The Effect of Therapeutic Lumbar Punctures on Acute Mortality From Cryptococcal Meningitis
Identifieur interne : 000165 ( Pmc/Checkpoint ); précédent : 000164; suivant : 000166The Effect of Therapeutic Lumbar Punctures on Acute Mortality From Cryptococcal Meningitis
Auteurs : Melissa A. Rolfes ; Kathy Huppler Hullsiek ; Joshua Rhein ; Henry W. Nabeta ; Kabanda Taseera [Ouganda] ; Charlotte Schutz [Afrique du Sud] ; Abdu Musubire ; Radha Rajasingham ; Darlisha A. Williams ; Friedrich Thienemann [Afrique du Sud] ; Conrad Muzoora [Ouganda] ; Graeme Meintjes [Afrique du Sud, Royaume-Uni] ; David B. Meya [Ouganda] ; David R. BoulwareSource :
- Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America [ 1058-4838 ] ; 2014.
Abstract
Intracranial pressure management with repeat lumbar puncture (LP) was investigated in patients with cryptococcal meningitis in sub-Saharan Africa. Conducting at least 1 additional LP soon after cryptococcal diagnosis was related to decreased risk of acute mortality regardless of initial pressure.
Url:
DOI: 10.1093/cid/ciu596
PubMed: 25057102
PubMed Central: 4441057
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Meya</name><affiliation><nlm:aff id="af1"><addr-line>Department of Medicine</addr-line>,<institution>Medical School</institution></nlm:aff></affiliation><affiliation><nlm:aff id="af3"><institution>Infectious Diseases Institute</institution>,<institution>Makerere University</institution>,<addr-line>Kampala</addr-line></nlm:aff></affiliation><affiliation wicri:level="1"><nlm:aff id="af7"><addr-line>School of Medicine, College of Health Sciences</addr-line>,<institution>Makerere University</institution>,<addr-line>Kampala</addr-line>,<country>Uganda</country></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Boulware, David R" sort="Boulware, David R" uniqKey="Boulware D" first="David R." last="Boulware">David R. Boulware</name><affiliation><nlm:aff id="af1"><addr-line>Department of Medicine</addr-line>,<institution>Medical School</institution></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25057102</idno><idno type="pmc">4441057</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441057</idno><idno type="RBID">PMC:4441057</idno><idno type="doi">10.1093/cid/ciu596</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000052</idno><idno type="wicri:Area/Pmc/Curation">000052</idno><idno type="wicri:Area/Pmc/Checkpoint">000165</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Effect of Therapeutic Lumbar Punctures on Acute Mortality From Cryptococcal Meningitis</title><author><name sortKey="Rolfes, Melissa A" sort="Rolfes, Melissa A" uniqKey="Rolfes M" first="Melissa A." last="Rolfes">Melissa A. Rolfes</name><affiliation><nlm:aff id="af1"><addr-line>Department of Medicine</addr-line>,<institution>Medical School</institution></nlm:aff></affiliation></author><author><name sortKey="Hullsiek, Kathy Huppler" sort="Hullsiek, Kathy Huppler" uniqKey="Hullsiek K" first="Kathy Huppler" last="Hullsiek">Kathy Huppler Hullsiek</name><affiliation><nlm:aff id="af2"><addr-line>Division of Biostatistics</addr-line>,<institution>School of Public Health, University of Minnesota</institution>,<addr-line>Minneapolis</addr-line></nlm:aff></affiliation></author><author><name sortKey="Rhein, Joshua" sort="Rhein, Joshua" uniqKey="Rhein J" first="Joshua" last="Rhein">Joshua Rhein</name><affiliation><nlm:aff id="af1"><addr-line>Department of Medicine</addr-line>,<institution>Medical School</institution></nlm:aff></affiliation><affiliation><nlm:aff id="af3"><institution>Infectious Diseases Institute</institution>,<institution>Makerere University</institution>,<addr-line>Kampala</addr-line></nlm:aff></affiliation></author><author><name sortKey="Nabeta, Henry W" sort="Nabeta, Henry W" uniqKey="Nabeta H" first="Henry W." last="Nabeta">Henry W. Nabeta</name><affiliation><nlm:aff id="af3"><institution>Infectious Diseases Institute</institution>,<institution>Makerere