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Title: Clinical and epidemiological features of Cryptococcus neoformans var. gattii meningitis in Papua New Guinea
Author: Seaton, R. Andrew
ISNI:       0000 0001 3392 1015
Awarding Body: University of Aberdeen
Current Institution: University of Aberdeen
Date of Award: 1996
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In the Central Province of Papua New Guinea (PNG) the annual incidence of Cryptococcus neoformans meningitis was calculated at 42.8 cases/million. Men were most frequently affected (2,2:1). In immunocompetent patients 95% of cerebrospinal fluid (CSF) isolates were var. gattii. Var. neoformans infection was associated with immunosuppression (p=0.009). In a cohort of 88 immunocompetent patients visual loss occurred in 52.6% of survivors and was associated with post-papilloedema optic atrophy in 60.9%. Progression to optic atrophy was associated with an abducens palsy (p=0.049) and high CSF cryptococcal antigen titres (p=0.036). Raised intracranial pressure (RICP) was not associated with visual loss. In survivors who had received corticosteroids visual deterioration was reduced (p=0.007) and blindness was less frequent (p=0.018), perhaps due to reduced immune-mediated optic nerve dysfunction. Mortality (34.1%) was associated with male sex (p=0.025), older age (p=0.0.39), altered consciousness (p<0.001), convulsions (p=0.002), and raised systolic blood pressure (p=0.017). RICP was common (81%) but did not predict outcome. Mortality may be reduced by lowering intracranial pressure in those with poor prognostic signs. Cell mediated immunity, assessed by an intradermal multi-test device, was similar in 37 cured, healthy patients and matched controls, although male patients had higher compound scores than controls (p=0.041). Male scores were higher in both patients (p=0.002) and controls (p=0.017). Three of four patients tested pre-treatment were anergic but survivors showed improved responsiveness post-treatment.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Medicine