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2. Recurrence of Symptoms Following Cryptococcal Meningitis: Characterizing a Diagnostic Conundrum With Multiple Etiologies.

Author

Bahr, Nathan, Skipper, Caleb, Huppler-Hullsiek, Kathy, Ssebambulidde, Kenneth, Morawski, Bozena, Engen, Nicole, Nuwagira, Edwin, Quinn, Carson, Ramachandran, Prashanth, Evans, Emily, Lofgren, Sarah, Abassi, Mahsa, Muzoora, Conrad, Meya, David, Rhein, Joshua, Boulware, David, and Wilson, Michael

Subjects
cryptococcal meningitis, cryptococcosis, immune reconstitution inflammatory syndrome, meningitis, relapse, Humans, Meningitis, Cryptococcal, AIDS-Related Opportunistic Infections, HIV Infections, Antifungal Agents, Recurrence
Abstract

BACKGROUND: Cryptococcal meningitis is a common cause of AIDS-related mortality. Although symptom recurrence after initial treatment is common, the etiology is often difficult to decipher. We sought to summarize characteristics, etiologies, and outcomes among persons with second-episode symptomatic recurrence. METHODS: We prospectively enrolled Ugandans with cryptococcal meningitis and obtained patient characteristics, antiretroviral therapy (ART) and cryptococcosis histories, clinical outcomes, and cerebrospinal fluid (CSF) analysis results. We independently adjudicated cases of second-episode meningitis to categorize patients as (1) microbiological relapse, (2) paradoxical immune reconstitution inflammatory syndrome (IRIS), (3) persistent elevated intracranial pressure (ICP) only, or (4) persistent symptoms only, along with controls of primary cryptococcal meningitis. We compared groups with chi-square or Kruskal-Wallis tests as appropriate. RESULTS: 724 participants were included (n = 607 primary episode, 81 relapse, 28 paradoxical IRIS, 2 persistently elevated ICP, 6 persistent symptoms). Participants with culture-positive relapse had lower CD4 (25 cells/μL; IQR: 9-76) and lower CSF white blood cell (WBC; 4 cells/μL; IQR: 4-85) counts than paradoxical IRIS (CD4: 78 cells/μL; IQR: 47-142; WBC: 45 cells/μL; IQR: 8-128). Among those with CSF WBC

Published
2023

6. Cost-effectiveness of single, high-dose, liposomal amphotericin regimen for HIV-associated cryptococcal meningitis in five countries in sub-Saharan Africa: an economic analysis of the AMBITION-cm trial

Author

Goodall, Jack, Lechiile, Kwana, Mawoko, Norah, Mbangiwa, Tshepiso, Milburn, James, Mmipi, Refilwe, Ponatshego, Ponego, Rulaganyang, Ikanyang, Seatla, Kaelo, Siamisang, Keatlaretse, Tlhako, Nametso, Tsholo, Katlego, April, Samantha, Bekiswa, Abulele, Boloko, Linda, Bookholane, Hloni, Crede, Thomas, Davids, Lee-Ann, Goliath, Rene, Hlungulu, Siphokazi, Hoffman, Regina, Kyepa, Henriette, Masina, Noma, Maughan, Deborah, Mnguni, Trevor, Moosa, Sumaiyya, Morar, Tania, Mpalali, Mkanyiseli, Naude, Jonathan, Oliphant, Ida, Singh, Achita, Sayed, Sumaya, Sebesho, Leago, Shey, Muki, Swanepoel, Loraine, Chasweka, Madalitso, Chimang'anga, Wezi, Chimphambano, Tipatseni, Gondwe, Ebbie, Mzinganjira, Henry, Kadzilimbile, Aubrey, Kateta, Steven, Kossam, Evelyn, Kukacha, Christopher, Lipenga, Bright, Ndaferankhande, John, Ndalama, Maureen, Shah, Reya, Singini, Andreas, Stott, Katherine, Zambasa, Agness, Banda, Towera, Chikaonda, Tarsizio, Chitulo, Gladys, Chiwoko, Lorren, Chome, Nelecy, Gwin, Mary, Kachitosi, Timothy, Kamanga, Beauty, Kazembe, Mussah, Kumwenda, Emily, Kumwenda, Masida, Maya, Chimwemwe, Mhango, Wilberforce, Mphande, Chimwemwe, Msumba, Lusungu, Munthali, Tapiwa, Ngoma, Doris, Nicholas, Simon, Simwinga, Lusayo, Stambuli, Anthony, Tegha, Gerald, Zambezi, Janet, Ahimbisibwe, Cynthia, Akampurira, Andrew, Alice, Anamudde, Cresswell, Fiona, Gakuru, Jane, Kagimu, Enock, Kasibante, John, Kiiza, Daniel, Kisembo, John, Kwizera, Richard, Kugonza, Florence, Laker, Eva, Luggya, Tonny, Lule, Andrew, Musubire, Abdu, Muyise, Rhona, Namujju, Carol Olivie, Ndyetukira, Jane Francis, Nsangi, Laura, Okirworth, Michael, Rhein, Joshua, Rutakingirwa, Morris K, Sadiq, Alisat, Ssebambulidde, Kenneth, Tadeo, Kiiza, Tukundane, Asmus, Atwine, Leo, Buzaare, Peter, Collins, Muganzi, Emily, Ninsima, Inyakuwa, Christine, Kariisa, Samson, Mwesigye, James, Nuwamanya, Simpson, Rodgers, Ankunda, Rukundo, Joan, Rwomushana, Irene, Ssemusu, Mike, Stead, Gavin, Boyd, Kathyrn, Gondo, Secrecy, Kufa, Prosper, Makaha, Edward, Moyo, Colombus, Mtisi, Takudzwa, Mudzinga, Shepherd, Mutata, Constantine, Mwarumba, Taddy, Zinyandu, Tawanda, Alanio, Alexandre, Dromer, Francoise, Lortholary, Olivier, Sturny-Leclere, Aude, Griffin, Philippa, Hafeez, Sophia, Loyse, Angela, van Widenfelt, Erik, Lawrence, David S, Muthoga, Charles, Meya, David B, Tugume, Lillian, Williams, Darlisha, Rajasingham, Radha, Boulware, David R, Mwandumba, Henry C, Moyo, Melanie, Dziwani, Eltas N, Maheswaran, Hendramoorthy, Kanyama, Cecilia, Hosseinipour, Mina C, Chawinga, Chimwemwe, Meintjes, Graeme, Schutz, Charlotte, Comins, Kyla, Bango, Funeka, Muzoora, Conrad, Jjunju, Samuel, Nuwagira, Edwin, Mosepele, Mosepele, Leeme, Tshepo, Ndhlovu, Chiratidzo E, Hlupeni, Admire, Shamu, Shepherd, Boyer-Chammard, Timothée, Molloy, Síle F, Youssouf, Nabila, Chen, Tao, Shiri, Tinevimbo, Jaffar, Shabbar, Harrison, Thomas S, Jarvis, Joseph N, and Niessen, Louis W

