Symptomatic Relapse of Hiv-Associated Cryptococcal Meningitis in South Africa: The Role of Inadequate Secondary Prophylaxis (Original Articles) (Clinical Report)

Symptomatic Relapse of Hiv-Associated Cryptococcal Meningitis in South Africa: The Role of Inadequate Secondary Prophylaxis (Original Articles) (Clinical Report)

Cryptococcal meningitis (CM) is now the most common cause of adult meningitis in southern Africa (1,2) and is a major burden on local health care services. (3) Treatment remains unsatisfactory, with acute mortality in Africa ranging from 30% to 50%, even with optimal therapy. (4,5) Consequently, CM is a major cause of mortality in African HIV-infected patients, accounting for 13–44% of all deaths. (6-8) Estimates from the Centers for Disease Control and Prevention (CDC) show that CM is responsible for 504 000 deaths in sub-Saharan Africa annually. (9) A sizeable proportion of the cryptococcal disease burden is thought to be due to symptomatic relapse of previously treated infection. Recent work has highlighted the contribution made by immune reconstitution syndrome (IRIS) and fluconazole resistance to relapse in South African patients taking secondary fluconazole prophylaxis. (10-12)

Symptomatic Relapse of Hiv-Associated Cryptococcal Meningitis in South Africa: The Role of Inadequate Secondary Prophylaxis (Original Articles) (Clinical Report)



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