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Cryptococcal Meningitis in Africa: Burden, Prevention, and Treatment
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Cryptococcal Meningitis in Africa: Burden, Prevention, and Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Infectious Diseases".

Deadline for manuscript submissions: closed (15 December 2020) | Viewed by 4177

Special Issue Editor

Prof. Dr. Shabbar Jaffar

E-Mail Website
Guest Editor
Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
Interests: HIV late-stage; cryptococcal meningitis; multi-morbidity; clinical trials; global health; Africa

Special Issue Information

Dear Colleagues,

There remains a substantial burden of cryptococcal meningitis associated mortality in sub Saharan Africa, more than a decade after improved access to antiretroviral therapy and several years after guidelines on universal HIV test-and-treat were introduced.

In this Special Issue of the Journal of Clinical Medicine, we will address why mortality remains high and how it could be reduced in sub Saharan Africa.

We particularly welcome articles providing new insights into (i) the causes of mortality or (ii) recent developments in screening for cryptococcal antigen and pre-emptive treatment, and (iii) articles that provide new clinical or health system data related to the prevention and management of cryptococcal meningitis. We welcome both solicited and unsolicited submissions that will contribute to this goal.

Prof. Dr. Shabbar Jaffar
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • advanced HIV disease
  • causes of death
  • cryptococcal antigen screening
  • barriers to access to flucytosine and other products
  • management of cryptococcal meningitis
  • cost-effectiveness
  • linkage into and retention in care
  • health system challenges
  • clinical research priorities

Published Papers (1 paper)

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Research

9 pages, 513 KiB  
Article
Tuberculosis in HIV-Associated Cryptococcal Meningitis is Associated with an Increased Risk of Death
by Morris K. Rutakingirwa, Fiona V. Cresswell, Richard Kwizera, Kenneth Ssebambulidde, Enock Kagimu, Edwin Nuwagira, Lillian Tugume, Edward Mpoza, Joanna Dobbin, Darlisha A. Williams, Conrad Muzoora, David B. Meya, David R. Boulware, Kathy H. Hullsiek and Joshua Rhein
J. Clin. Med. 2020, 9(3), 781; https://doi.org/10.3390/jcm9030781 - 13 Mar 2020
Cited by 12 | Viewed by 3909
Abstract
Tuberculosis (TB) and cryptococcal meningitis are leading causes of morbidity and mortality in advanced HIV disease. Data are limited on TB co-infection among individuals with cryptococcal meningitis. We performed a retrospective analysis of HIV-infected participants with cryptococcal meningitis from 2010–2017. Baseline demographics were [...] Read more.
Tuberculosis (TB) and cryptococcal meningitis are leading causes of morbidity and mortality in advanced HIV disease. Data are limited on TB co-infection among individuals with cryptococcal meningitis. We performed a retrospective analysis of HIV-infected participants with cryptococcal meningitis from 2010–2017. Baseline demographics were compared between three groups: ‘prevalent TB’ if TB treated >14 days prior to cryptococcal meningitis diagnosis, ‘concurrent TB’ if TB treated ± 14 days from diagnosis, or ‘No TB at baseline’. We used time-updated proportional-hazards regression models to assess TB diagnosis as a risk for death. Of 870 participants with cryptococcal meningitis, 50 (6%) had prevalent TB, 67 (8%) had concurrent TB, and 753 (86%) had no baseline TB. Among participants without baseline TB, 67 (9%) were diagnosed with incident TB (after >14 days), with a median time to TB incidence of 41 days (IQR, 22–69). The 18-week mortality was 50% (25/50) in prevalent TB, 46% (31/67) in concurrent TB, and 45% (341/753) in the no TB group (p = 0.81). However, TB co-infection was associated with an increased hazard of death (HR = 1.75; 95% CI, 1.33–2.32; p < 0.001) in a time-updated model. TB is commonly diagnosed in cryptococcal meningitis, and the increased mortality associated with co-infection is a public health concern. Full article
(This article belongs to the Special Issue Cryptococcal Meningitis in Africa: Burden, Prevention, and Treatment)
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