Year: 2013
Type: article
Abstract: Despite improvements in the antifungal regimens and the roll out of antiretroviral therapy (ART) in sub-Saharan Africa, mortality due to cryptococcal meningitis remains high. Relapse of an initially successfully treated infection contributes to this mortality and is often a clinical dilemma in differentiating between paradoxical immune reconstitution inflammatory syndrome (IRIS) and culture-positive relapse or treatment failure. Herein, we present a clinical case scenario and review the case definitions, differential diagnosis, and management of relapse with an emphasis on the current diagnostic and management strategies. We also highlight the challenges of resistance testing and management of refractory relapse cases. The risk of relapse is influenced by: 1) the choice of induction therapy, with higher mortality risk with fluconazole monotherapy which can select for resistance; 2) non-adherence to or lack of secondary prophylaxis; 3) failure of linkage-to-care or retention-in-care of HIV ART programs.
Author: Abdu K Musubire
Institutions: Infectious Diseases Institute, Makerere University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Awards: Infectious Disease Training in Clinical Investigation, Northern/Pacific Universities Global Health Research Training Consortium, Impact of HIV and HIV therapy on the Etiology and Outcome of Meningitis in Uganda, Trial for the Optimal Timing of HIV Therapy after Cryptococcal Meningitis, Immune Reconstitution Syndrome in HIV infected Persons in Resource-Limited Areas
OpenAlex ID: W1978076412