Publications by authors named "M Okirwoth"
Background: In 2022, the World Health Organization (WHO) recommended a single 10mg/kg dose of liposomal amphotericin B in combination with 14 days of flucytosine and fluconazole (AMBITION-cm regimen) for induction therapy of HIV-associated cryptococcal meningitis, based on the results of the multisite AMBITION-cm trial. We evaluated outcomes after real-world implementation of this novel regimen in Uganda.
Methods: We enrolled Ugandan adults with cryptococcal meningitis into an observational cohort receiving the AMBITION-cm regimen with therapeutic lumbar punctures in routine care during 2022-2023.
Article Synopsis
- The IMPROVE trial aims to improve outcomes for adults suffering from HIV-associated cryptococcal meningitis by testing two TPT strategies for preventing tuberculosis (TB).
- The study will enroll 205 participants in Uganda, who will be randomized to receive either early inpatient or standard outpatient initiation of a one-month TB treatment regimen.
- The trial will assess the safety, feasibility, and treatment completion rates, with a focus on gathering data that could enhance TB prevention methods in high-risk populations.
Objectives: CMV viremia is associated with increased mortality in persons with HIV. We previously demonstrated that CMV viremia was a risk factor for 10-week mortality in antiretroviral therapy (ART)-naïve persons with cryptococcal meningitis. We investigated whether similar observations existed over a broader cohort of patients with HIV-associated meningitis at 18 weeks.
View Article and Find Full Text PDFThe epidemiology of infectious causes of meningitis in sub-Saharan Africa is not well understood, and a common cause of meningitis in this region, Mycobacterium tuberculosis (TB), is notoriously hard to diagnose. Here we show that integrating cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) with a host gene expression-based machine learning classifier (MLC) enhances diagnostic accuracy for TB meningitis (TBM) and its mimics. 368 HIV-infected Ugandan adults with subacute meningitis were prospectively enrolled.
View Article and Find Full Text PDFArticle Synopsis
- A new cryptococcal antigen semiquantitative (CrAgSQ) lateral flow assay (LFA) offers rapid results for diagnosing cryptococcal meningitis without needing time-consuming serial dilutions.
- The study compared the CrAgSQ assay's diagnostic performance with existing CrAg LFA in cerebrospinal fluid samples from HIV-associated meningitis patients, showing 100% sensitivity and specificity.
- Higher grades of CrAgSQ correlate with increased fungal culture positivity and disease severity, implying that this test not only identifies infection accurately but also provides insights into the patient's condition.