Repository: Freie Universität Berlin, Math Department

“Time-to-Amphotericin B” in Cryptococcal Meningitis in a European Low-Prevalence Setting: Analysis of Diagnostic Delays

Katchanov, J. and von Kleist, M. and Arasteh, K. and Stocker, H. (2014) “Time-to-Amphotericin B” in Cryptococcal Meningitis in a European Low-Prevalence Setting: Analysis of Diagnostic Delays. QJM: An International Journal of Medicine, 107 (10). pp. 799-803. ISSN 1460-2393

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BACKGROUND: Cryptococcal meningitis is a rare disease in Europe, resulting in delayed recognition and slower initiation of specific treatment. AIM: To analyse the time-to-treatment and the factors that delay the diagnosis and treatment in the low-prevalence setting of a European centre. DESIGN: Retrospective review METHODS: We reviewed full medical records of all adult patients with cryptococcal meningitis referred to an HIV centre in Berlin, Germany in 10-year period between 1st of October 2003 and 31st of September 2013. Multivariant statistics with bootstrap-resampling were performed. RESULTS: We identified 19 patients with a diagnosis of HIV-related cryptococcal meningitis (0.55% of all consecutive HIV-infected patients). In almost half of our patients the diagnosis was not considered initially on admission to the secondary care centre and the first diagnostic clue being an accidental positive blood, cerebrospinal fluid, or bronchoalveolar lavage culture growing C. neoformans. The median time-to-treatment was 5 days (range: 1- 16). Known positive HIV status accelerated the time-to-diagnosis (p< 0.05) by a median of 1.89 days, whereas the CSF cell count ≤ 10/μl delayed diagnosis by a median time of 1.93 days (p < 0.1). CONCLUSIONS: Diagnostic delays could be avoided by encouraging practising physicians (1) to consider cryptococcal meningitis in immunosuppressed HIV infected patients irrespective of neurological symptoms, (2) to test for India ink, cryptococcal antigen and fungal cultures in immunosuppressed HIV infected patients with normal CSF, (3) to consider a possibility of underlying HIV infection in patients with unknown HIV status presenting with meningitis, (4) to consider early targeted HIV testing in persons at risk according to locally validated criteria.

Item Type:Article
Subjects:Medicine and Dentistry
Mathematical and Computer Sciences
Divisions:Department of Mathematics and Computer Science > Institute of Computer Science
Department of Mathematics and Computer Science > Institute of Mathematics > BioComputing Group
ID Code:1423
Deposited By: BioComp Admin
Deposited On:27 Jun 2014 08:52
Last Modified:08 Dec 2014 14:22

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