title: Clinical presentation and aetiologies of acute or complicated headache among HIV-seropositive patients in a Ugandan clinic.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. bcoleb@itg.be.
authors.forename: Michael
authors.initials: M
authors.lastname: Katwere
authors.forename: Andrew
authors.initials: A
authors.lastname: Kambugu
authors.forename: Theresa
authors.initials: T
authors.lastname: Piloya
authors.forename: Matthew
authors.initials: M
authors.lastname: Wong
authors.forename: Brett
authors.initials: B
authors.lastname: Hendel-Paterson
authors.forename: Merle A
authors.initials: MA
authors.lastname: Sande
authors.forename: Allan
authors.initials: A
authors.lastname: Ronald
authors.forename: Elly
authors.initials: E
authors.lastname: Katabira
authors.forename: Edward M
authors.initials: EM
authors.lastname: Were
authors.forename: Joris
authors.initials: J
authors.lastname: Menten
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders