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dc.contributor.authorRolfes, Melissa A
dc.contributor.authorHuppler Hullsiek, Kathy
dc.contributor.authorRhein, Joshua
dc.contributor.authorNabeta, Henry W
dc.contributor.authorTaseera, Kabanda
dc.contributor.authorSchutz, Charlotte
dc.contributor.authorMusubire, Abdu
dc.contributor.authorRajasingham, Radha
dc.contributor.authorWilliams, Darlisha A
dc.contributor.authorThienemann, Friedrich
dc.contributor.authorMuzoora, Conrad
dc.contributor.authorMeintjes, Graeme
dc.contributor.authorMeya, David B
dc.contributor.authorBoulware, David R
dc.date.accessioned2020-02-24T18:39:02Z
dc.date.available2020-02-24T18:39:02Z
dc.date.issued2014
dc.identifier.citationRolfes, M. A., Hullsiek, K. H., Rhein, J., Nabeta, H. W., Taseera, K., Schutz, C., ... & Muzoora, C. (2014). The effect of therapeutic lumbar punctures on acute mortality from cryptococcal meningitis. Clinical infectious diseases, 59(11), 1607-1614.en_US
dc.identifier.urihttp://ir.must.ac.ug/xmlui/handle/123456789/509
dc.description.abstractIntroduction. Cryptococcal meningitis is the most common cause of adult meningitis in sub-Saharan Africa. Raised intracranial pressure (ICP) is common in cryptococcosis. Prior studies suggest elevated ICP is associated with mortality, and guidelines recommend frequent lumbar punctures (LPs) to control ICP. However, the magnitude of the impact of LPs on cryptococcal-related mortality is unknown. Methods. In sum, 248 individuals with human immunodeficiency virus (HIV)-associated cryptococcal meningitis, screened for the Cryptococcal Optimal ART Timing (COAT) trial in Uganda and South Africa, were observed. Individuals received an LP to diagnose meningitis, and subsequent therapeutic LPs were recommended for elevated ICP (>250 mmH2O) or new symptoms. We compared survival, through 11 days, between individuals receiving at least 1 therapeutic LP with individuals not receiving therapeutic LPs. The COAT trial randomized subjects at 7–11 days; thus, follow-up stopped at time of death, randomization, or 11 days. Results. Seventy-five (30%) individuals had at least 1 therapeutic LP. Individuals receiving therapeutic LPs had higher cerebrospinal fluid (CSF) opening pressures, higher CSF fungal burdens, and were more likely to have altered mental status at baseline than those with no therapeutic LPs. Thirty-one deaths (18%) occurred among 173 individuals without a therapeutic LP and 5 deaths (7%) among 75 with at least 1 therapeutic LP. The adjusted relative risk of mortality was 0.31 (95% confidence interval: .12–.82). The association was observed regardless of opening pressure at baseline. Conclusions. Therapeutic LPs were associated with a 69% relative improvement in survival, regardless of initial intracranial pressure. The role of therapeutic LPs should be reevaluated.en_US
dc.language.isoenen_US
dc.subjectHIVen_US
dc.subjectcryptococcal meningitisen_US
dc.subjectepidemiologyen_US
dc.subjectmortalityen_US
dc.subjecttherapeutic lumbar puncturesen_US
dc.titleThe Effect of Therapeutic Lumbar Punctures on Acute Mortality From Cryptococcal Meningitisen_US
dc.typeArticleen_US


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