• Disease
  • Cryptococcal
  • Cryptococcal Meningitis
  • Nathan C Bahr

    Prominent publications by Nathan C Bahr

    KOL Index score: 19474

    BACKGROUND: WHO recommends Xpert MTB/RIF as initial diagnostic testing for tuberculous meningitis. However, diagnosis remains difficult, with Xpert sensitivity of about 50-70% and culture sensitivity of about 60%. We evaluated the diagnostic performance of the new Xpert MTB/RIF Ultra (Xpert Ultra) for tuberculous meningitis.

    METHODS: We prospectively obtained diagnostic cerebrospinal fluid (CSF) specimens during screening for a trial on the treatment of HIV-associated cryptococcal ...

    Also Ranks for: Tuberculous Meningitis |  xpert ultra |  prospective cohort study |  infected adults |  meningeal tuberculosis
    KOL Index score: 14387

    INTRODUCTION: Tuberculous meningitis accounts for 1-5% of tuberculosis cases. Diagnostic delay contributes to poor outcomes. We evaluated the performance of the new Xpert MTB/RIF Ultra (Xpert Ultra) for tuberculous meningitis diagnosis.

    METHODS: In this prospective validation study, we tested the cerebrospinal fluid (CSF) of adults presenting with suspected meningitis (ie, headache or altered mental status with clinical signs of meningism) to the Mulago National Referral Hospital and ...

    Also Ranks for: Xpert Ultra |  tuberculous meningitis |  specificity tuberculosis |  tests sensitivity |  uniform case definition
    KOL Index score: 13238

    BACKGROUND: TB meningitis (TBM) diagnosis is difficult and novel diagnostic methods are needed. The World Health Organization recommends Xpert(®) MTB/RIF as the initial TBM diagnostic test based on two studies reporting suboptimal sensitivity (~50-60%).

    OBJECTIVE: To study the effect of cerebrospinal fluid (CSF) centrifugation on Xpert performance for TBM detection.

    DESIGN: A total of 107 predominantly human immunodeficiency virus (HIV) infected adults with presumed meningitis were ...

    Also Ranks for: Xpert Mtb |  diagnostic sensitivity |  tuberculous meningitis |  centrifuged csf |  definite tbm
    KOL Index score: 12393

    BACKGROUND: Cryptococcus is the most common cause of adult meningitis in Africa. We assessed the safety and microbiological efficacy of adjunctive sertraline, previously shown to have in-vitro and in-vivo activity against cryptococcus.

    METHODS: In this open-label dose-finding study, we recruited HIV-infected individuals with cryptococcal meningitis who presented to Mulago Hospital in Kampala, Uganda between Aug 14, 2013, and Aug 30, 2014. To assess safety and tolerability, the first 60 ...

    Also Ranks for: Adjunctive Sertraline |  cryptococcal meningitis |  2 weeks |  induction therapy |  400 day
    KOL Index score: 11130

    Background: Increased antiretroviral therapy (ART) availability has been associated with more patients developing cryptococcosis after ART initiation. Despite this changing epidemiology, data regarding cryptococcal meningitis in those already receiving ART are limited. We compared clinical presentations and outcomes among ART-naïve and ART-experienced Ugandans.

    Methods: We prospectively enrolled 605 HIV-infected persons with first-episode cryptococcal meningitis from August 2013 to May ...

    Also Ranks for: Cryptococcal Meningitis |  art initiation |  6 months |  changing epidemiology |  2 weeks
    KOL Index score: 9304

    BACKGROUND: Identifying new antifungals for cryptococcal meningitis is a priority given the inadequacy of current therapy. Sertraline has previously shown in vitro and in vivo activity against cryptococcus. We aimed to assess the efficacy and cost-effectiveness of adjunctive sertraline in adults with HIV-associated cryptococcal meningitis compared with placebo.

    METHODS: In this double-blind, randomised, placebo-controlled trial, we recruited HIV-positive adults with cryptococcal ...

    Also Ranks for: Adjunctive Sertraline |  cryptococcal meningitis |  3 trial |  patients hiv |  2 weeks
    KOL Index score: 8770

    Background: Tuberculous meningitis (TBM) is the second most common cause of meningitis in sub-Saharan Africa and is notoriously difficult to diagnose. We describe the impact of improved TBM diagnostics over 6.5 years at two Ugandan referral hospitals. Methods: Cohort one received cerebrospinal fluid (CSF) smear microscopy only (2010-2013). Cohort two received smear microscopy and Xpert MTB/Rif (Xpert) on 1ml unprocessed CSF at physician discretion (2011-2013). Cohort three received smear ...

