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báo cáo hóa học:" Universal screening of Tanzanian HIV-infected adult inpatients with the serum cryptococcal antigen to improve diagnosis and reduce mortality: an operational study"

Tuyển tập các báo cáo nghiên cứu về hóa học được đăng trên tạp chí sinh học đề tài : Universal screening of Tanzanian HIV-infected adult inpatients with the serum cryptococcal antigen to improve diagnosis and reduce mortality: an operational study | Wajanga et al. Journal of the International AIDS Society 2011 14 48 http www.jiasociety.Org content 14 1 48 JOURNALOF THE INTERNATIONAL AIDS SOCIETY RESEARCH Open Access Universal screening of Tanzanian HIV-infected adult inpatients with the serum cryptococcal antigen to improve diagnosis and reduce mortality an operational study 1.2 1.2 1.2.3 3 3 Bahati MK Wajanga 1 Samuel Kalluvya 1 Jennifer A Downs 1 Warren D Johnson Daniel W Fitzgerald and Robert N Peck1 2 3 Abstract Background Cryptococcal meningitis is a leading cause of death among HIV-infected individuals in sub-Saharan Africa. Recent developments include the availability of intravenous fluconazole cryptococcal antigen assays and new data to support fluconazole pre-emptive treatment. In this study we describe the impact of screening HIVpositive adult inpatients with serum cryptococcal antigen CRAG at a Tanzanian referral hospital. Methods All adults admitted to the medical ward of Bugando Medical Centre are counseled and tested for HIV. In this prospective cohort study we consecutively enrolled HIV-positive patients admitted between September 2009 and January 2010. All patients were interviewed examined and screened with serum CRAG. Patients with positive serum CRAG or signs of meningitis underwent lumbar puncture. Patients were managed according to standard World Health Organization treatment guidelines. Discharge diagnoses and in-hospital mortality were recorded. Results Of 333 HIV-infected adults enrolled in our study 15 4.4 had confirmed cryptococcal meningitis and 10 of these 15 66 died. All patients with cryptococcal meningitis had at least two of four classic symptoms and signs of meningitis fever headache neck stiffness and altered mental status. Cryptococcal meningitis accounted for a quarter of all in-hospital deaths. Conclusions Despite screening of all HIV-positive adult inpatients with the serum CRAG at the time of admission and prompt treatment with high-dose intravenous fluconazole in those .