Atherton Rachel R, Ellis Jayne, Cresswell Fiona V, Rhein Joshua, Boulware David R
Institute of Infectious Diseases, Kampala, Uganda.
Clinical Research Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
Wellcome Open Res. 2018 Oct 12;3:80. doi: 10.12688/wellcomeopenres.14666.2. eCollection 2018.
Cryptococcal meningitis is a leading cause of morbidity and mortality among HIV-infected persons, accounting for 15% of AIDS-related deaths. Visual disturbance is commonly reported, and a wide range of ophthalmic signs may be present on examination. There is limited published literature to date describing the range and incidence of ophthalmic signs in HIV-associated cryptococcal meningitis. Nested within the Adjunctive Sertraline for the Treatment of HIV-Associated Cryptococcal Meningitis (ASTRO-CM) trial (ClinicalTrials.gov number: NCT01802385), we conducted an observational study of 696 Ugandan adults with HIV-associated cryptococcal meningitis. Patients were screened for visual disturbance and external ophthalmic signs at initial presentation and at follow-up appointments over 18 weeks. Assessment comprised simple clinical history and basic examination and required no specialist equipment. More than a quarter of our cohort demonstrated ocular signs or symptoms, which were observed throughout the study period. A broad range of ocular signs were demonstrated: these included neurological signs (10.9%), localized ocular pathology (4.5%), and evidence of concurrent systemic disease (12.9%). The range of signs observed demonstrates the complexities of case management in patients with advanced HIV and cryptococcosis and also the importance of basic ocular examination in low resource settings. There remains an urgent need for studies conducting comprehensive ocular examination in patients with HIV-associated cryptococcal meningitis; these studies should include formal assessment of visual acuity, slit lamp examination and dilated indirect ophthalmoscopy. Prospective studies should investigate whether there is a correlation between reported visual disturbance and objective signs, in order to further clarify the underlying mechanisms and to guide effective diagnosis, follow-up and management.
隐球菌性脑膜炎是艾滋病毒感染者发病和死亡的主要原因，占艾滋病相关死亡人数的15%。视觉障碍是常见的报告症状，检查时可能出现多种眼部体征。迄今为止，关于艾滋病毒相关隐球菌性脑膜炎眼部体征的范围和发生率的已发表文献有限。在辅助性舍曲林治疗艾滋病毒相关隐球菌性脑膜炎（ASTRO-CM）试验（ClinicalTrials.gov编号：NCT01802385）中，我们对696名乌干达成年艾滋病毒相关隐球菌性脑膜炎患者进行了一项观察性研究。在患者初次就诊时以及18周的随访预约中，对其进行视觉障碍和外部眼部体征筛查。评估包括简单的临床病史和基本检查，无需专业设备。我们队列中超过四分之一的患者出现了眼部体征或症状，在整个研究期间均有观察到。出现了广泛的眼部体征：包括神经体征（10.9%）、局部眼部病变（4.5%）以及并发全身性疾病的证据（12.9%）。观察到的体征范围表明了晚期艾滋病毒和隐球菌病患者病例管理的复杂性，也凸显了在资源匮乏地区进行基本眼部检查的重要性。迫切需要对艾滋病毒相关隐球菌性脑膜炎患者进行全面眼部检查的研究；这些研究应包括视力的正式评估、裂隙灯检查和散瞳间接检眼镜检查。前瞻性研究应调查报告的视觉障碍与客观体征之间是否存在关联，以便进一步阐明潜在机制并指导有效的诊断、随访和管理。
