAZ3aT failed to cure the infection due to an inability to reach the CSF. Optimization of the galenic formulation e.g. using liposomes might enable crossing of the BBB and improve treatment efficacy. Læs mere Tjek på PubMed12 Varicella Zoster Virus (VZV) Meningitis in an Immunocompetent Adult following BNT162b2 mRNA COVID-19 Vaccination: A Case Report R Medhat, R El Lababidi, M Abdelsalam, A Nusair International Journal of Infectious Diseases, 5.04.2022 Tilføjet 6.04.2022 The introduction of vaccines against SARS-CoV-2 brought hope to end the pandemic, save lives, begin economic recovery, and restore social life. An unprecedented number of mass vaccination campaigns globally were initiated to curb transmission, prevent hospitalizations and deaths, and reestablish normalcy (Our World in Data, 2021). The mRNA-based BNT162b2 COVID-19 vaccine has demonstrated a high efficacy rate with an acceptable safety profile and was rapidly rolled out through several nationwide vaccination campaigns (Polack et al, 2021; Frenck et al., 2021; Our World in Data, 2021). Læs mere Tjek på PubMed13 A case report of human infection with lymphocytic choriomeningitis virus in Israel Daniel Grupel, Yaniv Lustig, Tal Brosh‐Nissimov Journal of Medical Virology, 30.03.2022 Tilføjet 30.03.2022 14 Varicella zoster meningitis following COVID-19 vaccination: a report of two cases Marturod Buranasakda, Praew Kotruchin, Kittisap Phanthachai, Piroon Mootsikapun, Ploenchan Chetchotisakd International Journal of Infectious Diseases, 29.03.2022 Tilføjet 30.03.2022 In Thailand, immunization against COVID-19 began in February 2021. The two major types of vaccines used are inactivated (CoronaVac or Sinovacࣨ) and viral vector (AstraZenecaࣨ). Globally, there have been a number of case reports of reactivation of varicella zoster infection within 28 days after immunization with mRNA COVID-19 vaccines (Chiu et al., 2021; Furer et al., 2021; Lee et al., 2021; McMahon et al., 2021; Psichogiou et al., 2021; Rodríguez-Jiménez et al., 2021). A few cases have also been reported after viral vector and inactivated COVID-19 vaccination (Aksu and Öztürk, 2021; Arora et al., 2021; Bostan and Yalici-Armagan, 2021; Chiu et al., 2021). Læs mere Tjek på PubMed15 Ventriculoperitoneal shunt is associated with increased cerebrospinal fluid protein level in HIV-infected cryptococcal meningitis patients BMC Infectious Diseases, 26.03.2022 Tilføjet 30.03.2022 Abstract
Background The impact of ventriculoperitoneal shunt on cerebrospinal fluid (CSF) biochemical profiles in HIV-associated cryptococcal meningitis (HCM) patients remains unclear.
Methods Twenty-nine HCM patients who underwent ventriculoperitoneal shunt (the VPS group) and 57 HCM patients who did not undergo ventriculoperitoneal shunt (the non-VPS group) were enrolled in this propensity score matching analysis. Demographic characteristics, symptoms, CSF biochemical profiles, and adverse events were compared between the two groups. The Kaplan–Meier method was used to analyze the survival rate. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for increased CSF protein levels.
Results After 24 weeks of treatment, the intracranial pressure was significantly lower in the VPS group than in the non-VPS group (mmH2O; 155.0 [120.0–190.0] vs. 200.0 [142.5–290.0]; P = 0.025), and the rate of neuroimaging improvement was significantly higher in the VPS group (16/17 [94.1%] vs. 2/10 [20%]; P < 0.001). Furthermore, the 24-week cumulative survival rates were also significantly higher in the VPS group (96.6% vs. 83.5%, P = 0.025). Notably, the CSF protein levels were higher in the VPS group than in the non-VPS group at each examination time, and the CSF glucose was lower in the VPS group than in the non-VPS group even at the 12-week follow-up. In the multivariate analysis, we found that VPS placement was an independent risk factor for increased CSF protein (odds ratio [OR]: 27.8, 95% confidence interval [95% CI] 2.2–348.7; P = 0.010).