University</institution>,<addr-line>Kampala</addr-line></nlm:aff></affiliation></author><author><name sortKey="Taseera, Kabanda" sort="Taseera, Kabanda" uniqKey="Taseera K" first="Kabanda" last="Taseera">Kabanda Taseera</name><affiliation wicri:level="1"><nlm:aff id="af4"><addr-line>Internal Medicine, Faculty of Medicine</addr-line>,<institution>Mbarara University of Science and Technology</institution>,<country>Uganda</country></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Schutz, Charlotte" sort="Schutz, Charlotte" uniqKey="Schutz C" first="Charlotte" last="Schutz">Charlotte Schutz</name><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Institute of Infectious Disease and Molecular Medicine and Department of Medicine</addr-line>,<institution>University of Cape Town</institution>,<country>South Africa</country></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Musubire, Abdu" sort="Musubire, Abdu" uniqKey="Musubire A" first="Abdu" last="Musubire">Abdu Musubire</name><affiliation><nlm:aff id="af3"><institution>Infectious Diseases Institute</institution>,<institution>Makerere University</institution>,<addr-line>Kampala</addr-line></nlm:aff></affiliation></author><author><name sortKey="Rajasingham, Radha" sort="Rajasingham, Radha" uniqKey="Rajasingham R" first="Radha" last="Rajasingham">Radha Rajasingham</name><affiliation><nlm:aff id="af1"><addr-line>Department of Medicine</addr-line>,<institution>Medical School</institution></nlm:aff></affiliation><affiliation><nlm:aff id="af3"><institution>Infectious Diseases Institute</institution>,<institution>Makerere University</institution>,<addr-line>Kampala</addr-line></nlm:aff></affiliation></author><author><name sortKey="Williams, Darlisha A" sort="Williams, Darlisha A" uniqKey="Williams D" first="Darlisha A." last="Williams">Darlisha A. Williams</name><affiliation><nlm:aff id="af1"><addr-line>Department of Medicine</addr-line>,<institution>Medical School</institution></nlm:aff></affiliation><affiliation><nlm:aff id="af3"><institution>Infectious Diseases Institute</institution>,<institution>Makerere University</institution>,<addr-line>Kampala</addr-line></nlm:aff></affiliation></author><author><name sortKey="Thienemann, Friedrich" sort="Thienemann, Friedrich" uniqKey="Thienemann F" first="Friedrich" last="Thienemann">Friedrich Thienemann</name><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Institute of Infectious Disease and Molecular Medicine and Department of Medicine</addr-line>,<institution>University of Cape Town</institution>,<country>South Africa</country></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Muzoora, Conrad" sort="Muzoora, Conrad" uniqKey="Muzoora C" first="Conrad" last="Muzoora">Conrad Muzoora</name><affiliation wicri:level="1"><nlm:aff id="af4"><addr-line>Internal Medicine, Faculty of Medicine</addr-line>,<institution>Mbarara University of Science and Technology</institution>,<country>Uganda</country></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Meintjes, Graeme" sort="Meintjes, Graeme" uniqKey="Meintjes G" first="Graeme" last="Meintjes">Graeme Meintjes</name><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Institute of Infectious Disease and Molecular Medicine and Department of Medicine</addr-line>,<institution>University of Cape Town</institution>,<country>South Africa</country></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af6"><addr-line>Department of Medicine</addr-line>,<institution>Imperial College London</institution>,<country>United Kingdom</country>;</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Meya, David B" sort="Meya, David B" uniqKey="Meya D" first="David B." last="Meya">David B. Meya</name><affiliation><nlm:aff id="af1"><addr-line>Department of Medicine</addr-line>,<institution>Medical School</institution></nlm:aff></affiliation><affiliation><nlm:aff id="af3"><institution>Infectious Diseases Institute</institution>,<institution>Makerere University</institution>,<addr-line>Kampala</addr-line></nlm:aff></affiliation><affiliation wicri:level="1"><nlm:aff