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Review
. 2013 May-Jun;17(3):353-62.
doi: 10.1016/j.bjid.2012.10.020. Epub 2013 May 10.

Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America

Jose E Vidal  1 , Augusto C Penalva de Oliveira, Rafi F Dauar, David R Boulware
Affiliations
Review

Strategies to reduce mortality and morbidity due to AIDS-related cryptococcal meningitis in Latin America

Jose E Vidal et al. Braz J Infect Dis. 2013 May-Jun.

Abstract

Latin America is the region with the third most AIDS-related cryptococcal meningitis infections globally. Highly active antiretroviral therapy (HAART) has reduced the number of infections; however, the number of deaths and the case-fatality rate continues to be unacceptable. In this review, we focus on the burden of AIDS-related cryptococcosis in Latin America and discuss potential strategies to reduce early mortality from Cryptococcus. In this review, we highlight the importance of: (1) earlier HIV diagnosis and HAART initiation with retention-in-care to avoid AIDS; (2) pre-HAART cryptococcal antigen (CRAG) screening with preemptive fluconazole treatment; (3) better diagnostics (e.g. CRAG testing); and (4) optimal treatment with aggressive management of intracranial pressure and induction therapy with antifungal combination. Implementation of these strategies can reduce cryptococcal-related deaths, improve care, and reduce healthcare costs.

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Figures

Fig. 1
Fig. 1
Number of cases of AIDS-related extrapulmonary cryptococcosis cases. Sao Paulo, 1982–2010. Source: Base Integrada Paulista de Aids (BIPAIDS) – Cooperação Técnica PEDST/Aids-SP e Fundação SEADE, MS/SVS/Departamento Nacional de DST, Aids e Hepatites Virais.
Fig. 2
Fig. 2
Case-fatality rate of AIDS-related extra-pulmonary cryptococcosis. Sao Paulo, 1982–2010. Source: Base Integrada Paulista de Aids (BIPAIDS) – Cooperação Técnica PEDST/Aids-SP e Fundação SEADE, MS/SVS/Departamento Nacional de DST, Aids e Hepatites Virais.
Fig. 3
Fig. 3
Algorithm of management of intracranial pressure in AIDS-related cryptococcal meningitis. Emilio Ribas Institute of Infectious Diseases, São Paulo, Brazil. LP, lumbar puncture; ICP, intracranial pressure; CT, computerized tomography. * Alternatively, a temporary external lumbar drainage can be placed.
See this image and copyright information in PMC

References

    1. Park B.J., Wannemuehler K.A., Marston B.J., Govender N., Pappas P.G., Chiller T.M. Estimation of the global burden of cryptococcal meningitis among persons living with HIV(AIDS. AIDS. 2009;23:525–530. - PubMed
    1. Satishchandra P., Nalini A., Gourie-Devi M., et al. Profile of neurologic disorders associated with HIV(AIDS from Bangalore, south India (1989-96) Indian J Med Res. 2000;111:14–23. - PubMed
    1. Harrison T.S. The burden of HIV-associated cryptococcal disease. AIDS. 2009;23:531–532. - PubMed
    1. Ganiem A.R., Parwati I., Wisaksana R., et al. The effect of HIV infection on adult meningitis in Indonesia: a prospective cohort study. AIDS. 2009;23:2309–2316. - PubMed
    1. Prado M., Silva M.B., Laurenti R., Travassos L.R., Taborda C.P. Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: a review from 1996 to 2006. Mem Inst Oswaldo Cruz. 2009;104:513–521. - PubMed

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