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Reproducibility of CSF quantitative culture methods for estimating rate of clearance in cryptococcal meningitis.
Dyal, Jonathan; Akampurira, Andrew; Rhein, Joshua; Morawski, Bozena M; Kiggundu, Reuben; Nabeta, Henry W; Musubire, Abdu K; Bahr, Nathan C; Williams, Darlisha A; Bicanic, Tihana; Larsen, Robert A; Meya, David B; Boulware, David R.
Afiliação
  • Dyal J; University of Minnesota, Minneapolis, Minnesota Infectious Disease Institute, Makerere University, Kampala, Uganda.
  • Akampurira A; Infectious Disease Institute, Makerere University, Kampala, Uganda Makerere University College of Health Sciences, Kampala, Uganda.
  • Rhein J; University of Minnesota, Minneapolis, Minnesota Infectious Disease Institute, Makerere University, Kampala, Uganda.
  • Morawski BM; University of Minnesota, Minneapolis, Minnesota.
  • Kiggundu R; Infectious Disease Institute, Makerere University, Kampala, Uganda.
  • Nabeta HW; Infectious Disease Institute, Makerere University, Kampala, Uganda.
  • Musubire AK; University of Minnesota, Minneapolis, Minnesota Infectious Disease Institute, Makerere University, Kampala, Uganda Makerere University College of Health Sciences, Kampala, Uganda.
  • Bahr NC; University of Minnesota, Minneapolis, Minnesota.
  • Williams DA; University of Minnesota, Minneapolis, Minnesota Infectious Disease Institute, Makerere University, Kampala, Uganda.
  • Bicanic T; Institute of Infection and Immunity, St. George's University of London, London, UK.
  • Larsen RA; LAC+USC Medical Center, University of Southern California, Los Angeles, California.
  • Meya DB; University of Minnesota, Minneapolis, Minnesota Infectious Disease Institute, Makerere University, Kampala, Uganda Makerere University College of Health Sciences, Kampala, Uganda.
  • Boulware DR; University of Minnesota, Minneapolis, Minnesota boulw001@umn.edu.
Med Mycol ; 54(4): 361-9, 2016 May.
Article em En | MEDLINE | ID: mdl-26768372
Quantitative cerebrospinal fluid (CSF) cultures provide a measure of disease severity in cryptococcal meningitis. The fungal clearance rate by quantitative cultures has become a primary endpoint for phase II clinical trials. This study determined the inter-assay accuracy of three different quantitative culture methodologies. Among 91 participants with meningitis symptoms in Kampala, Uganda, during August-November 2013, 305 CSF samples were prospectively collected from patients at multiple time points during treatment. Samples were simultaneously cultured by three methods: (1) St. George's 100 mcl input volume of CSF with five 1:10 serial dilutions, (2) AIDS Clinical Trials Group (ACTG) method using 1000, 100, 10 mcl input volumes, and two 1:100 dilutions with 100 and 10 mcl input volume per dilution on seven agar plates; and (3) 10 mcl calibrated loop of undiluted and 1:100 diluted CSF (loop). Quantitative culture values did not statistically differ between St. George-ACTG methods (P= .09) but did for St. George-10 mcl loop (P< .001). Repeated measures pairwise correlation between any of the methods was high (r≥0.88). For detecting sterility, the ACTG-method had the highest negative predictive value of 97% (91% St. George, 60% loop), but the ACTG-method had occasional (∼10%) difficulties in quantification due to colony clumping. For CSF clearance rate, St. George-ACTG methods did not differ overall (mean -0.05 ± 0.07 log10CFU/ml/day;P= .14) on a group level; however, individual-level clearance varied. The St. George and ACTG quantitative CSF culture methods produced comparable but not identical results. Quantitative cultures can inform treatment management strategies.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Líquido Cefalorraquidiano / Meningite Criptocócica / Micologia Idioma: En Ano de publicação: 2016 Tipo de documento: Article País de afiliação: Uganda

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Líquido Cefalorraquidiano / Meningite Criptocócica / Micologia Idioma: En Ano de publicação: 2016 Tipo de documento: Article País de afiliação: Uganda