Published
2022
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7. Cytomegalovirus viremia as a risk factor for mortality in HIV-associated cryptococcal and tuberculous meningitis

Author

Skipper, Caleb P., Hullsiek, Katherine Huppler, Cresswell, Fiona V., Tadeo, Kiiza K., Okirwoth, Michael, Blackstad, Mark, Hernandez-Alvarado, Nelmary, Fernández-Alarcón, Claudia, Walukaga, Stewart, Martyn, Emily, Ellis, Jayne, Ssebambulidde, Kenneth, Tugume, Lillian, Nuwagira, Edwin, Rhein, Joshua, Meya, David B., Boulware, David R., and Schleiss, Mark R.

Published
2022
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9. Diagnostic Prediction Model for Tuberculous Meningitis: An Individual Participant Data Meta-Analysis.

Author

Stadelman-Behar, Anna M., Tiffin, Nicki, Ellis, Jayne, Creswell, Fiona V., Ssebambulidde, Kenneth, Nuwagira, Edwin, Richards, Lauren, Lutje, Vittoria, Hristea, Adriana, Jipa, Raluca Elena, Vidal, José E., Azevedo, Renata G. S., de Almeida, Sérgio Monteiro, Kussen, Gislene Botão, Nogueira, Keite, Souza Gualberto, Felipe Augusto, Metcalf, Tatiana, Heemskerk, Anna Dorothee, Dendane, Tarek, and Khalid, Abidi

Published
2024
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11. Mid–Upper Arm Circumference Is a Strong Predictor of Mortality Among Ugandan Adults With HIV-Associated Cryptococcal Meningitis: A Prospective Cohort Study.

Author

Hale, Gila, Adzemovic, Tessa, Hullsiek, Kathy Huppler, Mulwana, Suzan, Ndyetukira, Jane Francis, Sadiq, Alisat, Kabahubya, Mable, Ayebare, Peruth, Nankungu, Lydia, Namudde, Alice, Namanda, Sylvia, Menya, Grace, Nakitto, Grace, Muzoora, Conrad, Nuwagira, Edwin, Rhein, Joshua, Meya, David B, Boulware, David R, Ellis, Jayne, and Abassi, Mahsa

Subjects
ARM circumference, MORTALITY risk factors, CD4 lymphocyte count, ANTIRETROVIRAL agents, COHORT analysis
Abstract

Background Mortality among adults diagnosed with HIV-associated cryptococcal meningitis remains high (24%–40%). We hypothesized that nutritional state, as measured by mid–upper arm circumference (MUAC), is a potentially modifiable risk factor for mortality. Methods Ugandan adults hospitalized with HIV-associated cryptococcal meningitis had MUAC measurements performed at baseline. We compared MUAC measurements with baseline clinical and demographic variables and investigated associations with survival using Cox regression. Results Of 433 participants enrolled, 41% were female, the median CD4 T-cell count (interquartile range [IQR]) was 15 (6–41) cells/μL, and 37% were antiretroviral therapy naïve. The median MUAC (IQR) was 24 (22–26) cm, the median weight (IQR) was 53 (50–60) kg, and MUAC correlated with weight (Pearson r = 0.6; P <.001). Overall, 46% (200/433) died during the 18-week follow-up. Participants in the lowest MUAC quartile (≤22 cm) had the highest mortality: 39% (46/118) at 2 weeks and 62% (73/118) at 18 weeks. A baseline MUAC ≤22 cm was associated with an 82% increased risk of 18-week mortality as compared with participants with an MUAC >22 cm (unadjusted hazard ratio, 1.82; 95% CI, 1.36–2.42; P <.001). Following adjustment for antiretroviral therapy status, CD4 count, hemoglobin, amphotericin dose, and tuberculosis status, the adjusted hazard ratio was 1.84 (95% CI, 1.27–2.65; P <.001). As a continuous variable, 18-week mortality was reduced by 10% for every 1-cm increase in MUAC. CSF Th17 immune responses were positively associated with MUAC quartile. Conclusions MUAC measurement is a simple bedside tool that can identify adults with HIV-associated cryptococcal meningitis at high risk for mortality for whom an enhanced bundle of care, including nutritional supplementation, should be further investigated. [ABSTRACT FROM AUTHOR]

Published
2024
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14. Utility of Cerebrospinal Fluid Protein Levels as a Potential Predictive Biomarker of Disease Severity in HIV-Associated Cryptococcal Meningitis

Author

Kasibante, John, primary, Irfanullah, Eesha, additional, Wele, Abduljewad, additional, Okafor, Elizabeth, additional, Ssebambulidde, Kenneth, additional, Okurut, Samuel, additional, Kagimu, Enock, additional, Gakuru, Jane, additional, Rutakingirwa, Morris K., additional, Mugabi, Timothy, additional, Nuwagira, Edwin, additional, Jjunju, Samuel, additional, Mpoza, Edward, additional, Tugume, Lillian, additional, Nsangi, Laura, additional, Musibire, Abdu K, additional, Muzoora, Conrad, additional, Rhein, Joshua, additional, Meya, David B., additional, Boulware, David R., additional, and Abassi, Mahsa, additional

