Publications by authors named "Tadeo K Kandole"
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 Visitect CD4 Advanced Disease test is a rapid method to assess CD4 levels in HIV patients, specifically designed to identify patients with counts above or below 200 cells/μL, and was evaluated in Uganda's semi-urban labs.
- In a study involving 1,495 blood samples, the Visitect test showed a high sensitivity of 100% but variable specificity, ranging from 63% to 99%, and a positive predictive value of 69% when compared to a confirmatory CD4 testing method.
- The findings suggest that while the Visitect test is reliable for low CD4 counts, its varying specificity needs to be taken into account based on specific clinic environments and available laboratory support for effective implementation.
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.
Article Synopsis
- The study aimed to understand the significance of cerebrospinal fluid (CSF) lactate levels in diagnosing tuberculosis meningitis (TBM) and its prognosis among HIV-positive adults in Uganda.
- Results showed that higher CSF lactate levels correlate with definite TBM cases, with a threshold of >5.5 mmol/L indicating both good sensitivity and specificity for diagnosis.
- However, while CSF lactate helps in diagnosing TBM, it does not predict 2-week mortality rates for patients.
Background: Several viral, bacterial and fungal co-infections have been associated with increased morbidity and mortality among patients with COVID-19. We report a fatal case of severe COVID-19 pneumonia in a patient with a recent diagnosis of advanced HIV disease complicated by cryptococcal meningitis, disseminated tuberculosis and acute ischemic stroke.
Case Presentation: A 37-year-old Ugandan woman was diagnosed with HIV infection 8 days prior to her referral to our center.
Article 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.
Early antiretroviral therapy (ART) initiation after cryptococcal meningitis increases mortality, and those unmasking cryptococcosis after <2 weeks of ART have higher mortality. However, it is unknown if those presenting as ART experienced are actually adherent to their ART. Unknowingly, restarting ART in persons, who have discontinued ART, may be a fatal iatrogenic error.
View Article and Find Full Text PDFBackground: Individuals with cryptococcal antigenemia are at high risk of developing cryptococcal meningitis if untreated. The progression and timing from asymptomatic infection to cryptococcal meningitis is unclear. We describe a subpopulation of individuals with neurologic symptomatic cryptococcal antigenemia but negative cerebral spinal fluid (CSF) studies.
View Article and Find Full Text PDFCerebrospinal fluid (CSF) culture can determine a quantitative viability of Cryptococcus yeasts; however, culture has a long turnaround-time. The TC20 automated cell counter (Bio-Rad) is a benchtop instrument used to count cells in 30 seconds. In vitro studies suggest trypan blue staining can distinguish between viable and dead cryptococcal yeasts.
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- HIV-associated cryptococcal meningitis is a major health issue in Sub-Saharan Africa and accounts for a significant portion of AIDS deaths, highlighting the need for effective diagnostic tools.
- The study evaluated the StrongStep lateral flow assay for detecting cryptococcal antigens in cerebrospinal fluid and plasma from HIV-positive individuals in Uganda, showing high sensitivity and specificity for CSF but lower specificity for plasma.
- While the assay demonstrated strong performance, the lower specificity in blood samples suggests a higher likelihood of false positives in areas with low prevalence of cryptococcal antigenemia, limiting its utility in those settings.
Background: Quantitative culture is the most common method to determine the fungal burden and sterility of cerebrospinal fluid (CSF) among persons with cryptococcal meningitis. A major drawback of cultures is a long turnaround-time. Recent evidence demonstrates that live and dead Cryptococcus yeasts can be distinguished using trypan blue staining.
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