Conclusions VPS decreased the intracranial pressure, improved neuroimaging radiology and reduced the 24-week mortality in HCM patients. However, VPS significantly altered the CSF profiles, which could lead to misdiagnosis of tuberculous meningitis and some of them were diagnosed with immune reconstitution inflammatory syndrome. Physicians should be aware of these changes in the CSF profiles of patients with HCM undergoing VPS. Læs mere Tjek på PubMed 16 Toward Simpler, Safer Treatment of Cryptococcal Meningitis Mahomed-Yunus S. Moosa, Richard J. Lessells New England Journal of Medicine, 23.03.2022 Tilføjet 24.03.2022 New England Journal of Medicine, Volume 386, Issue 12, Page 1179-1181, March 2022. Læs mere Tjek på PubMed17 Single-Dose Liposomal Amphotericin B Treatment for Cryptococcal Meningitis Joseph N. Jarvis, David S. Lawrence, David B. Meya, Enock Kagimu, John Kasibante, Edward Mpoza, Morris K. Rutakingirwa, Kenneth Ssebambulidde, Lillian Tugume, Joshua Rhein, David R. Boulware, Henry C. Mwandumba, Melanie Moyo, Henry Mzinganjira, Cecilia Kanyama, Mina C. Hosseinipour, Chimwemwe Chawinga, Graeme Meintjes, Charlotte Schutz, Kyla Comins, Achita Singh, Conrad Muzoora, Samuel Jjunju, Edwin Nuwagira, Mosepele Mosepele, Tshepo Leeme, Keatlaretse Siamisang, Chiratidzo E. Ndhlovu, Admire Hlupeni, Constantine Mutata, Erik van Widenfelt, Tao Chen, Duolao Wang, William Hope, Timothée Boyer-Chammard, Angela Loyse, Síle F. Molloy, Nabila Youssouf, Olivier Lortholary, David G. Lalloo, Shabbar Jaffar, Thomas S. Harrison New England Journal of Medicine, 23.03.2022 Tilføjet 24.03.2022 New England Journal of Medicine, Volume 386, Issue 12, Page 1109-1120, March 2022. Læs mere Tjek på PubMed18 Prevalence and significance of anaemia in childhood bacterial meningitis: a secondary analysis of prospectively collected data from clinical trials in Finland, Latin America and Angola Pelkonen, T., Roine, I., Kallio, M., Jahnukainen, K., Peltola, H. BMJ Open, 14.03.2022 Tilføjet 14.03.2022 Objectives To describe the prevalence and severity of anaemia and to examine its associations with outcome in children with bacterial meningitis (BM). Design Secondary analysis of descriptive data from five randomised BM treatment trials. Setting Hospitals in Finland, Latin America and Angola. Participants Consecutive children from 2 months to 15 years of age admitted with BM and who had haemoglobin (Hb) measured on admission. Outcome measures Prevalence and degree of anaemia using the WHO criteria, and their associations with recovery with sequelae or death. Results The median Hb was 11.8 g/dL in Finland (N=341), 9.2 g/dL in Latin America (N=597) and 7.6 g/dL in Angola (N=1085). Of the children, 79% had anaemia, which was severe in 29%, moderate in 58% and mild in 13% of cases. Besides study area, having anaemia was independently associated with age <1 year, treatment delay >3 days, weight-for-age z-score <–3 and other than meningococcal aetiology. Irrespective of the study area, anaemia correlated with the markers of disease severity. In children with severe to moderate anaemia (vs mild or no anaemia), the risk ratio for death was 3.38 and for death or severe sequelae was 3.07. Conclusion Anaemia, mostly moderate, was common in children with BM, especially in Angola, in underweight children, among those with treatment delay, and in pneumococcal meningitis. Poor outcome was associated with anaemia in all three continents. Trial registration number The registration numbers of Angolan trials were ISRCTN62824827 and NCT01540838. Læs mere Tjek på PubMed 19 Implementation of tuberculosis and cryptococcal meningitis rapid diagnostic tests amongst patients with advanced HIV at Kamuzu Central Hospital, Malawi, 2016–2017 BMC Infectious Diseases, 5.03.2022 Tilføjet 6.03.2022 Abstract
Background Cryptococcal meningitis (CM) and tuberculosis (TB) remain leading causes of hospitalization and death amongst people living with HIV, particularly those with advanced HIV disease. In hospitalized patients, prompt diagnosis of these diseases may improve patient outcomes. The advanced HIV rapid diagnostic tests such as determine TB urine lipoarabinomannan lateral flow assay (urine LAM), urine X-pert MTB/RIF assay (urine X-pert), and serum/blood cryptococcal antigen test (serum CrAg) are recommended but frequently not available in many resource-limited settings. We describe our experience providing these tests in a routine hospital setting.
Method From 1 August 2016 to 31 January 2017, a prospective cohort study to diagnose TB and Cryptococcal meningitis using point of care tests was conducted in the medical wards at Kamuzu Central Hospital, in Lilongwe, Malawi. The tests offered were PIMA CD4 cell count, serum CrAg, urine LAM, and urine X-pert. The testing was integrated into an existing HIV/TB treatment room on the wards and performed close to admission time. Patients were followed until discharge or death in the ward.