Published
2023
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15. Fungal-Bacterial Di-Kingdom Microbial Communities Associated with Chronic Pulmonary Disease

Author

Njovu, Israel Kiiza, primary, Akatuhumuriza, Mary, additional, Mumbere, Brian, additional, Magurusa, Rose, additional, Matovu, Musa, additional, Mugenyi, Jastus Kizito, additional, Ssedyabane, Frank, additional, Nalumaga, Pauline Petra, additional, Kassaza, Kennedy, additional, Nuwagira, Edwin, additional, Bazira, Joel, additional, Kiguli, James Mukasa, additional, Mwesigye, James, additional, Iramiot, Jacob Stanely, additional, Musinguzi, Benson, additional, King, Jason, additional, Ballou, Elizabeth, additional, Ampaire, Lucas, additional, and Itabangi, Herbert, additional

Published
2023
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16. 1490. Predictors of Early Mortality in HIV-associated Tuberculous Meningitis

Author

Kagimu, Enock, primary, Bangdiwala, Ananta, additional, Kasibante, John, additional, Kabahubya, Mable, additional, Gakuru, Jane, additional, Timothy, Mugabi, additional, Namombwe, Suzan, additional, Kimuda, Sarah, additional, Kasozi, Derrick, additional, Rutakingirwa, Morris K, additional, Ssebambulidde, Kenneth, additional, Tugume, Lillian, additional, Nuwagira, Edwin, additional, Okurut, Samuel, additional, Nsangi, Laura, additional, Atukunda, Mucunguzi, additional, Ellis, Jayne P, additional, Williams, Darlisha A, additional, Musubire, Abdu Kisekka, additional, Boulware, David R, additional, Meya, David, additional, Bahr, Nathan C, additional, and Cresswell, Fiona V, additional

Published
2023
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20. Adjunctive sertraline for HIV-associated cryptococcal meningitis: a randomised, placebo-controlled, double-blind phase 3 trial

Author

Rhein, Joshua, Huppler Hullsiek, Kathy, Tugume, Lillian, Nuwagira, Edwin, Mpoza, Edward, Evans, Emily E, Kiggundu, Reuben, Pastick, Katelyn A, Ssebambulidde, Kenneth, Akampurira, Andrew, Williams, Darlisha A, Bangdiwala, Ananta S, Abassi, Mahsa, Musubire, Abdu K, Nicol, Melanie R, Muzoora, Conrad, Meya, David B, Boulware, David R, Ndyetukira, Jane Francis, Ahimbisibwe, Cynthia, Kugonza, Florence, Namuju, Carolyne, Sadiq, Alisat, Namudde, Alice, Mwesigye, James, Tadeo, Kiiza K, Kirumira, Paul, Okirwoth, Michael, Luggya, Tonny, Kaboggoza, Julian, Laker, Eva, Atwine, Leo, Muganzi, Davis, Walukaga, Stewart, Jawed, Bilal, Merry, Matthew, Stadelman, Anna, Stephens, Nicole, Flynn, Andrew G, Fujita, Ayako W, Kwizera, Richard, Mukaremera, Liliane, Lofgren, Sarah M, Cresswell, Fiona V, Morawski, Bozena M, Bahr, Nathan C, and Nielsen, Kirsten

Published
2019
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21. Death after cure: Mortality among pulmonary tuberculosis survivors in rural Uganda

Author

Baluku, Joseph Baruch, Namanda, Brenda, Namiiro, Sharon, Rwabwera, Diana Karungi, Mwesigwa, Gloria, Namaara, Catherine, Twinomugisha, Bright, Nyirazihawe, Isabella, Nuwagira, Edwin, Kansiime, Grace, Kizito, Enock, Nabukenya-Mudiope, Mary G., Sekadde, Moorine Penninah, Bongomin, Felix, Senfuka, Joshua, Olum, Ronald, Byaruhanga, Aggrey, Munabi, Ian, and Kiguli, Sarah

Published
2024
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22. Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: a prospective cohort study

Author

Williams, Darlisha A, Taseera, Kabanda, Nyehangane, Dan, Ivan, Mugisha, Orikiriza, Patrick, Rhein, Joshua, Hullsiek, Kathy Huppler, Musubire, Abdu, Pastick, Katelyn, Nabeta, Pamela, Mwesigye, James, Rajasingham, Radha, Bahr, Nathan C, Nuwagira, Edwin, Evans, Emily E, Cresswell, Fiona V, Bystrom, Philip V, Byamukama, Adolf, Bridge, Sarah C, Bangdiwala, Ananta S, Meya, David B, Denkinger, Claudia M, Muzoora, Conrad, and Boulware, David R

Published
2018
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24. Thirty-Day Outcomes of Young and Middle-Aged Adults Admitted with Severe COVID-19 in Uganda: A Retrospective Cohort Study

Author

Kyagambiddwa, Tonny, primary, Kintu, Timothy Mwanje, additional, Miiro, Emmanuel, additional, Nabalamba, Franchesca, additional, Asiimwe, Gloria Suubi, additional, Namutebi, Anne Marion, additional, Abeya, Fardous C, additional, Lumori, Boniface A, additional, Ijuka, Isaac, additional, Muhindo, Rose K, additional, Mutekanga, Andrew, additional, Musinguzi, Richard, additional, Natuhwera, Francis, additional, Ngonzi, Joseph, additional, and Nuwagira, Edwin, additional

Published
2023
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28. “If you have light, your heart will be at peace”: A qualitative study of household lighting and social integration in southwestern Uganda

Author

Ponticiello, Matthew, primary, Nuwagira, Edwin, additional, Tayebwa, Mellon, additional, Mugerwa, Joseph, additional, Nahabwe, Hellen, additional, Nakasita, Catherine, additional, Tumuhimbise, John Bosco, additional, Lam, Nicholas L, additional, Wiens, Matthew O, additional, Vallarino, Jose, additional, Allen, Joseph G, additional, Muyanja, Daniel, additional, Tsai, Alexander C, additional, Sundararajan, Radhika, additional, and Lai, Peggy S, additional