id="af7"><addr-line>School of Medicine, College of Health Sciences</addr-line>,<institution>Makerere University</institution>,<addr-line>Kampala</addr-line>,<country>Uganda</country></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Boulware, David R" sort="Boulware, David R" uniqKey="Boulware D" first="David R." last="Boulware">David R. Boulware</name><affiliation><nlm:aff id="af1"><addr-line>Department of Medicine</addr-line>,<institution>Medical School</institution></nlm:aff></affiliation></author></analytic><series><title level="j">Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America</title><idno type="ISSN">1058-4838</idno><idno type="eISSN">1537-6591</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Intracranial pressure management with repeat lumbar puncture (LP) was investigated in patients with cryptococcal meningitis in sub-Saharan Africa. Conducting at least 1 additional LP soon after cryptococcal diagnosis was related to decreased risk of acute mortality regardless of initial pressure.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Brouwer, Ae" uniqKey="Brouwer A">AE Brouwer</name></author><author><name sortKey="Rajanuwong, A" uniqKey="Rajanuwong A">A Rajanuwong</name></author><author><name sortKey="Chierakul, W" uniqKey="Chierakul W">W Chierakul</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Heyderman, Rs" uniqKey="Heyderman R">RS Heyderman</name></author><author><name sortKey="Gangaidzo, It" uniqKey="Gangaidzo I">IT Gangaidzo</name></author><author><name sortKey="Hakim, Jg" uniqKey="Hakim J">JG Hakim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jarvis, Jn" uniqKey="Jarvis J">JN Jarvis</name></author><author><name sortKey="Meintjes, G" uniqKey="Meintjes G">G 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">Clin. Infect. Dis</journal-id><journal-id journal-id-type="publisher-id">cid</journal-id><journal-id journal-id-type="hwp">cid</journal-id><journal-title-group><journal-title>Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America</journal-title></journal-title-group><issn pub-type="ppub">1058-4838</issn><issn pub-type="epub">1537-6591</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25057102</article-id><article-id pub-id-type="pmc">4441057</article-id><article-id pub-id-type="doi">10.1093/cid/ciu596</article-id><article-id pub-id-type="publisher-id">ciu596</article-id><article-categories><subj-group subj-group-type="heading"><subject>HIV/AIDS</subject></subj-group></article-categories><title-group><article-title>The Effect of Therapeutic Lumbar Punctures on Acute Mortality From Cryptococcal Meningitis</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Rolfes</surname><given-names>Melissa A.</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Hullsiek</surname><given-names>Kathy Huppler</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Rhein</surname><given-names>Joshua</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Nabeta</surname><given-names>Henry W.</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Taseera</surname><given-names>Kabanda</given-names></name><xref ref-type="aff" rid="af4">4</xref></contrib><contrib contrib-type="author"><name><surname>Schutz</surname><given-names>Charlotte</given-names></name><xref ref-type="aff" rid="af5">5</xref></contrib><contrib contrib-type="author"><name><surname>Musubire</surname><given-names>Abdu</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Rajasingham</surname><given-names>Radha</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Williams</surname><given-names>Darlisha A.</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af3">3</xref></contrib><contrib contrib-type="author"><name><surname>Thienemann</surname><given-names>Friedrich</given-names></name><xref ref-type="aff" rid="af5">5</xref></contrib><contrib contrib-type="author"><name><surname>Muzoora</surname><given-names>Conrad</given-names></name><xref ref-type="aff" rid="af4">4</xref></contrib><contrib contrib-type="author"><name><surname>Meintjes</surname><given-names>Graeme</given-names></name><xref ref-type="aff" rid="af5">5</xref><xref ref-type="aff" rid="af6">6</xref></contrib><contrib contrib-type="author"><name><surname>Meya</surname><given-names>David B.