Title
Clinical presentation and aetiologies of acute or complicated headache among HIV-seropositive patients in a Ugandan clinicClinical presentation and aetiologies of acute or complicated headache among HIV-seropositive patients in a Ugandan clinic
Author
Faculty/Department
Faculty of Medicine and Health Sciences
Research group
Epidemiology and social medicine (ESOC)
Publication type
article
Publication
Subject
Human medicine
Source (journal)
Journal of the International AIDS Society
Volume/pages
12(2009):1, p. 21,1-21,8
ISSN
1758-2652
ISI
000208106500021
Carrier
E
Target language
English (eng)
Full text (Publishers DOI)
Affiliation
University of Antwerp
Abstract
Background We set out to define the relative prevalence and common presentations of the various aetiologies of headache within an ambulant HIV-seropositive adult population in Kampala, Uganda. Methods We conducted a prospective study of adult HIV-1-seropositive ambulatory patients consecutively presenting with new onset headaches. Patients were classified as focal-febrile, focal-afebrile, non-focal-febrile or non-focal-afebrile, depending on presence or absence of fever and localizing neurological signs. Further management followed along a pre-defined diagnostic algorithm to an endpoint of a diagnosis. We assessed outcomes during four months of follow up. Results One hundred and eighty patients were enrolled (72% women). Most subjects presented at WHO clinical stages III and IV of HIV disease, with a median Karnofsky performance rating of 70% (IQR 60-80). The most common diagnoses were cryptococcal meningitis (28%, n = 50) and bacterial sinusitis (31%, n = 56). Less frequent diagnoses included cerebral toxoplasmosis (4%, n = 7), and tuberculous meningitis (4%, n = 7). Thirty-two (18%) had other diagnoses (malaria, bacteraemia, etc.). No aetiology could be elucidated in 28 persons (15%). Overall mortality was 13.3% (24 of 180) after four months of follow up. Those without an established headache aetiology had good clinical outcomes, with only one death (4% mortality), and 86% were ambulatory at four months. Conclusion In an African HIV-infected ambulatory population presenting with new onset headache, aetiology was found in at least 70%. Cryptococcal meningitis and sinusitis accounted for more than half of the cases.
Full text (open access)
https://repository.uantwerpen.be/docman/irua/768af7/76f102f6.pdf
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