Published
2023
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29. Adherence of health workers to guidelines for screening and management of cryptococcal meningitis in Uganda

Author

Namuju, Olivie C., primary, Namuwenge, Proscovia M., additional, Kwizera, Richard, additional, Obuya, Emmanuel, additional, Kirumira, Paul, additional, Naluyima, Rose, additional, Ahimbisibwe, Cynthia, additional, Ndyetukira, JaneFrancis, additional, Nakato, Hawa, additional, Kirungi, Robert, additional, Gakuru, Jane, additional, Junju, Samuel, additional, Nuwagira, Edwin, additional, Rutakagirwa, Morris, additional, Nsibirwa, Sara, additional, Nabitaka, Vennie, additional, Nalintya, Elizabeth, additional, Mpoza, Edward, additional, Muzoora, Conrad K., additional, Musubire, Abdu K., additional, Boulware, David R., additional, and Meya, David B., additional

Published
2023
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30. Investigating Metabolic and Molecular Ecological Evolution of Opportunistic Pulmonary Fungal Coinfections: Protocol for a Laboratory-Based Cross-Sectional Study (Preprint)

Author

Njovu, Israel Kiiza, primary, Nalumaga, Pauline Petra, additional, Ampaire, Lucas, additional, Nuwagira, Edwin, additional, Mwesigye, James, additional, Musinguzi, Benson, additional, Kassaza, Kennedy, additional, Taseera, Kabanda, additional, Kiguli Mukasa, James, additional, Bazira, Joel, additional, Iramiot, Jacob Stanley, additional, Baguma, Andrew, additional, Bongomin, Felix, additional, Kwizera, Richard, additional, Achan, Beatrice, additional, Cox, Michael J, additional, King, Jason S, additional, May, Robin, additional, Ballou, Elizabeth R, additional, and Itabangi, Herbert, additional

Published
2023
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31. Investigating metabolic and molecular ecological evolution of opportunistic pulmonary fungal co-infections, a project protocol (Preprint)

Author

Njovu, Israel Kizza, primary, Nalumaga, Pauline Petra, additional, Ampaire, Lucas, additional, Nuwagira, Edwin, additional, Musinguzi, Benson, additional, Kassaza, Kennedy, additional, Kiguli, James Mukasa, additional, Bazira, Joel, additional, Mwesigye, James, additional, Iramiot, Jacob Stanley, additional, Baguma, Andrew, additional, Kabanda, Tasera, additional, Bongomin, Felix, additional, Kwizera, Richard, additional, Achan, Beatrice, additional, Cox, Mike. J., additional, King, Jason, additional, May, Robin.C., additional, Ballou, Elizabeth, additional, and Itabangi, Herbert, additional

Published
2023
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33. Thirty-Day Outcomes of Young and Middle-Aged Adults Admitted with Severe COVID-19 in Uganda: A Retrospective Cohort Study

Author

Kyagambiddwa,Tonny, Kintu,Timothy Mwanje, Miiro,Emmanuel, Nabalamba,Franchesca, Asiimwe,Gloria Suubi, Namutebi,Anne Marion, Abeya,Fardous C, Lumori,Boniface A, Ijuka,Isaac, Muhindo,Rose K, Mutekanga,Andrew, Musinguzi,Richard, Natuhwera,Francis, Ngonzi,Joseph, Nuwagira,Edwin, Kyagambiddwa,Tonny, Kintu,Timothy Mwanje, Miiro,Emmanuel, Nabalamba,Franchesca, Asiimwe,Gloria Suubi, Namutebi,Anne Marion, Abeya,Fardous C, Lumori,Boniface A, Ijuka,Isaac, Muhindo,Rose K, Mutekanga,Andrew, Musinguzi,Richard, Natuhwera,Francis, Ngonzi,Joseph, and Nuwagira,Edwin

Abstract

Tonny Kyagambiddwa,1,&ast; Timothy Mwanje Kintu,1,&ast; Emmanuel Miiro,1,&ast; Franchesca Nabalamba,1 Gloria Suubi Asiimwe,1 Anne Marion Namutebi,2 Fardous C Abeya,3 Boniface A Lumori,3 Isaac Ijuka,4 Rose K Muhindo,1,3 Andrew Mutekanga,1,3 Richard Musinguzi,5 Francis Natuhwera,6 Joseph Ngonzi,1,7 Edwin Nuwagira3,8 1Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 2Kabale Regional Referral Hospital, Kabale, Uganda; 3Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 4Mayanja Memorial Hospital, Mbarara, Uganda; 5Masaka Regional Referral Hospital, Masaka, Uganda; 6Fort Portal Regional Referral Hospital, Fort Portal, Uganda; 7Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda; 8Tuberculosis Treatment Unit, Mbarara Regional Referral Hospital, Mbarara, Uganda&ast;These authors contributed equally to this workCorrespondence: Tonny Kyagambiddwa; Edwin Nuwagira, Mbarara University of Science and Technology, Tel +256782980116 ; +256779096887, Email tonnykyagambiddwa97@gmail.com; enuwagira@must.ac.ugBackground: There is scarcity of data regarding young and middle-aged adults hospitalized with severe Corona Virus Disease 2019 (COVID-19) in Africa. In this study, we describe the clinical characteristics and 30-day survival among adults aged 18 to 49 years admitted with severe COVID-19 in Uganda.Methods: We reviewed treatment records of patients admitted with severe COVID-19 across five COVID-19 treatment units (CTU) in Uganda. We included individuals aged 18 to 49 years, who had a positive test or met the clinical criteria for COVID-19. We defined severe COVID-19 as having an oxygen saturation < 94%, lung infiltrates > 50% on imaging and presence of a co-morbidity that required admission in the CTU. Our main outcome was the 30-day survival from the time of admission. We used a Cox proportional hazards model to determine the factors asso