Results We included 438 HIV-positive patients; 76% had a previously known HIV diagnosis (87% already on ART). We measured CD4 count in 365/438 (83%), serum CrAg in 301/438 (69%), urine LAM in 363/438 (83%), and urine X-pert in 292/438 (67%). The median CD4 count was 144 cells/ml (IQR 46–307). Serum CrAg positivity rate was 23 /301 (8%) and CM was confirmed by CSF Crag in 13/23 (56%). The majority of CM patients 9/13 (69%) started antifungal therapy within two days of diagnosis. Urine LAM and urine X-pert positivity rates were 81/363(22%) and (14/292 (5%) respectively. The positivity rate of urine LAM was higher in patients with low CD4 cell counts (< 100 cells/ml) and low BMI (< 18.5). Most patients with positive urine LAM started TB treatment on the same day. Despite the early diagnosis and treatment of TB and CM, the inpatient mortality was high; 30% and 25% respectively.
Conclusion Although advanced HIV rapid diagnostic tests are recommended, one key challenge in implementation is the limited trained personnel administering the tests. Despite the effective use of the point of care tests in the clinical care of hospitalized TB and CM patients, mortality among these patients remained unacceptably high. Henceforth we need to train other cadres apart from nurses, clinicians, and laboratory technicians to conduct the tests. There is an urgent need to identify and modify other risks of death from TB and CM. Trial registration: Malawi National Health Science Research committee: Protocol # 1144. Registered 2 July 2014 and University Of North Carolina IRB #: UNCPM 21412, approved 13th October 2014. Læs mere Tjek på PubMed 20 Implementation of tuberculosis and cryptococcal meningitis rapid diagnostic tests amongst patients with advanced HIV at Kamuzu Central Hospital, Malawi, 2016–2017 BMC Infectious Diseases, 5.03.2022 Tilføjet 7.03.2022 Abstract
Background Cryptococcal meningitis (CM) and tuberculosis (TB) remain leading causes of hospitalization and death amongst people living with HIV, particularly those with advanced HIV disease. In hospitalized patients, prompt diagnosis of these diseases may improve patient outcomes. The advanced HIV rapid diagnostic tests such as determine TB urine lipoarabinomannan lateral flow assay (urine LAM), urine X-pert MTB/RIF assay (urine X-pert), and serum/blood cryptococcal antigen test (serum CrAg) are recommended but frequently not available in many resource-limited settings. We describe our experience providing these tests in a routine hospital setting.
Method From 1 August 2016 to 31 January 2017, a prospective cohort study to diagnose TB and Cryptococcal meningitis using point of care tests was conducted in the medical wards at Kamuzu Central Hospital, in Lilongwe, Malawi. The tests offered were PIMA CD4 cell count, serum CrAg, urine LAM, and urine X-pert. The testing was integrated into an existing HIV/TB treatment room on the wards and performed close to admission time. Patients were followed until discharge or death in the ward.
Results We included 438 HIV-positive patients; 76% had a previously known HIV diagnosis (87% already on ART). We measured CD4 count in 365/438 (83%), serum CrAg in 301/438 (69%), urine LAM in 363/438 (83%), and urine X-pert in 292/438 (67%). The median CD4 count was 144 cells/ml (IQR 46–307). Serum CrAg positivity rate was 23 /301 (8%) and CM was confirmed by CSF Crag in 13/23 (56%). The majority of CM patients 9/13 (69%) started antifungal therapy within two days of diagnosis. Urine LAM and urine X-pert positivity rates were 81/363(22%) and (14/292 (5%) respectively. The positivity rate of urine LAM was higher in patients with low CD4 cell counts (< 100 cells/ml) and low BMI (< 18.5). Most patients with positive urine LAM started TB treatment on the same day. Despite the early diagnosis and treatment of TB and CM, the inpatient mortality was high; 30% and 25% respectively.
Conclusion Although advanced HIV rapid diagnostic tests are recommended, one key challenge in implementation is the limited trained personnel administering the tests. Despite the effective use of the point of care tests in the clinical care of hospitalized TB and CM patients, mortality among these patients remained unacceptably high. Henceforth we need to train other cadres apart from nurses, clinicians, and laboratory technicians to conduct the tests. There is an urgent need to identify and modify other risks of death from TB and CM. Trial registration: Malawi National Health Science Research committee: Protocol # 1144. Registered 2 July 2014 and University Of North Carolina IRB #: UNCPM 21412, approved 13th October 2014. Læs mere Tjek på PubMed |
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Globalt
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