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Ophthalmic features of HIV associated cryptococcal meningitis in Malawian Adults: an observational study

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Ellis, Jayne P., Gaskell, Kate, Peirse, Mary, Gormley, Jack, Kalata, Newton, Burgess, Philip I., Mopamboli, Patty, Manda, Chatonda A., Kiire, Christine A., Maccormick, Ian, Gondwe, Ebbie, Molloy, Sile, Harrison, Thomas, Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200 and Heyderman, Robert S. (2019) 'Ophthalmic features of HIV associated cryptococcal meningitis in Malawian Adults: an observational study'. Wellcome Open Research, Vol 4, p. 83.

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Abstract

Background: Cryptococcal meningitis (CM) is the commonest neurological complication in patients with advanced HIV. Visual disturbance is a frequent presenting symptom. Papilloedema is commonly reported but other ophthalmic findings are not well described. Methods: We performed an observational study comparing severely immunocompromised HIV-infected patients with and without CM to determine the nature and prevalence of retinal pathology attributable to CM. 70 adult patients were enrolled in Blantyre Malawi, 35 with CM and 35 HIV-infected patients without CM. Results: 79% (19/24) of CM patients examined on day one had evidence of retinal abnormalities compared to 17% (6/35) of HIV-infected controls (p <0.001). In the CM group, retinal whitening was the commonest abnormality (50%), followed by optic disc swelling (29%), haemorrhage (25%) and vascular abnormalities (7%). Retinal whitening was the only abnormality observed in the comparator group (17%). In CM, there was no significant difference between those with and without retinal abnormalities in fungal burden (13,550 cfu/ml vs. 9,150 cfu/ml; p = 0.65), CD4 count (28 cells/µl vs. 76 cells/µl; p = 0.79) or CSF opening pressure (21cm H20 vs. 27cm H20; p = 0.5). There was no association between presence/absence of retinal abnormalities and death (40% 10-week mortality vs. 26%; p = 0.6). Conclusions: Whether the presence of CM retinopathy could be used as a marker of disease severity warrants further investigation. The observed ophthalmic findings provide a descriptive framework for CM retinopathy to be utilised in future CM studies. Trial registration: ISRCTN (ISRCTN45035509) 19/06/2012.

Item Type: Article
Subjects: QW Microbiology and Immunology > Fungi. Pathogenic Fungi. > QW 180 Pathogenic Fungi
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.5 Complications
WL Nervous System > WL 200 Meninges. Blood-brain barrier
WW Ophthalmology > WW 100 General works
WW Ophthalmology > Manifestations of Disease. Poor Vision > WW 475 Eye manifestations of general disease
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.12688/wellcomeopenres.15067.1
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 13 Jun 2019 11:33
Last Modified: 13 Jun 2019 11:33
URI: https://archive.lstmed.ac.uk/id/eprint/11028

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