Published
2023

35. Sterile Cerebrospinal Fluid Culture at Cryptococcal Meningitis Diagnosis Is Associated with High Mortality

Author

Skipper, Caleb P, primary, Hullsiek, Katherine Huppler, additional, Stadelman, Anna, additional, Williams, Darlisha A, additional, Ssebambulidde, Kenneth, additional, Okafor, Elizabeth, additional, Tugume, Lillian, additional, Nuwagira, Edwin, additional, Akampurira, Andrew, additional, Musubire, Abdu K, additional, Abassi, Mahsa, additional, Muzoora, Conrad, additional, Rhein, Joshua, additional, Boulware, David R, additional, and Meya, David B, additional

Published
2022
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36. Factors Associated with 30-Day in-Hospital Mortality Among Patients Admitted with Severe Covid-19 in Mbarara Regional Referral Hospital

Author

Mutekanga, Andrew, primary, Nuwagira, Edwin, additional, Kumbakumba, Elias, additional, Nyaiteera, Victoria, additional, Asiimwe, Stephen, additional, Gasumuni, Medal, additional, Wandera, Nelson, additional, Natumanya, Robert, additional, Akena, Denis, additional, Senoga, Siraje, additional, Kyobe Kiwanuka, Joseph, additional, Kateregga, George, additional, Munyarugero, Emmanuel, additional, Abeya, Fardous Charles, additional, Obwoya, Paul Stephen, additional, Ttendo, Stephen, additional, and Muhindo, Rose, additional

Published
2022
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37. Cost-effectiveness of single, high-dose, liposomal amphotericin regimen for HIV-associated cryptococcal meningitis in five countries in sub-Saharan Africa: an economic analysis of the AMBITION-cm trial

Author

Lawrence, David S, primary, Muthoga, Charles, additional, Meya, David B, additional, Tugume, Lillian, additional, Williams, Darlisha, additional, Rajasingham, Radha, additional, Boulware, David R, additional, Mwandumba, Henry C, additional, Moyo, Melanie, additional, Dziwani, Eltas N, additional, Maheswaran, Hendramoorthy, additional, Kanyama, Cecilia, additional, Hosseinipour, Mina C, additional, Chawinga, Chimwemwe, additional, Meintjes, Graeme, additional, Schutz, Charlotte, additional, Comins, Kyla, additional, Bango, Funeka, additional, Muzoora, Conrad, additional, Jjunju, Samuel, additional, Nuwagira, Edwin, additional, Mosepele, Mosepele, additional, Leeme, Tshepo, additional, Ndhlovu, Chiratidzo E, additional, Hlupeni, Admire, additional, Shamu, Shepherd, additional, Boyer-Chammard, Timothée, additional, Molloy, Síle F, additional, Youssouf, Nabila, additional, Chen, Tao, additional, Shiri, Tinevimbo, additional, Jaffar, Shabbar, additional, Harrison, Thomas S, additional, Jarvis, Joseph N, additional, Niessen, Louis W, additional, Goodall, Jack, additional, Lechiile, Kwana, additional, Mawoko, Norah, additional, Mbangiwa, Tshepiso, additional, Milburn, James, additional, Mmipi, Refilwe, additional, Ponatshego, Ponego, additional, Rulaganyang, Ikanyang, additional, Seatla, Kaelo, additional, Siamisang, Keatlaretse, additional, Tlhako, Nametso, additional, Tsholo, Katlego, additional, April, Samantha, additional, Bekiswa, Abulele, additional, Boloko, Linda, additional, Bookholane, Hloni, additional, Crede, Thomas, additional, Davids, Lee-Ann, additional, Goliath, Rene, additional, Hlungulu, Siphokazi, additional, Hoffman, Regina, additional, Kyepa, Henriette, additional, Masina, Noma, additional, Maughan, Deborah, additional, Mnguni, Trevor, additional, Moosa, Sumaiyya, additional, Morar, Tania, additional, Mpalali, Mkanyiseli, additional, Naude, Jonathan, additional, Oliphant, Ida, additional, Singh, Achita, additional, Sayed, Sumaya, additional, Sebesho, Leago, additional, Shey, Muki, additional, Swanepoel, Loraine, additional, Chasweka, Madalitso, additional, Chimang'anga, Wezi, additional, Chimphambano, Tipatseni, additional, Gondwe, Ebbie, additional, Mzinganjira, Henry, additional, Kadzilimbile, Aubrey, additional, Kateta, Steven, additional, Kossam, Evelyn, additional, Kukacha, Christopher, additional, Lipenga, Bright, additional, Ndaferankhande, John, additional, Ndalama, Maureen, additional, Shah, Reya, additional, Singini, Andreas, additional, Stott, Katherine, additional, Zambasa, Agness, additional, Banda, Towera, additional, Chikaonda, Tarsizio, additional, Chitulo, Gladys, additional, Chiwoko, Lorren, additional, Chome, Nelecy, additional, Gwin, Mary, additional, Kachitosi, Timothy, additional, Kamanga, Beauty, additional, Kazembe, Mussah, additional, Kumwenda, Emily, additional, Kumwenda, Masida, additional, Maya, Chimwemwe, additional, Mhango, Wilberforce, additional, Mphande, Chimwemwe, additional, Msumba, Lusungu, additional, Munthali, Tapiwa, additional, Ngoma, Doris, additional, Nicholas, Simon, additional, Simwinga, Lusayo, additional, Stambuli, Anthony, additional, Tegha, Gerald, additional, Zambezi, Janet, additional, Ahimbisibwe, Cynthia, additional, Akampurira, Andrew, additional, Alice, Anamudde, additional, Cresswell, Fiona, additional, Gakuru, Jane, additional, Kagimu, Enock, additional, Kasibante, John, additional, Kiiza, Daniel, additional, Kisembo, John, additional, Kwizera, Richard, additional, Kugonza, Florence, additional, Laker, Eva, additional, Luggya, Tonny, additional, Lule, Andrew, additional, Musubire, Abdu, additional, Muyise, Rhona, additional, Namujju, Carol Olivie, additional, Ndyetukira, Jane Francis, additional, Nsangi, Laura, additional, Okirworth, Michael, additional, Rhein, Joshua, additional, Rutakingirwa, Morris K, additional, Sadiq, Alisat, additional, Ssebambulidde, Kenneth, additional, Tadeo, Kiiza, additional, Tukundane, Asmus, additional, Atwine, Leo, additional, Buzaare, Peter, additional, Collins, Muganzi, additional, Emily, Ninsima, additional, Inyakuwa, Christine, additional, Kariisa, Samson, additional, Mwesigye, James, additional, Nuwamanya, Simpson, additional, Rodgers, Ankunda, additional, Rukundo, Joan, additional, Rwomushana, Irene, additional, Ssemusu, Mike, additional, Stead, Gavin, additional, Boyd, Kathyrn, additional, Gondo, Secrecy, additional, Kufa, Prosper, additional, Makaha, Edward, additional, Moyo, Colombus, additional, Mtisi, Takudzwa, additional, Mudzinga, Shepherd, additional, Mutata, Constantine, additional, Mwarumba, Taddy, additional, Zinyandu, Tawanda, additional, Alanio, Alexandre, additional, Dromer, Francoise, additional, Lortholary, Olivier, additional, Sturny-Leclere, Aude, additional, Griffin, Philippa, additional, Hafeez, Sophia, additional, Loyse, Angela, additional, and van Widenfelt, Erik, additional

