"Mushroom Meningitis of Uganda"

By Melanie Nicol

Hard to believe that my time in Uganda for this trip is halfway over. I honestly feel like I just got here and am still getting settled in.

This week Sara and I have been rounding with the meningitis research team. Working with this team is a unique experience for the students as they get to see firsthand the intersection of clinical research and clinical care. The cryptococcal meningitis team from University of Minnesota has been working in Uganda for over 10 years; their work has led to landmark findings that have changed clinical guidelines for the management of cryptococcal disease. While also doing groundbreaking research, the team (comprised of health professionals from Uganda, U.S., and the UK) is also providing quality clinical care for these very sick patients. Today Sara got to see a lumbar puncture being performed on a patient newly diagnosed with cryptococcal meningitis. Lumbar punctures are done to 1) collect cerebrospinal fluid to test for the presence of cryptococcal antigen and confirm diagnosis and 2) relieve intracranial pressure which becomes quite high during this disease leading to severe headaches, and sometimes seizures and neurological damage.

Postings on the infectious disease wards at Kiruddu Hospital

Cryptococcus is a fungus that typically only affects those with significant immunosuppression, such as those with advanced HIV. We learned today that there is no good word in Luganda ( the common language spoken in Central Uganda) for fungus so one of the doctors describes the disease to the patients as "Mushroom Meningitis of Uganda"

My involvement with the meningitis team began in 2015 when one of my mentors, Paul Bohjanen, introduced me to David Boulware, one of the principal investigators of the team. This all stemmed from when I was approached by my college Dean and asked to find connections between my work and what was going on in Uganda. I met with David, trying to think of a way my work in HIV prevention and drug exposure in the female genital tract (more on this research in a later post) could tie in to his work in advanced HIV and co-infections of the brain. I asked about access to tissues to measure drug exposure- he talked about ongoing initiatives to do more autopsy related work.

There is a great deal we don't know about HIV and related co-infections because many events are happening in tissues, while most of the sampling for clinical monitoring comes from the blood (and sometimes urine, CSF, or other fluids). Autopsies provide a unique opportunity to study some of these infections and understand how the drug is interacting with the bugs in tissues that we cannot sample in living patients. I decided to apply for and was ultimately awarded a Global Health Seed Grant to test the feasibility of combining autopsy and pharmacology research. We presented results of this proof of concept study at CROI 2018. Part of my time in Uganda this trip has been working on the logistics of keeping the next phase of this study going. I hope to have a later post describing some of the unique challenges and rewards to performing international clinical research.