Fungal Burden and Raised Intracranial Pressure Are Independently Associated With Visual Loss in Human Immunodeficiency Virus-Associated Cryptococcal Meningitis

Síle F Molloy; Brad Ross; Cecilia Kanyama; Sayoki Mfinanga; Sokoine Lesikari; Robert S Heyderman; Newton Kalata; Jayne Ellis; Charles Kouanfack; Duncan Chanda; Elvis Temfack; Shabir Lakhi; Anand Moodley; Adrienne K Chan; Joep J van Oosterhout; Yacouba Mapoure; Peter Mwaba; David G Lalloo; Duolao Wang; Olivier Lortholary; Shabbar Jaffar; Mina C Hosseinipour; Angela Loyse; Thomas S Harrison; Tihana Bicanic

doi:10.1093/ofid/ofab066

Fungal Burden and Raised Intracranial Pressure Are Independently Associated With Visual Loss in Human Immunodeficiency Virus-Associated Cryptococcal Meningitis

Open Forum Infect Dis. 2021 Feb 5;8(4):ofab066. doi: 10.1093/ofid/ofab066. eCollection 2021 Apr.

Authors

Síle F Molloy^{1

2}, Brad Ross¹, Cecilia Kanyama³, Sayoki Mfinanga^{4

5}, Sokoine Lesikari⁴, Robert S Heyderman^{6

7

8}, Newton Kalata^{7

8}, Jayne Ellis^{7

8

9}, Charles Kouanfack¹⁰, Duncan Chanda¹¹, Elvis Temfack^{12

13}, Shabir Lakhi¹⁴, Anand Moodley¹⁵, Adrienne K Chan^{16

17}, Joep J van Oosterhout^{18

19}, Yacouba Mapoure¹², Peter Mwaba²⁰, David G Lalloo⁵, Duolao Wang⁵, Olivier Lortholary^{21

22}, Shabbar Jaffar⁵, Mina C Hosseinipour^{3

23}, Angela Loyse^{1

2}, Thomas S Harrison^{1

2}, Tihana Bicanic^{1

2}

Affiliations

¹ Centre for Global Health, Institute of Infection and Immunity, St George's University of London, London, United Kingdom.
² Clinical Academic Group in Infection, St George's University Hospital, LondonUnited Kingdom.
³ UNC Project, Kamuzu Central Hospital, Lilongwe, Malawi.
⁴ National Institute for Medical Research, Muhimbili Centre, Dar es Salaam, Tanzania.
⁵ Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
⁶ University College London, London, United Kingdom.
⁷ Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
⁸ College of Medicine, Queen Elizabeth Hospital, Blantyre, Malawi.
⁹ The Hospital for Tropical Diseases, University College Hospital, LondonUnited Kingdom.
¹⁰ Hȏpital Central Yaoundé/Site ANRS Cameroun, Yaoundé, Cameroon.
¹¹ Institute for Medical Research and Training, University Teaching Hospital, Lusaka, Zambia.
¹² Douala General Hospital, Douala, Cameroon.
¹³ National Public Health Laboratory, Yaounde, Cameroon.
¹⁴ University Teaching Hospital, Lusaka, Zambia.
¹⁵ Department of Neurology, University of the Free State, Bloemfontein, South Africa.
¹⁶ Dignitas International, Zomba Central Hospital, Zomba, Malawi.
¹⁷ Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
¹⁸ Partners in Hope, LilongweMalawi.
¹⁹ David Geffen School of Medicine, University of California, Los Angeles, USA.
²⁰ Department of Internal Medicine and Directorate of Research and Post Graduate Studies, Lusaka Apex Medical University, Lusaka, Zambia.
²¹ Institut Pasteur, Molecular Mycology Unit, Centre National de la Recherche Scientifique, Paris, France.
²² Paris Descartes University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, Institut Imagine, Assistance Publique - Hôpitaux de Paris, Paris, France.
²³ University of North Carolina, Chapel Hill, North Carolina, USA.

Abstract

Among 472 patients with human immunodeficiency virus-associated cryptococcal meningitis, 16% had severe visual loss at presentation, and 46% of these were 4-week survivors and remained severely impaired. Baseline cerebrospinal fluid opening pressure ≥40 cmH₂O (adjusted odds ratio [aOR], 2.56; 95% confidence interval [CI], 1.36-4.83; P = .02) and fungal burden >6.0 log₁₀ colonies/mL (aOR, 3.01; 95% CI, 1.58-5.7; P = .003) were independently associated with severe visual loss.

Keywords: HIV; cryptococcal meningitis; fungal burden; raised intracranial pressure; visual loss.