Published
2022
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38. Recurrence of Symptoms Following Cryptococcal Meningitis: Characterizing a Diagnostic Conundrum With Multiple Etiologies

Author

Bahr, Nathan C, primary, Skipper, Caleb P, additional, Huppler-Hullsiek, Kathy, additional, Ssebambulidde, Kenneth, additional, Morawski, Bozena M, additional, Engen, Nicole W, additional, Nuwagira, Edwin, additional, Quinn, Carson M, additional, Ramachandran, Prashanth S, additional, Evans, Emily E, additional, Lofgren, Sarah M, additional, Abassi, Mahsa, additional, Muzoora, Conrad, additional, Wilson, Michael R, additional, Meya, David B, additional, Rhein, Joshua, additional, and Boulware, David R, additional

Published
2022
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39. Prevalence of Intestinal Helminth Coinfection in Drug-Resistant Tuberculosis in Uganda

Author

Baluku, Joseph Baruch, primary, Nakazibwe, Bridget, additional, Wasswa, Amir, additional, Naloka, Joshua, additional, Ntambi, Samuel, additional, Waiswa, Damalie, additional, Okwir, Mark, additional, Nabwana, Martin, additional, Bongomin, Felix, additional, Katuramu, Richard, additional, Nuwagira, Edwin, additional, Ntabadde, Kauthrah, additional, Katongole, Paul, additional, Senyimba, Catherine, additional, and Andia-Biraro, Irene, additional

Published
2022
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41. Diagnostic and Prognostic Value of Cerebrospinal Fluid Lactate and Glucose in HIV-Associated Tuberculosis Meningitis

Author

Nuwagira, Edwin, primary, Huppler Hullsiek, Kathy, additional, Jjunju, Samuel, additional, Rutakingirwa, Morris, additional, Kasibante, John, additional, Tadeo, Kiiza Kandole, additional, Kagimu, Enock, additional, Tugume, Lillian, additional, Ssebambulidde, Kenneth, additional, Musubire, Abdu K., additional, Bangdiwala, Ananta, additional, Muzoora, Conrad, additional, Meya, David B., additional, Boulware, David R., additional, Bahr, Nathan C., additional, and Creswell, Fiona V., additional

Published
2022
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43. Therapeutic Lumbar Punctures in Human Immunodeficiency Virus–Associated Cryptococcal Meningitis: Should Opening Pressure Direct Management?

Author

Kagimu, Enock, primary, Engen, Nicole, additional, Ssebambulidde, Kenneth, additional, Kasibante, John, additional, Kiiza, Tadeo K, additional, Mpoza, Edward, additional, Tugume, Lillian, additional, Nuwagira, Edwin, additional, Nsangi, Laura, additional, Williams, Darlisha A, additional, Hullsiek, Kathy Huppler, additional, Boulware, David R, additional, Meya, David B, additional, Rhein, Joshua, additional, Abassi, Mahsa, additional, and Musubire, Abdu K, additional

Published
2022
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45. Association of Hyponatremia on Mortality in Cryptococcal Meningitis: A Prospective Cohort

Author

Tugume, Lillian, Fieberg, Ann, Ssebambulidde, Kenneth, Nuwagira, Edwin, Williams, Darlisha A, Mpoza, Edward, Rutakingirwa, Morris K, Kagimu, Enoch, Kasibante, John, Nsangi, Laura, Jjunju, Samuel, Musubire, Abdu K, Muzoora, Conrad, Lawrence, David S, Rhein, Joshua, Meya, David B, Hullsiek, Kathy Huppler, Boulware, David R, Abassi, Mahsa, and Adjunctive Sertraline for HIV-Associated Cryptococcal Meningitis

Abstract

BACKGROUND: Sodium abnormalities are frequent in central nervous system infections and may be caused by cerebral salt wasting, syndrome of inappropriate antidiuretic hormone secretion, or medication adverse events. In cryptococcal meningitis (CM), the prevalence of baseline hyponatremia and whether hyponatremia adversely impacts survival is unknown. METHODS: We conducted a secondary analysis of data from 2 randomized trials of human immunodeficiency virus-infected adult Ugandans with CM. We grouped serum sodium into 3 categories

Published
2022

46. Outpatient Cryptococcal Antigen Screening Is Associated With Favorable Baseline Characteristics and Improved Survival in Persons With Cryptococcal Meningitis in Uganda

Author

Levin, Anna E, primary, Bangdiwala, Ananta S, additional, Nalintya, Elizabeth, additional, Kagimu, Enock, additional, Kasibante, John, additional, Rutakingirwa, Morris K, additional, Mpoza, Edward, additional, Jjunju, Samuel, additional, Nuwagira, Edwin, additional, Naluyima, Rose, additional, Kirumira, Paul, additional, Hou, Cody, additional, Ssebambulidde, Kenneth, additional, Musubire, Abdu K, additional, Williams, Darlisha A, additional, Abassi, Mahsa, additional, Muzoora, Conrad, additional, Hullsiek, Katherine H, additional, Rajasingham, Radha, additional, Meya, David B, additional, Boulware, David R, additional, and Skipper, Caleb P, additional

