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
|Article Title||Clinical practice : policy : routine cryptococcal antigen screening for HIV-infected patients with low CD4+ T-lymphocyte counts - time to implement in South Africa? : forum|
|© Publisher:||Health and Medical Publishing Group (HMPG)|
|Journal||South African Medical Journal|
|Author||Joseph N. Jarvis, Thomas S. Harrison, Nelesh Govender, Stephen D. Lawn, Nicky Longley, Tihana Bicanic, Gary Maartens, Francois Venter, Linda-Gail Bekker, Robin Wood and Graeme Meintjes|
|Publication Date||Jan 2011|
|Pages||232 - 234|
|Keyword(s)||London School of Hygiene and Tropical Medicine, St George's University of London, University of Cape Town and University of the Witwatersrand|
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an urban hospital in Johannesburg, 67% of patients had died or were lost to follow-up at 3 months (N Govender et al., unpublished data).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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