{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:17:29Z","timestamp":1790716649094,"version":"4.1.0"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"914","license":[{"start":{"date-parts":[[2001,12,1]],"date-time":"2001-12-01T00:00:00Z","timestamp":1007164800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2001,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>SETTING<\/jats:title>\n                  <jats:p>Inpatient medical wards, Department of Medicine, University Teaching Hospital, Lusaka, Zambia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>To define the natural history, clinical presentation, and management outcome of microbiologically confirmed cryptococcal meningitis in adult AIDS patients treated under local conditions where antifungal and antiretroviral therapies are not routinely available.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A descriptive, longitudinal, observational study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>All adult patients admitted to the medical wards of the University Teaching Hospital, Lusaka, Zambia with cerebrospinal fluid culture proved, primary cryptococcal meningitis, during a 12 month period were enrolled into the study. The following details were acquired: clinical features, HIV status, laboratory data, treatment accorded, and survival.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 230 patients with primary cryptococcal meningitis were studied (median age 32 years; range 15\u201365 years; 112 males, 118 females). Cryptococcal meningitis was the first AIDS defining illness in 210 (91%) patients. One hundred and thirty of the 230 (56%) patients had received treatment with fluconazole monotherapy and 100 (43%) patients received palliative care only without any antifungal therapy. A 100% case fatality rate was observed in both groups at follow up: by seven weeks in the untreated group and at six months in the fluconazole treated group. The cumulative median survival from time of diagnosis was 19 days (range 1\u2013164 days) for the fluconazole treated group and 10 days (range 0\u201342 days) for the untreated group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Cryptococcal meningitis, under current treatment accorded at the University Teaching Hospital, Lusaka, has a 100% mortality in young Zambian adults with AIDS. The current treatment accorded to Zambian adults with cryptococcal meningitis is inappropriate. An urgent need exists to improve strategies for the clinical management of AIDS patients in poor African countries. The wider ethical and operational issues of making available antifungals to African AIDS patients are discussed.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/pgmj.77.914.769","type":"journal-article","created":{"date-parts":[[2017,12,28]],"date-time":"2017-12-28T15:10:44Z","timestamp":1514473844000},"page":"769-773","source":"Crossref","is-referenced-by-count":264,"title":["Clinical presentation, natural history, and cumulative death rates of 230 adults with primary cryptococcal meningitis in Zambian AIDS patients treated under local conditions"],"prefix":"10.1093","volume":"77","author":[{"given":"P","family":"Mwaba","sequence":"first","affiliation":[{"name":"Department of Medicine and the UNZA-UCLMS Project, University Teaching Hospital , Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Mwansa","sequence":"additional","affiliation":[{"name":"Department of Pathology and Microbiology, University Teaching Hospital , Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Chintu","sequence":"additional","affiliation":[{"name":"UNZA-UCLMS Project, University Teaching Hospital , Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Pobee","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Teaching Hospital , Lusaka, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Scarborough","sequence":"additional","affiliation":[{"name":"University College London Hospitals Trust , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Portsmouth","sequence":"additional","affiliation":[{"name":"University College London Hospitals Trust , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Zumla","sequence":"additional","affiliation":[{"name":"UNZA-UCLMS Project, University Teaching Hospital, Lusaka, Zambia and Centre for Infectious Diseases and International Health, Royal Free and University College Medical School, University College London, University College London Hospitals Trust , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2001,12,1]]},"reference":[{"key":"2023042613441028200_B1","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1086\/516298","article-title":"Cryptococcal meningitis in human immunodeficiency virus infected patients in Harare, Zimbabwe.","volume":"26","author":"Heyderman","year":"1998","journal-title":"Clin Infect Dis"},{"key":"2023042613441028200_B2","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1086\/516372","article-title":"Combination therapy with fluconazole and flucytosine for cryptococcal meningitis in Ugandan patients with AIDS.","volume":"26","author":"Mayanja-Kizza","year":"1998","journal-title":"Clin Infect 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AIDS.","volume":"22","author":"Sharkey","year":"1996","journal-title":"Clin Infect Dis"},{"key":"2023042613441028200_B6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1056\/NEJM199707033370103","article-title":"Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome.","volume":"337","author":"Van der Horst","year":"1997","journal-title":"N Engl J Med"},{"key":"2023042613441028200_B7","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1099\/00222615-45-5-376","article-title":"Cryptococcal infections of the central nervous system: an analysis of predisposing factors, laboratory findings and outcome in patients from South India with special reference to HIV infection.","volume":"45","author":"Khanna","year":"1996","journal-title":"J Med Microbiol"},{"key":"2023042613441028200_B8","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1093\/clinids\/20.2.263","article-title":"Amphotericin B as primary therapy for cryptococcosis in patients with AIDS: reliability of relatively high doses adminstered over a relatively short period.","volume":"20","author":"De-Lalla","year":"1995","journal-title":"Clin Infect Dis"},{"key":"2023042613441028200_B9","first-page":"694","article-title":"Use of fluconazole in the treatment of non-AIDS cryptococcal meningitis.","volume":"89","author":"Anthony","year":"1997","journal-title":"J Natl Med Assoc"},{"key":"2023042613441028200_B10","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1097\/00002030-199712000-00010","article-title":"Liposomal amphotericin B (AmBisome) compared with amphotericin B both followed by oral fluconazole in the treatment of AIDS associated cryptococcal meningitis.","volume":"11","author":"Leenders","year":"1997","journal-title":"AIDS"},{"key":"2023042613441028200_B11","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1093\/infdis\/170.1.238","article-title":"High dose fluconazole for treatment of cryptococcal disease in patients with human immunodeficiency virus infection.","volume":"170","author":"Haubrich","year":"1994","journal-title":"J Infect Dis"},{"key":"2023042613441028200_B12","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1093\/clinids\/22.5.838","article-title":"High dose fluconazole therapy for cryptococcal meningitis in patients with AIDS.","volume":"22","author":"Menichetti","year":"1996","journal-title":"Clin Infect Dis"},{"key":"2023042613441028200_B13","first-page":"229","article-title":"Cryptococcal disease: implications of recent clinical trials on treatment and management.","volume":"98","author":"Aberg","year":"1997","journal-title":"AIDS Clin Rev"},{"key":"2023042613441028200_B14","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0163-4453(94)94161-0","article-title":"Cryptococcal meningitis in Lilongwe and Blantyre, Malawi.","volume":"28","author":"Maher","year":"1994","journal-title":"J 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