Published
2022
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47. Early empiric anti-Mycobacterium tuberculosis therapy for sepsis in sub-Saharan Africa: a protocol of a randomised clinical trial

Author

Said, Bibie, primary, Nuwagira, Edwin, additional, Liyoyo, Alphonce, additional, Arinaitwe, Rinah, additional, Gitige, Catherine, additional, Mushagara, Rhina, additional, Buzaare, Peter, additional, Chongolo, Anna, additional, Jjunju, Samuel, additional, Twesigye, Precious, additional, Boulware, David R, additional, Conaway, Mark, additional, Null, Megan, additional, Thomas, Tania A, additional, Heysell, Scott K, additional, Moore, Christopher C, additional, Muzoora, Conrad, additional, and Mpagama, Stellah G, additional

Published
2022
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48. Single-Dose Liposomal Amphotericin B Treatment for Cryptococcal Meningitis

Author

Jarvis, Joseph N, Lawrence, David S, Meya, David B, Kagimu, Enock, Kasibante, John, Mpoza, Edward, Rutakingirwa, Morris K, Ssebambulidde, Kenneth, Tugume, Lillian, Rhein, Joshua, Boulware, David R, Mwandumba, Henry C, Moyo, Melanie, Mzinganjira, Henry, Kanyama, Cecilia, Hosseinipour, Mina C, Chawinga, Chimwemwe, Meintjes, Graeme, Schutz, Charlotte, Comins, Kyla, Singh, Achita, Muzoora, Conrad, Jjunju, Samuel, Nuwagira, Edwin, Mosepele, Mosepele, Leeme, Tshepo, Siamisang, Keatlaretse, Ndhlovu, Chiratidzo E, Hlupeni, Admire, Mutata, Constantine, van Widenfelt, Erik, Chen, Tao, Wang, Duolao, Hope, William, Boyer-Chammard, Timothée, Loyse, Angela, Molloy, Síle F, Youssouf, Nabila, Lortholary, Olivier, Lalloo, David G, Jaffar, Shabbar, Harrison, Thomas S, Ambition Study Group, London School of Hygiene and Tropical Medicine (LSHTM), Bostwana Harvard AIDS Institute Partneship Gaborone, National Center for Atmospheric Research [Boulder] (NCAR), University of North Carolina Project-Malawi (UNC Project), University of North Carolina [Chapel Hill] (UNC), University of North Carolina System (UNC), University of Cape Town, Mycologie moléculaire - Molecular Mycology, Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPC), Centre National de Référence Mycoses Invasives et Antifongiques - National Reference Center Invasive Mycoses & Antifungals (CNRMA), Institut Pasteur [Paris]-Université Paris Cité (UPC), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Supported by a grant (TRIA2015-1092) through the European and Developing Countries Clinical Trials Partnership, with assistance from the Swedish International Development Cooperation Agency, as well as by funding from the U.K. Department of Health and Social Care, the U.K. Foreign Commonwealth and Development Office, the U.K. Medical Research Council, and Wellcome Trust, through the Joint Global Health Trials scheme (MR/P006922/1). Funding was also provided by the National Institute for Health Research (NIHR) through a Global Health Research Professorship (RP-2017-08-ST2-012, to Dr. Jarvis) with aid from the U.K. government to support global health research. Dr. Meintjes was supported by grants (098316, 214321/Z/18/Z, and 203135/Z/16/Z) from the Wellcome Trust and a grant (64787) from the South African Research Chairs Initiative of the Department of Science and Technology and the National Research Foundation of South Africa. Diagnostic testing in Uganda was supported by a grant (R01NS086312) from the National Institute of Neurological Disorders and Stroke. Dr. Rhein was supported by a grant (K01 TW010268) from the Fogarty International Center. Liposomal amphotericin B (AmBisome) was donated by Gilead Sciences., We thank the trial participants and their families and caregivers, as well as all the clinical, laboratory, and administrative staff at all the sites who were not directly involved in the trial, Andrew Nunn, Sayoki Mfinanga, Robert Peck, and William Powderly for serving on the data and safety monitoring committee, and John Perfect, Andrew Kambugu, Saidi Kapigi, and Douglas Wilson for serving on the trial steering committee. We dedicate the trial to the memory of Siphokazi Hlungulu, who worked as a research nurse and study coordinator for the Cape Town Ambition site for the duration of the trial and died before seeing the results published., Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), and Institut Pasteur [Paris] (IP)-Université Paris Cité (UPCité)

Subjects
wl_200, qv_350, General Medicine, [SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology, wc_245
Abstract

BackgroundCryptococcal meningitis is a leading cause of human immunodeficiency virus (HIV)-related death in sub-Saharan Africa. Whether a treatment regimen that includes a single high dose of liposomal amphotericin B would be efficacious is not known.MethodsIn this phase 3 randomized, controlled, noninferiority trial conducted in five African countries, we assigned HIV-positive adults with cryptococcal meningitis in a 1:1 ratio to receive either a single high dose of liposomal amphotericin B (10 mg per kilogram of body weight) on day 1 plus 14 days of flucytosine (100 mg per kilogram per day) and fluconazole (1200 mg per day) or the current World Health Organization-recommended treatment, which includes amphotericin B deoxycholate (1 mg per kilogram per day) plus flucytosine (100 mg per kilogram per day) for 7 days, followed by fluconazole (1200 mg per day) for 7 days (control). The primary end point was death from any cause at 10 weeks; the trial was powered to show noninferiority at a 10-percentage-point margin.ResultsA total of 844 participants underwent randomization; 814 were included in the intention-to-treat population. At 10 weeks, deaths were reported in 101 participants (24.8%; 95% confidence interval [CI], 20.7 to 29.3) in the liposomal amphotericin B group and 117 (28.7%; 95% CI, 24.4 to 33.4) in the control group (difference, -3.9 percentage points); the upper boundary of the one-sided 95% confidence interval was 1.2 percentage points (within the noninferiority margin; P10 colony-forming units (CFU) per milliliter per day in the liposomal amphotericin B group and -0.42 log10 CFU per milliliter per day in the control group. Fewer participants had grade 3 or 4 adverse events in the liposomal amphotericin B group than in the control group (50.0% vs. 62.3%).ConclusionsSingle-dose liposomal amphotericin B combined with flucytosine and fluconazole was noninferior to the WHO-recommended treatment for HIV-associated cryptococcal meningitis and was associated with fewer adverse events. (Funded by the European and Developing Countries Clinical Trials Partnership and others; Ambition ISRCTN number, ISRCTN72509687.).

