International Journal of STD & AIDS > Volume 19, Number 4 > Pp. 268-271

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Manosuthi, W. Articles by Pappas, P. G Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?

Original research articles

Temporary external lumbar drainage for reducing elevated intracranial pressure in HIV-infected patients with cryptococcal meningitis^a

Weerawat Manosuthi MD ^*  , Somnuek Sungkanuparph MD , Suthat Chottanapund MD ^*, Somsit Tansuphaswadikul MD ^*, Sukanya Chimsuntorn MD ^*, Putthiporn Limpanadusadee BSc ^* and Peter G Pappas MD 

^* Department of Medicine, Bamrasnaradura Infectious Diseases Institute, Tiwanon Road, Nonthaburi 11000; Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA

Correspondence to: Dr Weerawat Manosuthi Email: idweerawat{at}yahoo.com

The aim of this study was to investigate safety and impact of temporary external lumbar drainage for continuous release of cerebrospinal fluid among patients with HIV-associated cryptococcal meningitis and elevated intracranial pressure (ICP). We conducted a retrospective cohort study among patients with cryptococcal meningitis in whom temporary external lumbar drains were placed to reduce intractable elevated ICP between January 2002 and December 2005. Patients were followed for three months after the procedure. Among 601 HIV-infected patients with cryptococcal meningitis, 54 (8.9%) underwent lumbar drain placement. Of these patients, mean age was 33 years and 80% were males. The median duration of an indwelling lumbar drain was seven days. There were 61 placement procedures among 54 patients, totalling to 473 device-days of observation. Overall incidence of secondary bacterial infections was 6.3 per 1000 device-days, and three (4.9%) of 61 catheters became secondarily infected with nosocomially acquired bacteria. All three drains were removed and appropriate antibiotics were given. There was no difference in median duration of placement between infected and uninfected drains (six days vs. seven days, P = 0.572). The overall mortality rate was 5.6% in this cohort of 54 patients. In conclusion, the incidence of nosocomial infection of external lumbar drains is low. In resource-limited settings, the use of temporary external lumbar drainage is a safe and effective management strategy for intractable elevated ICP in HIV-infected patients with cryptococcal meningitis.

Key Words: cryptococcal meningitis • cryptococcosis • HIV • lumbar drainage • infection

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?