    Also Ranks for: Xpert Mtb |  tuberculous meningitis |  outcomes tbm |  subsaharan africa |  cryptococcal antigen
    KOL Index score: 7919

    Meningitis remains a worldwide problem, and rapid diagnosis is essential to optimize survival. We evaluated the utility of a multiplex PCR test in differentiating possible etiologies of meningitis. Cerebrospinal fluid (CSF) from 69 HIV-infected Ugandan adults with meningitis was collected at diagnosis (n=51) and among persons with cryptococcal meningitis during therapeutic lumbar punctures (n=68). Cryopreserved CSF specimens were analyzed with BioFire FilmArray® Meningitis/Encephalitis ...

    Also Ranks for: Multiplex Pcr |  cryptococcal meningitis |  diagnostic performance |  rapid diagnosis |  cerebrospinal fluid
    KOL Index score: 7886

    BACKGROUND: (1→3)-β-d-Glucan (BDG) is a helpful diagnostic marker for many invasive fungal infections. However, BDG is not thought to be useful in diagnosing cryptococcosis. We evaluated the utility of BDG as an adjunct diagnostic tool for patients infected with human immunodeficiency virus (HIV) and presenting with suspected cryptococcal meningitis.

    METHODS: The Fungitell assay was used to measure BDG concentrations in cerebrospinal fluid (CSF) (n = 177) and serum (n = 109) of ...

    Also Ranks for: Cryptococcal Meningitis |  cerebrospinal fluid |  csf bdg |  fungitell assay |  1→3β glucan
    KOL Index score: 7540

    Background: Diagnosis of extrapulmonary tuberculosis (TB) remains challenging. We sought to determine the prevalence of disseminated TB by testing urine with TB-lipoarabinomannan (TB-LAM) lateral flow assay and Xpert MTB/RIF Ultra (Ultra) in hospitalized adults.

    Methods: We prospectively enrolled human immunodeficiency virus (HIV)-positive adults with suspected meningitis in Uganda during 2018-2020. Participants underwent standardized urine-based TB screening. Urine (60 mcL) was tested ...

    Also Ranks for: Xpert Mtb |  urine ultra |  lam positive |  extrapulmonary tuberculosis |  ugandan adults
    KOL Index score: 7498

    The diagnosis of tuberculous meningitis (TBM) is difficult and poses a significant challenge to physicians worldwide. Recently, nucleic acid amplification (NAA) tests have shown promise for the diagnosis of TBM, although their performance has been variable. We undertook a systematic review and meta-analysis to evaluate the diagnostic accuracy of NAA tests with cerebrospinal fluid (CSF) samples against that of culture as the reference standard or a combined reference standard (CRS) for ...

    Also Ranks for: Tuberculous Meningitis |  sensitivity specificity |  reference standard |  diagnosis tbm |  acid amplification
    KOL Index score: 7392

    INTRODUCTION: Within this large-scale study, we compared clinical symptoms, laboratory findings, radiographic signs, and outcomes of COVID-19, SARS, and MERS to find unique features.

    METHOD: We searched all relevant literature published up to February 28, 2020. Depending on the heterogeneity test, we used either random or fixed-effect models to analyze the appropriateness of the pooled results. Study has been registered in the PROSPERO database (ID 176106).

    RESULT: Overall 114 articles ...

    Also Ranks for: Laboratory Findings |  radiographic signs |  covid19 sars |  mortality rate |  clinical characteristics
    KOL Index score: 7212

    Tuberculous meningitis (TBM) is the most severe form of tuberculous with substantial mortality. In May 2015, 54 researchers from 10 countries met in Da Lat, Vietnam, to discuss advances in TBM. Among the attendees were researchers involved in pivotal studies on the use of Xpert MTB/Rif for TBM diagnosis. Attendees discussed the 2014 World Health Organization strong recommendation favoring the use of Xpert "in preference to conventional microscopy and culture as the initial diagnostic ...

