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Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UKAID Joint Global Health Trials"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>It is unknown whether persons with symptomatic cryptococcal meningitis detected during routine blood cryptococcal antigen (CrAg) screening have better survival than persons presenting with overt meningitis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We prospectively enrolled Ugandans with HIV and cryptococcal meningitis from December 2018 to December 2021. Participants were treated with amphotericin-based combination therapy. We compared outcomes between persons who were CrAg screened then referred to hospital with those presenting directly to the hospital with symptomatic meningitis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 489 participants with cryptococcal meningitis, 40% (194\/489) received blood CrAg screening and were referred to hospital (median time to referral 2 days; interquartile range [IQR], 1\u20136). CrAg-screened persons referred to hospital had lower 14-day mortality than non\u2013CrAg-screened persons who presented directly to hospital with symptomatic meningitis (12% vs 21%; hazard ratio, .51; 95% confidence interval, .32\u2013.83; P = .006). Fewer CrAg-screened participants had altered mental status versus non\u2013CrAg-screened participants (29% vs 41%; P = .03). CrAg-screened persons had lower quantitative cerebrospinal fluid (CSF) culture burden (median [IQR], 4570 [11\u2013100 000] vs 26 900 [182\u2013324 000] CFU\/mL; P = .01) and lower CSF opening pressures (median [IQR], 190 [120\u2013270] vs 225 [140\u2013340] mmH2O; P = .004) compared with non\u2013CrAg-screened persons.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Survival from cryptococcal meningitis was higher in persons with prior CrAg screening than those without CrAg screening. Altered mental status was the most potent predictor for mortality in a multivariate model. We suggest that CrAg screening detects cryptococcal meningitis at an earlier stage, as evidenced by a favorable baseline risk profile and notably fewer persons with altered mental status.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciac599","type":"journal-article","created":{"date-parts":[[2022,7,21]],"date-time":"2022-07-21T03:08:32Z","timestamp":1658372912000},"page":"e759-e765","source":"Crossref","is-referenced-by-count":16,"title":["Outpatient Cryptococcal Antigen Screening Is Associated With Favorable Baseline Characteristics and Improved Survival in Persons With Cryptococcal Meningitis in Uganda"],"prefix":"10.1093","volume":"76","author":[{"given":"Anna E","family":"Levin","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota , Minneapolis, Minnesota , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananta S","family":"Bangdiwala","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, School of Public Health, University of Minnesota , Minneapolis, Minnesota , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Nalintya","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0291-651X","authenticated-orcid":false,"given":"Enock","family":"Kagimu","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kasibante","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morris K","family":"Rutakingirwa","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Mpoza","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University , Kampala , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Jjunju","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mbarara University of Science and Technology , Mbarara , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin","family":"Nuwagira","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mbarara University of Science and Technology , Mbarara , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Naluyima","sequence":"additional","affiliation":[{"name":"Infectious Diseases Institute, Makerere University , 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Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darlisha A","family":"Williams","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota , Minneapolis, Minnesota , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9601-3006","authenticated-orcid":false,"given":"Mahsa","family":"Abassi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota , Minneapolis, Minnesota , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conrad","family":"Muzoora","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mbarara University of Science and Technology , Mbarara , Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine H","family":"Hullsiek","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, School of Public Health, University of Minnesota , Minneapolis, Minnesota , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5531-0231","authenticated-orcid":false,"given":"Radha","family":"Rajasingham","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota , Minneapolis, Minnesota , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B","family":"Meya","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota , Minneapolis, Minnesota , USA"},{"name":"Infectious Diseases Institute, Makerere University , Kampala , Uganda"},{"name":"Department of Medicine, School of Medicine, Makerere University College of Health Sciences , 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