Abstract
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Highlights
While the developed world has seen a substantial decline in incidence rates of CC after the advent of highly active antiretroviral treatment (HAART),[1,2,3] the enormity of the burden of AIDS on the African sub-continent and the anticipated delays in achieving full coverage of antiretroviral therapy (ART) programmes imply that CC will continue to cause mortality among our population for years to come
A note on definitions: Cryptococcal meningitis (CM) refers to meningo-encephalitis resulting from infection; disseminated cryptococcosis refers to infection of multiple body sites; and cryptococcosis (CC) refers to infection of any body site, with an organism from the genus Cryptococcus, including Cryptococcus neoformans and C. gattii
The role of lumbar puncture (LP) and computed tomography (CT) scan of the brain in the investigation of patients with suspected CM LP is necessary to establish an aetiological diagnosis of meningitis
Summary
While the developed world has seen a substantial decline in incidence rates of CC after the advent of highly active antiretroviral treatment (HAART),[1,2,3] the enormity of the burden of AIDS on the African sub-continent and the anticipated delays in achieving full coverage of antiretroviral therapy (ART) programmes imply that CC will continue to cause mortality among our population for years to come. The prognosis of patients with cryptococcal meningitis was very poor prior to the availability of ART,[4,5,6] but present survival rates in the context of ART co-administration are much improved.[7,8,9] it has become essential to improve the initial acute management of CC in order to maximise the patient’s chances of initial survival and subsequent entry into the ART treatment programme. Existing international guidelines for the management of cryptococcosis[10,11,12,13,14] are written for different geographical and clinical contexts and may be impracticable for implementation in sub-Saharan Africa given limited availability of drugs and other resources
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