    Also Ranks for: Xpert Mtb |  tuberculous meningitis |  mycobacterium tuberculosis |  bacterial humans |  tbm diagnosis
    KOL Index score: 6943

    The delayed diagnosis of tuberculous meningitis (TBM) leads to poor outcomes, yet the current diagnostic methods for identifying Mycobacterium tuberculosis in cerebrospinal fluid (CSF) are inadequate. The first comparative study of the new GeneXpert MTB/RIF Ultra (Xpert Ultra) for TBM diagnosis suggested increased sensitivity of Xpert Ultra. Two subsequent studies have shown Xpert Ultra has improved sensitivity, but has insufficient negative predictive value to exclude TBM. Collecting ...

    Also Ranks for: Tuberculous Meningitis |  xpert ultra |  tbm diagnosis |  mycobacterium tuberculosis |  poor outcomes
    KOL Index score: 5807

    Histoplasmosis is endemic to the Midwestern United States, but cases have been reported nearly worldwide. A 1970 study found 3.8% skin test sensitivity to Histoplasma capsulatum in Uganda but no systemic study of histoplasmosis exposure has occurred since the onset of the human immunodeficiency virus (HIV) pandemic. This study investigated the seroprevalence of H. capsulatum and sought previously undetected cases of histoplasmosis in Kampala, Uganda. Serum, cerebrospinal fluid (CSF) ...

    Also Ranks for: Cryptococcal Meningitis |  histoplasma capsulatum |  hiv aids |  cross reactivity |  kampala uganda


    Nathan C Bahr: Influence Statistics

    Sample of concepts for which Nathan C Bahr is among the top experts in the world.
    Concept World rank
    outcomes tbm #1
    immune pathology tbiris #1
    detection microbe #1
    diagnose tuberculous meningitis #1
    management tbiris #1
    areas hyperendemicity #1
    immune suppressive medications #1
    presentation tbiris #1
    tbm diagnostic capacity #1
    form tbiris #1
    azathioprine disseminated histoplasmosis #1
    infectious diseases histoplasma #1
    paucity highperformance diagnostics #1
    dimorphic fungi variety #1
    crs tbm #1
    microbe diagnostic test #1
    unmasking form #1
    proper diagnostic work #1
    tbiris unmasking form #1
    trial supported therapy #1
    diagnostic test threshold #1
    diagnosis unnecessary antibiotic #1
    concentration microbe #1
    coccidioides paracoccidioides #1
    new lipoarabinomannan test #1
    form iris #1
    combatting tuberculosis #1
    clinical factors availability #1
    molecular technologies step #1
    diagnose tuberculous #1
    hyperendemicity disseminated histoplasmosis #1
    widening geographic ranges #1
    tbm genexpert mtb #1
    deadliest form histoplasmosis #1
    diagnosis pulmonary infections #1
    immune mediated worsening #1
    cns tbiris #1
    61742 patients #2
    csf afb smear #2
    95 laboratory analysis #2
    histoplasmosis common #2
    delay diagnosis contributes #2
    naa tests culture #2
    empiric therapy outcomes #2
    unmasking cryptococcal #2
    hightb burden settings #2
    test tuberculous #2
    examples meningitis diagnostics #2

    Key People For Cryptococcal Meningitis

    Top KOLs in the world
    William E Dismukes
    cryptococcal meningitis liposomal amphotericin prosthetic valve endocarditis
    Thomas Stephen Harrison
    cryptococcal meningitis cryptococcus neoformans south africa
    Robert A Larsen
    cryptococcal meningitis cryptococcus neoformans fluconazole flucytosine
    Peter G Pappas
    invasive candidiasis cryptococcal meningitis fungal infections
    John Robert Perfect
    cryptococcus neoformans invasive fungal infections cryptococcal meningitis
    William G Powderly†††
    hiv infection antiretroviral therapy cryptococcal meningitis

    Nathan C Bahr:Expert Impact

    Concepts for whichNathan C Bahrhas direct influence:Cryptococcal meningitis,  Tuberculous meningitis,  Xpert mtb,  Xpert ultra,  Community engagement,  Cerebrospinal fluid,  Afb smear,  Laboratory findings.

    Nathan C Bahr:KOL impact

    Concepts related to the work of other authors for whichfor which Nathan C Bahr has influence:Tuberculous meningitis,  Xpert ultra,  Fungal infections,  Central nervous,  Cerebrospinal fluid,  Histoplasma capsulatum,  Cryptococcus neoformans.



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    School of Medicine, University of Kansas Medical Center, Kansas, KS, USA, kumc.edu | Division of Infectious Diseases, Department of Medicine, University of Kansas, Medical Center, Kansas City, Kansas, USA | Division of Infectious Diseases, Department