Abstract
Cryptococcal meningitis is a leading cause of morbidity and mortality among HIV-infected persons, accounting for 15% of AIDS-related deaths. Visual disturbance is commonly reported, and a wide range of ophthalmic signs may be present on examination. There is limited published literature to date describing the range and incidence of ophthalmic signs in HIV-associated cryptococcal meningitis. Nested within the Adjunctive Sertraline for the Treatment of HIV-Associated Cryptococcal Meningitis (ASTRO-CM) trial (ClinicalTrials.gov number: NCT01802385), we conducted an observational study of 696 Ugandan adults with HIV-associated cryptococcal meningitis. Patients were screened for visual disturbance and external ophthalmic signs at initial presentation and at follow-up appointments over 18 weeks. Assessment comprised simple clinical history and basic examination and required no specialist equipment. More than a quarter of our cohort demonstrated ocular signs or symptoms, which were observed throughout the study period. A broad range of ocular signs were demonstrated: these included neurological signs (10.9%), localized ocular pathology (4.5%), and evidence of concurrent systemic disease (12.9%). The range of signs observed demonstrates the complexities of case management in patients with advanced HIV and cryptococcosis and also the importance of basic ocular examination in low resource settings. There remains an urgent need for studies conducting comprehensive ocular examination in patients with HIV-associated cryptococcal meningitis; these studies should include formal assessment of visual acuity, slit lamp examination and dilated indirect ophthalmoscopy. Prospective studies should investigate whether there is a correlation between reported visual disturbance and objective signs, in order to further clarify the underlying mechanisms and to guide effective diagnosis, follow-up and management.
| Original language | English (US) |
|---|---|
| Article number | 80 |
| Journal | Wellcome Open Research |
| Volume | 3 |
| DOIs | |
| State | Published - 2018 |
Bibliographical note
Funding Information:This research was supported by the Wellcome Trust [210772/Z/18/Z] to FVC and through the Joint Global Health Trials scheme jointly funded by the UK Medical Research Council, UK Department for International Development and the Wellcome Trust [M007413/1]. This work was also funded by the National Institute of Neurologic Disorders and Stroke and Fogarty International Center [R01NS086312, R25TW009345], and the National Institute of Allergy and Infectious Diseases [T32AI055433]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Funding Information:
Grant information: This research was supported by the Wellcome Trust [210772/Z/18/Z] to FVC and through the Joint Global Health Trials scheme jointly funded by the UK Medical Research Council, UK Department for International Development and the Wellcome Trust [M007413/1]. This work was also funded by the National Institute of Neurologic Disorders and Stroke and Fogarty International Center [R01NS086312, R25TW009345], and the National Institute of Allergy and Infectious Diseases [T32AI055433].
Funding Information:
This work was also funded by the National Institute of Neurologic Disorders and Stroke and Fogarty International Center [R01NS086312, R25TW009345], and the National Institute of Allergy and Infectious Diseases [T32AI055433].
Funding Information:
This research was supported by the Wellcome Trust [210772/ Z/18/Z] to FVC and through the Joint Global Health Trials scheme jointly funded by the UK Medical Research Council, UK Department for International Development and the Wellcome Trust [M007413/1].
Publisher Copyright:
© 2018 Atherton RR et al.
Keywords
- Cryptococcal meningitis
- Cryptococcus
- HIV
- Ocular
- Ophthalmic
- Visual
