Sruti Velamakanni - Academia.edu (original) (raw)
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Background Cryptococcus is the most common cause of adult meningitis in Africa. We assessed the s... more Background Cryptococcus is the most common cause of adult meningitis in Africa. We assessed the safety and microbiological efficacy of adjunctive sertraline, previously shown to have in-vitro and in-vivo activity against cryptococcus.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2015
Cryptococcus neoformans is the most common cause of adult meningitis in sub-Saharan Africa. The ... more Cryptococcus neoformans is the most common cause of adult meningitis in sub-Saharan Africa. The cryptococcal antigen lateral flow assay (CRAG LFA) has simplified diagnosis as a point-of-care test approved for serum or cerebrospinal fluid (CSF). We evaluated the accuracy of the CRAG LFA using fingerstick whole blood compared with serum/plasma and CSF for diagnosing meningitis. From August 2013 to August 2014, CRAG LFA (Immy, Norman, Oklahoma) tests were performed on fingerstick whole blood, plasma/serum and CSF in 207 HIV-infected adults in Kampala, Uganda with suspected meningitis. Venous blood was also collected and centrifuged to obtain serum and/or plasma. CSF was tested after lumbar puncture. Of 207 participants, 149 (72%) were fingerstick CRAG-positive. There was 100% agreement between fingerstick whole blood and serum/plasma. Of the 149 fingerstick CRAG-positive participants, 138 (93%) had evidence of cryptococcal meningitis with a positive CSF CRAG. Eleven participants (5%...
Sertraline, a selective serotonin reuptake inhibitor (SSRI), has dose-dependent activity against ... more Sertraline, a selective serotonin reuptake inhibitor (SSRI), has dose-dependent activity against Cryptococcus neoformans in vitro and in murine models. High dose fluconazole and other medications often used in the management of cryptococcal meningitis (CM) are individually associated with cardiac QTc interval prolongation, raising the concern for potentially life-threatening arrhythmias including torsades de pointes and/or polymeric ventricular tachycardia. Although QTc prolongation is considered a class effect of SSRIs, sertraline at doses of <200mg/day has not been associated with prolonged QTc. We assessed whether the addition of higher doses of sertraline to anti-fungal therapy resulted in QTc interval prolongation.
Medical mycology case reports, 2014
Mortality due to AIDS-related Cryptococcal meningitis (CM) is often >50% in low-middle income ... more Mortality due to AIDS-related Cryptococcal meningitis (CM) is often >50% in low-middle income countries. Dissemination of CM can result in intracranial mass lesions known as cryptococcoma. Patients who develop cryptococcomas often have worse outcomes when compared to patients with cryptococcosis without cryptococcoma. We describe a cryptococcoma in the central nervous system (CNS) in a Ugandan patient with AIDS, and review the diagnosis and management with special focus on difficulties encountered in low or middle-income countries.
Background Cryptococcus is the most common cause of adult meningitis in Africa. We assessed the s... more Background Cryptococcus is the most common cause of adult meningitis in Africa. We assessed the safety and microbiological efficacy of adjunctive sertraline, previously shown to have in-vitro and in-vivo activity against cryptococcus.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2015
Cryptococcus neoformans is the most common cause of adult meningitis in sub-Saharan Africa. The ... more Cryptococcus neoformans is the most common cause of adult meningitis in sub-Saharan Africa. The cryptococcal antigen lateral flow assay (CRAG LFA) has simplified diagnosis as a point-of-care test approved for serum or cerebrospinal fluid (CSF). We evaluated the accuracy of the CRAG LFA using fingerstick whole blood compared with serum/plasma and CSF for diagnosing meningitis. From August 2013 to August 2014, CRAG LFA (Immy, Norman, Oklahoma) tests were performed on fingerstick whole blood, plasma/serum and CSF in 207 HIV-infected adults in Kampala, Uganda with suspected meningitis. Venous blood was also collected and centrifuged to obtain serum and/or plasma. CSF was tested after lumbar puncture. Of 207 participants, 149 (72%) were fingerstick CRAG-positive. There was 100% agreement between fingerstick whole blood and serum/plasma. Of the 149 fingerstick CRAG-positive participants, 138 (93%) had evidence of cryptococcal meningitis with a positive CSF CRAG. Eleven participants (5%...
Sertraline, a selective serotonin reuptake inhibitor (SSRI), has dose-dependent activity against ... more Sertraline, a selective serotonin reuptake inhibitor (SSRI), has dose-dependent activity against Cryptococcus neoformans in vitro and in murine models. High dose fluconazole and other medications often used in the management of cryptococcal meningitis (CM) are individually associated with cardiac QTc interval prolongation, raising the concern for potentially life-threatening arrhythmias including torsades de pointes and/or polymeric ventricular tachycardia. Although QTc prolongation is considered a class effect of SSRIs, sertraline at doses of <200mg/day has not been associated with prolonged QTc. We assessed whether the addition of higher doses of sertraline to anti-fungal therapy resulted in QTc interval prolongation.
Medical mycology case reports, 2014
Mortality due to AIDS-related Cryptococcal meningitis (CM) is often >50% in low-middle income ... more Mortality due to AIDS-related Cryptococcal meningitis (CM) is often >50% in low-middle income countries. Dissemination of CM can result in intracranial mass lesions known as cryptococcoma. Patients who develop cryptococcomas often have worse outcomes when compared to patients with cryptococcosis without cryptococcoma. We describe a cryptococcoma in the central nervous system (CNS) in a Ugandan patient with AIDS, and review the diagnosis and management with special focus on difficulties encountered in low or middle-income countries.