Cryptococcal infections meningitis

Intra-abdominal infection Meningitis (cryptococcal, fungal)... 

A 26-year-old female with acquired immunodeficiency syndrome (AIDS) develops cryptococcal meningitis. She refuses all intravenous medication. Which antifungal agent can be given orally to treat the meningeal infection ... 

Cryptococcal meningitis in HIV Treatment of cryptococcal meningitis in HIV-infected patients AmBisome only). 

A significant decrease in mortality from deep-seated mycoses was noted among bone marrow transplant recipients treated prophylactically with fluconazole, but similar benefits have not been seen in leukemia patients receiving prophylactic fluconazole. Fluconazole taken prophylactically by end-stage AIDS patients can reduce the incidence of cryptococcal meningitis, esophageal candidiasis, and superficial fungal infections. 

Despite negligible cerebrospinal fluid concentrations, itraconazole shows promise in the treatment of cryptococcal and coccidioidal meningitis. Additional uses for itraconazole include treatment of vaginal candidiasis, tinea versicolor, dermatophyte infections, and onychomycosis. Fungal naU infections account for most use of this drug in the outpatient setting. 

The aim of this study reported by Powderly et al. (1992) was to establish the non-inferiority of a test treatment, fluconazole, compared to an established treatment, amphotericin B, in preventing the relapse of cryptococcal meningitis in HIV-infected patients. It was thought that fluconazole would be less effective than amphotericin B, but would offer other advantages in terms of reduced toxicity and ease of administration fluconazole was an oral treatment while amphotericin B was given intravenously. The non-inferiority margin was set at —15 per cent in terms of relapse rates. 

It is indicated in mucosal candidiasis, systemic candidiasis, crypttococcosis, prophylaxis of fungal infections following cytotoxic chemotherapy or radiotherapy maintenance to prevent relapse of cryptococcal meningitis in patients with AIDS sporotrichosis, histoplasmosis and vaginal candidiasis. 

To decrease dose-related toxicity by using reduced doses of one or more components of the drug regimen. The use of flucytosine in combination with amphotericin for the treatment of cryptococcal meningitis in non-HIV-infected patients allows for a reduction in amphotericin dosage with decreased amphotericin -induced nephrotoxicity. 

Indications Treatment of oropharyngeal and esophageal candidiasis and may be effective for the treatment of serious systemic candidal infections Cryptococcal meningitis c <... 

Mavinkurve-Groothuis AMC, Bokkerink JPM, Verweij PE, Veerman AJP, Hoogerbrugge PM. Cryptococcal meningitis in a child with acute lymphoblastic leukemia. Pediatr Infect Dis J 2003 22 576. 

In the treatment of entero-coccal endocarditis with penicillin and streptomycin or cryptococcal meningitis infections with amphotericin B in combination with flucytosine. 

Torre D, Banfi G, Tambini R, Speranza F, Zeroli C, Martegani R, Airoldi M, Fiori G. A retrospective study on the efficacy and safety of amphotericin B in a lipid emulsion for the treatment of cryptococcal meningitis in AIDS patients. J Infect 1998 37(l) 36-8. 

Dizziness, headache, and seizures were seen in 2-5% of 232 patients with severe systemic fungal infections taking fluconazole (36). In the same group there were three cases each of delirium and dysesthesia (1.3%). A possible effect of the underlying illness has to be considered. In 14 patients treated with fluconazole for cryptococcal meningitis, dizziness was reported in 14% (SED-12, 681). 

Menichetti F, Fiorio M, Tosti A, Gatti G, Bruna Pasticci M, MUetich F, Marroni M, Bassetti D, Pauluzzi S. High-dose fluconazole therapy for cryptococcal meningitis in patients with AIDS. CUn Infect Dis 1996 22(5) 838 0. 

Sugar AM, Stern JJ, Dupont B. Overview treatment of cryptococcal meningitis. Rev Infect Dis 1990 12(Suppl 3) S338-48. 

L-Amph is also approved for Cryptococcal meningitis in AIDS patients (recommended dose 6 mg/ kg/d), and in the treatment of other fungal infections with patients who were refractory and or intolerant to AmB or with baseline renal impairment (recommended dose 3-5 mg/kg/d) [182,190]. Different dose of ABLC have been compared to AmB in the treatment of cryptococcal meningitis however the risk of nephrotoxicity with ABLC was not convincingly lower than that with AmB [191]. 

Sharkey PK, Graybill JR, