{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:17:36Z","timestamp":1790716656144,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2011,10,11]],"date-time":"2011-10-11T00:00:00Z","timestamp":1318291200000},"content-version":"vor","delay-in-days":283,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"funder":[{"DOI":"10.13039\/100007273","name":"Weill Cornell Medical College","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007273","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2011,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cryptococcal meningitis is a leading cause of death among HIV\u2010infected individuals in sub\u2010Saharan Africa. Recent developments include the availability of intravenous fluconazole, cryptococcal antigen assays and new data to support fluconazole pre\u2010emptive treatment. In this study, we describe the impact of screening HIV\u2010positive adult inpatients with serum cryptococcal antigen (CRAG) at a Tanzanian referral hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All adults admitted to the medical ward of Bugando Medical Centre are counseled and tested for HIV. In this prospective cohort study, we consecutively enrolled HIV\u2010positive patients admitted between September 2009 and January 2010. All patients were interviewed, examined and screened with serum CRAG. Patients with positive serum CRAG or signs of meningitis underwent lumbar puncture. Patients were managed according to standard World Health Organization treatment guidelines. Discharge diagnoses and in\u2010hospital mortality were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 333 HIV\u2010infected adults enrolled in our study, 15 (4.4%) had confirmed cryptococcal meningitis and 10 of these 15 (66%) died. All patients with cryptococcal meningitis had at least two of four classic symptoms and signs of meningitis: fever, headache, neck stiffness and altered mental status. Cryptococcal meningitis accounted for a quarter of all in\u2010hospital deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite screening of all HIV\u2010positive adult inpatients with the serum CRAG at the time of admission and prompt treatment with high\u2010dose intravenous fluconazole in those with confirmed cryptococcal meningitis, the in\u2010hospital mortality rate remained unacceptably high. Improved strategies for earlier diagnosis and treatment of HIV, implementation of fluconazole pre\u2010emptive treatment for high\u2010risk patients and acquisition of better resources for treatment of cryptococcal meningitis are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/1758-2652-14-48","type":"journal-article","created":{"date-parts":[[2011,10,21]],"date-time":"2011-10-21T02:47:47Z","timestamp":1319165267000},"page":"48-48","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Universal screening of Tanzanian HIV\u2010infected adult inpatients with the serum cryptococcal antigen to improve diagnosis and reduce mortality: an operational study"],"prefix":"10.1002","volume":"14","author":[{"given":"Bahati MK","family":"Wajanga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Kalluvya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A","family":"Downs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren D","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel W","family":"Fitzgerald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert N","family":"Peck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2011,10,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1086\/367655"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e328322ffac"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200205030-00009"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/27.4.698"},{"issue":"8","key":"e_1_2_9_6_1","first-page":"705","article-title":"Factors associated with an increased case\u2010fatality rate in HIV\u2010infected and non\u2010infected South African gold miners with pulmonary tuberculosis","volume":"4","author":"Churchyard GJ","year":"2000","journal-title":"Int J Tuberc Lung Dis"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32832be0fc"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0102-311X2008001100013"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e32832fa214"},{"key":"e_1_2_9_10_1","first-page":"CD005647","article-title":"Treatment of acute cryptococcal meningitis in HIV infected adults, with an emphasis on resource\u2010limited settings","volume":"4","author":"Sloan D","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1086\/593194"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1086\/518607"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1086\/649858"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1086\/597262"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1086\/655143"},{"key":"e_1_2_9_16_1","unstructured":"World Health Organization:Antiretroviral Therapy for HIV Infection in Adults and Adolescents: a Public Health Approach. 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