Therapeutic Lumbar Punctures in Human Immunodeficiency Virus–Associated Cryptococcal Meningitis: Should Opening Pressure Direct Management?

Abstract Background Increased intracranial pressure (ICP) frequently complicates cryptococcal meningitis. Therapeutic lumbar punctures (LPs) have acute survival benefits in the first week, and we sought to understand the longer-term survival impact of therapeutic LPs. Methods We prospectively enroll...

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Bibliographic Details
Published in:Open forum infectious diseases 2022-09, Vol.9 (9), p.ofac416-ofac416
Main Authors: Kagimu, Enock, Engen, Nicole, Ssebambulidde, Kenneth, Kasibante, John, Kiiza, Tadeo K, Mpoza, Edward, Tugume, Lillian, Nuwagira, Edwin, Nsangi, Laura, Williams, Darlisha A, Hullsiek, Kathy Huppler, Boulware, David R, Meya, David B, Rhein, Joshua, Abassi, Mahsa, Musubire, Abdu K
Format: Article
Language:English
Subjects:
Analysis
Blood cell count
Cryptococcal meningitis
Editor's Choice
Health aspects
HIV (Viruses)
Major
Mortality
Penetrating wounds
Seizures (Medicine)
Uganda
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Summary:Abstract Background Increased intracranial pressure (ICP) frequently complicates cryptococcal meningitis. Therapeutic lumbar punctures (LPs) have acute survival benefits in the first week, and we sought to understand the longer-term survival impact of therapeutic LPs. Methods We prospectively enrolled human immunodeficiency virus (HIV)–seropositive adults with cryptococcal meningitis from 2013 to 2017 in Uganda. We assessed the association between clinical characteristics, CSF parameters, and 14- and 30-day mortality by baseline ICP. We also assessed 30-day mortality by number of follow-up therapeutic LPs performed within 7 days. Results Our analysis included 533 participants. Participants with baseline ICP >350 mm H2O were more likely to have Glasgow Coma Scale (GCS) score
ISSN:2328-8957
2328-8957
DOI:10.1093/ofid/ofac416