Published
2022

49. Factors Associated with 30-Day in-Hospital Mortality Among Patients Admitted with Severe Covid-19 in Mbarara Regional Referral Hospital

Author

Mutekanga,Andrew, Nuwagira,Edwin, Kumbakumba,Elias, Nyaiteera,Victoria, Asiimwe,Stephen, Gasumuni,Medal, Wandera,Nelson, Natumanya,Robert, Akena,Denis, Senoga,Siraje, Kyobe Kiwanuka,Joseph, Kateregga,George, Munyarugero,Emmanuel, Abeya,Fardous Charles, Obwoya,Paul Stephen, Ttendo,Stephen, Muhindo,Rose, Mutekanga,Andrew, Nuwagira,Edwin, Kumbakumba,Elias, Nyaiteera,Victoria, Asiimwe,Stephen, Gasumuni,Medal, Wandera,Nelson, Natumanya,Robert, Akena,Denis, Senoga,Siraje, Kyobe Kiwanuka,Joseph, Kateregga,George, Munyarugero,Emmanuel, Abeya,Fardous Charles, Obwoya,Paul Stephen, Ttendo,Stephen, and Muhindo,Rose

Abstract

Andrew Mutekanga,1,&ast; Edwin Nuwagira,1,&ast; Elias Kumbakumba,2 Victoria Nyaiteera,3 Stephen Asiimwe,4 Medal Gasumuni,5 Nelson Wandera,5 Robert Natumanya,5 Denis Akena,5 Siraje Senoga,1 Joseph Kyobe Kiwanuka,6 George Kateregga,6 Emmanuel Munyarugero,6 Fardous Charles Abeya,1 Paul Stephen Obwoya,1 Stephen Ttendo,6 Rose Muhindo1,&ast; 1Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 2Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda; 3Department of ENT, Mbarara University of Science and Technology, Mbarara, Uganda; 4Global Health Collaborative, Massachusetts General Hospital, Boston, MA, USA; 5Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda; 6Department of Anesthesiology and Critical Care, Mbarara University of Science and Technology, Mbarara, Uganda&ast;These authors contributed equally to this workCorrespondence: Rose Muhindo, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda, Tel +256772406337, Email rosie@must.ac.ugBackground: COVID-19 has created a burden on the healthcare system globally. Severe COVID-19 is linked with high hospital mortality. Data regarding 30-day in-hospital mortality and its factors has not been explored in southwestern Uganda.Methods: We carried out a retrospective, single-center cohort study, and included all in-patients with laboratory-confirmed, radiological, or clinical severe COVID-19 admitted between April 2020 and September 2021 at Mbarara Regional Referral Hospital (MRRH). Demographic, laboratory, treatment, and clinical outcome data were extracted from patients’ files. These data were described comparing survivors and non-survivors. We used logistic regression to explore the factors associated with 30-day in-hospital mortality.Results: Of the 283 patients with severe COVID-19 admitted at MRRH COVID-19 unit, 58.1% were male. The mean age ± standard deviation (SD) wa

Published
2022

50. Early culture conversion is a poor marker of treatment outcome among people with HIV and drug‐resistant TB.

Author

Baluku, Joseph Baruch, Nabwana, Martin, Mwanahamisi, Suleiman Bwika, Kansiime, Grace, Nuwagira, Edwin, Turyahabwe, Stavia, and Kirenga, Bruce

Subjects
CULTURE, HIV-positive persons, CONFIDENCE intervals, SPUTUM, DRUG resistance, RETROSPECTIVE studies, TREATMENT effectiveness, HIGHLY active antiretroviral therapy, TUBERCULOSIS, ODDS ratio
Abstract

Objective: Our objective was to determine associations between early (≤2 months) culture conversion (ECC) among people with HIV and drug‐resistant tuberculosis (DRTB) in Uganda. Methods: This was a countrywide retrospective cohort of people with bacteriologically confirmed DRTB and a positive baseline culture at 16 centres in Uganda between 2013 and 2019. Data were abstracted from treatment files and unit DRTB registers. Monthly sputum cultures were performed using the Lowenstein–Jensen solid medium. Results: We included 664 people with DRTB and a positive baseline culture, of whom 353 (53.4%) also had HIV. Among those living with HIV, 225 (63.7%) were male and 331 (94.3%) were on antiretroviral therapy. The median month of culture conversion was 2 (interquartile range [IQR] 1–3). ECC was observed among 226 people living with HIV (64.0%; 95% confidence interval [CI] 58.9–68.9). A DRTB treatment regimen of six or more drugs was associated with ECC among people living with HIV (adjusted odds ratio [aOR] 3.82; 95% CI 1.06–13.82; p = 0.041). Cure and overall treatment success was observed among 232 (65.7%) and 269 (76.2%) people living with HIV, respectively. However, ECC was not associated with cure (crude odds ratio [OR] 0.97; 95% CI 0.61–1.54; p = 0.901), death (OR 1.12; 95% CI 0.61–2.29; p = 0.610), or overall treatment success (OR 1.29; 95% CI 0.78–2.13; p = 0.326). Conclusion: The majority of people living with HIV and DRTB achieve ECC. However, ECC does not predict cure, death, or treatment success. Moreover, it may require six or more drugs to achieve ECC. ECC is not an excellent indicator of the effectiveness of DRTB regimens among people living with HIV. [ABSTRACT FROM AUTHOR]

Published
2023
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