</given-names></name><xref ref-type="aff" rid="af1">1</xref><xref ref-type="aff" rid="af3">3</xref><xref ref-type="aff" rid="af7">7</xref></contrib><contrib contrib-type="author"><name><surname>Boulware</surname><given-names>David R.</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><aff id="af1"><label>1</label><addr-line>Department of Medicine</addr-line>,<institution>Medical School</institution></aff><aff id="af2"><label>2</label><addr-line>Division of Biostatistics</addr-line>,<institution>School of Public Health, University of Minnesota</institution>,<addr-line>Minneapolis</addr-line></aff><aff id="af3"><label>3</label><institution>Infectious Diseases Institute</institution>,<institution>Makerere University</institution>,<addr-line>Kampala</addr-line></aff><aff id="af4"><label>4</label><addr-line>Internal Medicine, Faculty of Medicine</addr-line>,<institution>Mbarara University of Science and Technology</institution>,<country>Uganda</country></aff><aff id="af5"><label>5</label><addr-line>Institute of Infectious Disease and Molecular Medicine and Department of Medicine</addr-line>,<institution>University of Cape Town</institution>,<country>South Africa</country></aff><aff id="af6"><label>6</label><addr-line>Department of Medicine</addr-line>,<institution>Imperial College London</institution>,<country>United Kingdom</country>;</aff><aff id="af7"><label>7</label><addr-line>School of Medicine, College of Health Sciences</addr-line>,<institution>Makerere University</institution>,<addr-line>Kampala</addr-line>,<country>Uganda</country></aff></contrib-group><author-notes><corresp>Correspondence: Melissa A. Rolfes, PhD, MPH, 2001 6th St SE, MTRF Rm 3-500, University of Minnesota, Minneapolis, MN 55455 (<email>riede056@umn.edu</email>).</corresp></author-notes><pub-date pub-type="ppub"><day>1</day><month>12</month><year>2014</year></pub-date><pub-date pub-type="epub"><day>23</day><month>7</month><year>2014</year></pub-date><pub-date pub-type="pmc-release"><day>23</day><month>7</month><year>2014</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>59</volume><issue>11</issue><fpage>1607</fpage><lpage>1614</lpage><history><date date-type="received"><day>6</day><month>2</month><year>2014</year></date><date date-type="accepted"><day>8</day><month>6</month><year>2014</year></date></history><permissions><copyright-statement>© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.</copyright-statement><copyright-year>2014</copyright-year><license license-type="creative-commons" xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is anOpen Access article distributed under the terms of the Creative Commons Attribution License (<uri xlink:type="simple" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</uri>), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri content-type="pdf" xlink:type="simple" xlink:href="ciu596.pdf"></self-uri><abstract abstract-type="precis"><p>Intracranial pressure management with repeat lumbar puncture (LP) was investigated in patients with cryptococcal meningitis in sub-Saharan Africa. Conducting at least 1 additional LP soon after cryptococcal diagnosis was related to decreased risk of acute mortality regardless of initial pressure.</p></abstract><abstract><p><bold><italic>Introduction.</italic></bold> Cryptococcal meningitis is the most common cause of adult meningitis in sub-Saharan Africa. Raised intracranial pressure (ICP) is common in cryptococcosis. Prior studies suggest elevated ICP is associated with mortality, and guidelines recommend frequent lumbar punctures (LPs) to control ICP. However, the magnitude of the impact of LPs on cryptococcal-related mortality is unknown.</p><p><bold><italic>Methods.