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