Table 1.
Observed cases of HIV-related cryptococcal meningitis in pregnancy in Uganda from 2012 to 2018.
| No. | Disease severity | Treatment* | Duration of symptoms (days) | EGA (weeks) | Age | Recent CD4+ count (cells/μl) | ART status | Outcome of mother | Outcome of baby |
|---|---|---|---|---|---|---|---|---|---|
| 1 | 430,000 cfu/ml in CSF | Amphotericin B: 14 doses, followed by 7 additional weekly outpatient dosesFluconazole: 800 mg for 9 days during 1st trimester, 200 mg fluconazole during 3rd trimester | 14 | 6 | 18 | 7 | ART defaulter | Alive | No abnormalities, alive; HIV- |
| 2 | Amphotericin B: 17 doses prior to screening at nearby facility, 14 doses after repeated high growth | 4 | N/A | 23 | 34 | ART experienced, (TDF/3TC/EFV), 10 weeks prior | Alive at discharge | Miscarriage day 1 into treatment | |
| 3 | 1100 cfu/ml in CSF (CSF CrAg titers 1:4000) | Amphotericin B: unknown number of dosesFluconazole: 800 mg for 3 days in 2nd trimester (EGA 14 weeks), 400 mg/day at hospital discharge (2nd trimester, EGA 16 weeks) | 14 | 14 | 35 | 19 | ART naive | Alive at discharge | Unknown |
| 4 | 14,200 cfu/ml in CSF (CSF CrAg titers 1:700) | Amphotericin B: 14 doses, followed by weekly outpatient amphotericin B | 14 | 7 | 24 | 7 | ART naive | Alive at discharge | Miscarriage at ∼12 weeks EGA, confirmed by ultrasound |
| 5 | 141,000 cfu/ml in CSF | Amphotericin B: 14 doses, followed by weekly outpatient amphotericinFluconazole: 200 mg/day 3rd trimester | 21 | 16, twin gestation | 32 | 33 | ART naive | Alive | Twin babies without abnormalities, CrAg |
| 6 | 320,000 cfu/ml in CSF | Amphotericin B: 14 dosesFluconazole: 800 mg/day post-miscarriage | 4 | N/A | 21 | 7 | ART naive | Alive at discharge | Miscarriage, few days before diagnosis |
| 7 | Amphotericin B: unknown number of dosesFluconazole: discharged on unknown dose of daily fluconazole | 14 | ∼24 | 35 | 40 | ART experienced, (TDF/3TC/EFV),∼4 months | Alive | Delivered at term without abnormalities; CrAg, HIV status unknown | |
| 8 | Amphotericin B: 6 doses prior to deathFluconazole: unknown dose prior to death | 90 | ∼20 | 32 | 13 | ART naïve | Death six days into treatment | Death | |
| 9 | Postpartum IRIS 22 | Amphotericin B: 14 doses | 30 | 1 week postpartum | 30 | 38 | ART experienced, ∼1 month | Death | Without abnormalities, CrAg- |
| 10 | Postpartum | Amphotericin B: 2 doses postpartum prior to deathFluconazole: 800 mg/day for two days prior to death | 21 | ∼3 days postpartum | 29 | 9 | ART experienced (TDF/3TC/EFV),∼3 months | Death two days into treatment after CM diagnosis | Premature, 2.1 kg, CrAg-, HIV- baby was delivered at 36 weeks before the mother's condition deteriorated |
| 11 | 369,000 cfu/ml in CSF, postpartum | Amphotericin B: 14 doses Fluconazole: 1200 mg/day | 14 | 2 weeks postpartum; exclusively breastfeeding | 30 | 37 | ART experienced (AZT/3TC/NVP), 2 years, HIV viral load 34,872 copies/ml | Alive at discharge | Started on ABC/3TC/Aluvia for high-risk pregnancy, was CrAg- during first month of life |
| 12 | Post-CM receiving secondary prophylaxis | Fluconazole: Was on 200 mg/day maintenance therapy when found to be 2 months pregnant | N/A | 8 | 27 | 208 | ART experienced (TDF/3TC/EFV) | Alive | Ectopic pregnancy |
| 13 | Serum CrAg titer 1:320, on/off HA, but not overtly symptomatic, CSF CrAg+ | Amphotericin B: 7 doses during hospitalization, 4 doses weekly outpatient prior to lost to follow-up | N/A | 26 | 25 | N/A | ART experienced (TDF/3TC/EFV), 1 month | Alive | Stillbirth |
Abbreviations: CM, cryptococcal meningitis; EGA, estimated gestational age; HA, headache; N/A, not available.
*Amphotericin B = amphotericin B deoxycholate (0.7–1.0 mg/kg).