Related Experiment Video

Updated: Jul 12, 2026

Quantification of Cerebral Vascular Architecture using Two-photon Microscopy in a Mouse Model of HIV-induced Neuroinflammation
10:04

Quantification of Cerebral Vascular Architecture using Two-photon Microscopy in a Mouse Model of HIV-induced Neuroinflammation

Published on: January 12, 2016

9.5K

Intracranial pressure management in patients with human immunodeficiency virus-associated cryptococcal meningitis in

Philasande Mkoko1,2, Jessica Du Preez2, Senlika Naidoo2,3

  • 1Department of Medicine, Division of Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Southern African Journal of HIV Medicine
|January 4, 2021
PubMed

Insights

Performing four or more lumbar punctures in the first week of treatment for cryptococcal meningitis in people living with HIV significantly reduces in-hospital mortality. This intervention lowers the risk of death in patients with HIV-associated cryptococcal meningitis.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Public Health in Sub-Saharan Africa

Background:

  • Cryptococcal meningitis (CCM) is a major cause of death in people living with HIV (PLWH) in sub-Saharan Africa.
  • High mortality and morbidity rates persist despite combination antifungal therapy, intracranial pressure management, and timely antiretroviral therapy (ART).
  • Lack of spinal manometers hinders accurate cerebrospinal fluid (CSF) pressure measurement and control in many regional healthcare centers.

Purpose of the Study:

  • To investigate if performing four or more lumbar punctures (LPs) within the first week of CCM diagnosis and treatment reduces in-hospital mortality and morbidity in HIV-associated CCM (HIV/CCM) patients.
  • To test the hypothesis that frequent LPs can effectively manage intracranial pressure and improve outcomes.

Main Methods:

  • A retrospective study was conducted on 105 adult PLWH diagnosed with HIV/CCM between January and December 2016.
  • Patients received combination antifungal therapy, and the study assessed the association between receiving four or more LPs in the first week and in-hospital mortality.
  • Data included patient demographics, ART status, and the number of LPs performed within the initial hospitalization week.

Main Results:

  • Patients receiving four or more LPs (mean 4.58) had an 11.6% in-hospital mortality rate.
  • Patients receiving fewer than four LPs (mean 2.18) had a 29% in-hospital mortality rate.
  • The relative risk of in-hospital mortality was significantly lower (0.80) in the group that received four or more LPs (p=0.034).

Conclusions:

  • Performing four or more LPs within the first 7 days of admission and treatment for HIV/CCM is associated with a significant reduction in in-hospital mortality.
  • An absolute risk reduction of 17.4% and a relative risk reduction of 20% in mortality were observed.
  • This positive impact on mortality persisted until hospital discharge.
Abstract

Keywords:
HIVadult PLWHantifungal therapyantiretroviral therapycryptococcal meningitisin-hospital mortality

More Related Videos

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury06:18

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury

Published on: March 26, 2019

9.3K
Intracranial Pressure Monitoring In Nontraumatic Intraventricular Hemorrhage Rodent Model08:18

Intracranial Pressure Monitoring In Nontraumatic Intraventricular Hemorrhage Rodent Model

Published on: February 8, 2022

2.7K

Related Concept Videos

Cryptococcal Meningitis01:27

Cryptococcal Meningitis

Cryptococcal meningitis is a life-threatening opportunistic infection predominantly associated with HIV/AIDS, accounting for over 100,000 deaths annually worldwide. However, it also affects individuals with other forms of immunosuppression, including those undergoing immunosuppressive therapy, organ transplant recipients, patients with innate immunodeficiencies, and individuals with hematological disorders. The infection is caused mainly by Cryptococcus neoformans and Cryptococcus gattii,...
Brain Abscess l: Introduction01:26

Brain Abscess l: Introduction

A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial infections,...
Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...