</italic></bold> In sum, 248 individuals with human immunodeficiency virus (HIV)-associated cryptococcal meningitis, screened for the Cryptococcal Optimal ART Timing (COAT) trial in Uganda and South Africa, were observed. Individuals received an LP to diagnose meningitis, and subsequent therapeutic LPs were recommended for elevated ICP (>250 mmH<sub>2</sub>O) or new symptoms. We compared survival, through 11 days, between individuals receiving at least 1 therapeutic LP with individuals not receiving therapeutic LPs. The COAT trial randomized subjects at 7–11 days; thus, follow-up stopped at time of death, randomization, or 11 days.</p><p><bold><italic>Results.</italic></bold> Seventy-five (30%) individuals had at least 1 therapeutic LP. Individuals receiving therapeutic LPs had higher cerebrospinal fluid (CSF) opening pressures, higher CSF fungal burdens, and were more likely to have altered mental status at baseline than those with no therapeutic LPs. Thirty-one deaths (18%) occurred among 173 individuals without a therapeutic LP and 5 deaths (7%) among 75 with at least 1 therapeutic LP. The adjusted relative risk of mortality was 0.31 (95% confidence interval: .12–.82). The association was observed regardless of opening pressure at baseline.</p><p><bold><italic>Conclusions.</italic></bold> Therapeutic LPs were associated with a 69% relative improvement in survival, regardless of initial intracranial pressure. The role of therapeutic LPs should be reevaluated.</p></abstract><kwd-group><kwd>HIV</kwd><kwd>cryptococcal meningitis</kwd><kwd>epidemiology</kwd><kwd>mortality</kwd><kwd>therapeutic lumbar punctures</kwd></kwd-group></article-meta></front></pmc><affiliations><list><country><li>Afrique du Sud</li><li>Ouganda</li><li>Royaume-Uni</li></country></list><tree><noCountry><name sortKey="Boulware, David R" sort="Boulware, David R" uniqKey="Boulware D" first="David R." last="Boulware">David R. Boulware</name><name sortKey="Hullsiek, Kathy Huppler" sort="Hullsiek, Kathy Huppler" uniqKey="Hullsiek K" first="Kathy Huppler" last="Hullsiek">Kathy Huppler Hullsiek</name><name sortKey="Musubire, Abdu" sort="Musubire, Abdu" uniqKey="Musubire A" first="Abdu" last="Musubire">Abdu Musubire</name><name sortKey="Nabeta, Henry W" sort="Nabeta, Henry W" uniqKey="Nabeta H" first="Henry W." last="Nabeta">Henry W. Nabeta</name><name sortKey="Rajasingham, Radha" sort="Rajasingham, Radha" uniqKey="Rajasingham R" first="Radha" last="Rajasingham">Radha Rajasingham</name><name sortKey="Rhein, Joshua" sort="Rhein, Joshua" uniqKey="Rhein J" first="Joshua" last="Rhein">Joshua Rhein</name><name sortKey="Rolfes, Melissa A" sort="Rolfes, Melissa A" uniqKey="Rolfes M" first="Melissa A." last="Rolfes">Melissa A. Rolfes</name><name sortKey="Williams, Darlisha A" sort="Williams, Darlisha A" uniqKey="Williams D" first="Darlisha A." last="Williams">Darlisha A. Williams</name></noCountry><country name="Ouganda"><noRegion><name sortKey="Taseera, Kabanda" sort="Taseera, Kabanda" uniqKey="Taseera K" first="Kabanda" last="Taseera">Kabanda Taseera</name></noRegion><name sortKey="Meya, David B" sort="Meya, David B" uniqKey="Meya D" first="David B." last="Meya">David B. Meya</name><name sortKey="Muzoora, Conrad" sort="Muzoora, Conrad" uniqKey="Muzoora C" first="Conrad" last="Muzoora">Conrad Muzoora</name></country><country name="Afrique du Sud"><noRegion><name sortKey="Schutz, Charlotte" sort="Schutz, Charlotte" uniqKey="Schutz C" first="Charlotte" last="Schutz">Charlotte Schutz</name></noRegion><name sortKey="Meintjes, Graeme" sort="Meintjes, Graeme" uniqKey="Meintjes G" first="Graeme" last="Meintjes">Graeme Meintjes</name><name sortKey="Thienemann, Friedrich" sort="Thienemann, Friedrich" uniqKey="Thienemann F" first="Friedrich" last="Thienemann">Friedrich Thienemann</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Meintjes, Graeme" sort="Meintjes, Graeme" uniqKey="Meintjes G" first="Graeme" last="Meintjes">Graeme Meintjes</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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