Fungal Burden and Raised Intracranial Pressure Are Independently Associated With Visual Loss in Human Immunodeficiency Virus-Associated Cryptococcal Meningitis.

Síle F Molloy ,Shabbar Jaffar,Newton Kalata,Duncan Chanda,Shabir Lakhi,Tihana Bicanic,Olivier Lortholary,Angela Loyse,Anand Moodley,Charles Kouanfack,Cecilia Kanyama,Jayne Ellis,Duolao Wang,Peter Mwaba,Sokoine Lesikari,Sayoki Mfinanga,Elvis Temfack,B.a Ross ,Yacouba Njankouo Mapoure ,Robert S Heyderman ,Adrienne K Chan ,Mina C Hosseinipour ,Thomas S Harrison ,Joep J Van Oosterhout ,David G Lalloo

doi:10.1093/ofid/ofab066

Abstract

Among 472 patients with human immunodeficiency virus-associated cryptococcal meningitis, 16% had severe visual loss at presentation, and 46% of these were 4-week survivors and remained severely impaired. Baseline cerebrospinal fluid opening pressure ≥40 cmH2O (adjusted odds ratio [aOR], 2.56; 95% confidence interval [CI], 1.36–4.83; P = .02) and fungal burden >6.0 log10 colonies/mL (aOR, 3.01; 95% CI, 1.58–5.7; P = .003) were independently associated with severe visual loss.

Highlights

HIV-associated cryptococcal meningitis (CM) is the commonest cause of adult meningitis in sub-Saharan Africa, and accounts for ~180,000 deaths/year globally[1]
Age; baseline CSF pressure
There were no significant differences in the above parameters between patients remaining severely impaired and those improving (Supplementary Table 3), though numbers for comparison were low. This prospective study within a large African trial is the first to demonstrate an independent association of both fungal burden and raised intracranial pressure (ICP), in addition to age, with visual loss at presentation with HIV-CM

Summary

Introduction

HIV-associated cryptococcal meningitis (CM) is the commonest cause of adult meningitis in sub-Saharan Africa, and accounts for ~180,000 deaths/year globally[1]. CM often presents with altered mental status, raised intracranial pressure (ICP) and hearing and visual loss[2], with survivors often experiencing neurological sequelae[3,4,5]. Small retrospective cohorts (1024) or raised ICP (CSF opening pressure(OP) >30cm H20) are associated with visual loss in CM, but have been too small to undertake multivariable analyses[3, 6]. We report on the prevalence, risk factors and reversibility of visual loss in a large prospective CM patient multi-country cohort in sub-Saharan Africa[9]

Methods

Results

Conclusion