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Ophthalmic features of HIV associated cryptococcal meningitis in Malawian Adults: an observational study
Jayne P Ellis1,2,3, Kate Gaskell1,4, Mary Peirse1
1Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
Background:
Cryptococcal meningitis (CM) is the commonest neurological complication in patients with advanced HIV. Visual disturbance is a frequent presenting symptom. Papilloedema is commonly reported but other ophthalmic findings are not well described.
Methods:
We performed an observational study comparing severely immunocompromised HIV-infected patients with and without CM to determine the nature and prevalence of retinal pathology associated with CM. 70 adult patients were enrolled in Blantyre Malawi, 35 with CM and 35 HIV-infected patients without CM.
Results:
79% (19/24) of CM patients examined on day one had evidence of retinal abnormalities compared to 17% (6/35) of HIV-infected controls (p < 0.001). In the CM group, retinal whitening was the commonest abnormality (50%), followed by optic disc swelling (29%), haemorrhage (25%) and vascular abnormalities (7%). Retinal whitening was the only abnormality observed in the comparator group (17%). In CM, there was no significant difference between those with and without retinal abnormalities in fungal burden (13,550 cfu/ml vs. 9,150 cfu/ml; p = 0.65), CD4 count (28 cells/μl vs. 76 cells/μl; p = 0.79) or CSF opening pressure (21 cm H20 vs. 27 cm H20; p = 0.5). There was no association between presence/absence of retinal abnormalities and death (40% 10-week mortality vs. 26%; p = 0.6).
Conclusions:
Whether the presence of CM retinopathy could be used as a marker of disease severity warrants further investigation. The observed ophthalmic findings provide a descriptive framework for CM retinopathy to be utilised in future CM studies.
Trial Registration:
ISRCTN ( ISRCTN45035509) 19/06/2012.
Insights
Cryptococcal meningitis (CM) in advanced HIV patients frequently causes retinal abnormalities, with 79% showing issues. These findings, including retinal whitening and optic disc swelling, offer a framework for understanding CM retinopathy.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Neurology
Background:
- Cryptococcal meningitis (CM) is a common neurological complication in advanced HIV.
- Visual disturbances are frequent symptoms, with papilledema often reported, but other ophthalmic findings are less described.
Purpose of the Study:
- To determine the nature and prevalence of retinal pathology associated with CM.
- To compare retinal abnormalities in HIV-infected patients with and without CM.
Main Methods:
- An observational study was conducted in Blantyre, Malawi.
- 70 severely immunocompromised HIV-infected patients were enrolled: 35 with CM and 35 without CM.
Main Results:
- 79% of CM patients exhibited retinal abnormalities versus 17% of controls (p < 0.001).
- Common CM abnormalities included retinal whitening (50%), optic disc swelling (29%), and hemorrhage (25%).
- No significant differences in fungal burden, CD4 count, or CSF opening pressure were found between CM patients with and without retinal abnormalities. Mortality was not associated with retinal abnormalities.
Conclusions:
- The presence of CM retinopathy may serve as a marker of disease severity, warranting further investigation.
- The study provides a descriptive framework for CM retinopathy in future research.
