n South African Medical Journal - Clinical practice : policy : routine cryptococcal antigen screening for HIV-infected patients with low CD4+ T-lymphocyte counts - time to implement in South Africa? : forum




Cryptococcal meningitis (CM) is a major cause of death among HIV-infected individuals. It causes an estimated 957 900 cases and 624 700 deaths worldwide annually, the vast majority of them in sub- Saharan Africa. In Cape Town, CM is now the most common cause of adult meningitis (63% of all microbiologically confirmed cases), and acute outcomes are poor. Even with optimal treatment in study settings, 10-week mortality rates are between 24% and 37%. In 2009, in a routine care setting at an urban hospital in Johannesburg, 67% of patients had died or were lost to follow-up at 3 months (N Govender , unpublished data). Unfortunately almost half of South African patients still receive sub-optimal initial treatment with oral fluconazole rather than intravenous amphotericin B. Clearly, given the substantial mortality and morbidity associated with CM, preventive interventions should be prioritised.


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