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|Title: ||Clinical presentation and aetiologies of acute or complicated headache among HIV-seropositive patients in a Ugandan clinic|
|Authors: ||Katwere, Michael|
Sande, Merle A
Were, Edward M
Antiretroviral therapy (ART)
|Issue Date: ||2009 |
|Publisher: ||BioMed Central|
|Citation: ||Katwere, M., Kambugu, A., Piloya, T., Wong, M., Hendel-Paterson, B., Sande, M.A., Ronald, A., Katabira, E., Were, E.M., Menten, J., Colebunders, R. (2009). Clinical presentation and aetiologies of acute or complicated headache among HIV-seropositive patients in a Ugandan clinic. Journal of the International AIDS Society, 12(21)|
|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,
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, focalafebrile, 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 onsetheadache, aetiology was found in at least 70%. Cryptococcal meningitis and sinusitis accounted for more than half of the cases.|
|Appears in Collections:||Research Articles (IDI)|
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