Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures

被引：146

作者：

Bicanic, Tihana ^{[1
,2
,3
]}

Brouwer, Annemarie E. ^{[2
,5
,8
]}

Meintjes, Graeme ^{[3
,4
]}

Rebe, Kevin ^{[3
,4
]}

Limmathurotsakul, Direk ^{[5
]}

Chierakul, Wirongrong ^{[5
]}

Teparrakkul, Praprit ^{[6
]}

Loyse, Angela ^{[1
,2
,3
]}

White, Nicholas J. ^{[5
,7
]}

Wood, Robin ^{[1
]}

Jaffar, Shabbar ^{[9
]}

Harrison, Thomas ^{[2
]}

机构：

[1] Univ Cape Town, Desmond Tutu HIV Ctr, Inst Infect Dis & Mol Med, ZA-7925 Cape Town, South Africa

[2] St Georges Univ London, Dept Cellular & Mol Med, Div Infect Dis, London, England

[3] GF Jooste Hosp, Infect Dis Unit, Cape Town, South Africa

[4] Univ Cape Town, Dept Med, ZA-7925 Cape Town, South Africa

[5] Mahidol Univ, Fac Trop Med, Bangkok, Thailand

[6] Sappasithiprasong Hosp, Dept Med, Ubon Ratchathani, Thailand

[7] Univ Oxford, Nuffield Dept Clin Med, Ctr Trop Med, Oxford, England

[8] Radboud Univ Nijmegen, Med Ctr, Dept Internal Med & Infect Dis, NL-6525 ED Nijmegen, Netherlands

[9] London Sch Hyg & Trop Med, Dept Epidemiol & Populat, London WC1, England

来源：

AIDS | 2009年 / 23卷 / 06期

基金：

英国医学研究理事会; 英国惠康基金;

关键词：

cerebrospinal fluid pressure; cryptococcal meningitis; Cryptococcus; HIV; lumbar puncture; raised intracranial pressure; INCREASED INTRACRANIAL-PRESSURE; HIV-INFECTED PATIENTS; ANTIRETROVIRAL THERAPY; NEOFORMANS MENINGITIS; PRACTICE GUIDELINES; RANDOMIZED-TRIAL; AMPHOTERICIN-B; MANAGEMENT; DISEASE; AIDS;

D O I：

10.1097/QAD.0b013e32832605fe

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Objectives: To assess impact of serial lumbar punctures on association between cerebrospinal fluid (CSF) opening pressure and prognosis in HIV-associated cryptococcal meningitis; to explore time course and relationship of opening pressure with neurological findings, CSF fungal burden, immune response, and CD4 cell count. Design: Evaluation of 163 HIV-positive ART-naive patients enrolled in three trials of amphotericin B-based therapy for cryptococcal meningitis in Thailand and South Africa. Methods: Study protocols required four lumbar punctures with measurements of opening pressure over the first 2 weeks of treatment and additional lumbar punctures if opening pressure raised. Fungal burden and clearance, CSF immune parameters, CD4 cell count, neurological symptoms and signs, and outcome at 2 and 10 weeks were compared between groups categorized by opening pressure at cryptococcal meningitis diagnosis. Results: Patients with higher baseline fungal burden had higher baseline opening pressure. High fungal burden appeared necessary but not sufficient for development of high pressure. Baseline opening pressure was not associated with CD4 cell count, CSF pro-inflammatory cytokines, or altered mental status. Day 14 opening pressure was associated with day 14 fungal burden. Overall mortality was 12% (20/162) at 2 weeks and 26% (42/160) at 10 weeks, with no significant differences between opening pressure groups. Conclusion: Studies are needed to define factors, in addition to fungal burden, associated with raised opening pressure. Aggressive management of raised opening pressure through repeated CSF drainage appeared to prevent any adverse impact of raised opening pressure on outcome in patients with cryptococcal meningitis. The results support increasing access to manometers in resource-poor settings and routine management of opening pressure in patients with cryptococcal meningitis. (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

引用

页码：701 / 706

页数：6

共 16 条

[1] High-dose amphotericin B with flucytosine for the treatment of cryptococcal meningitis in HIV-infected patients: A randomized trial [J].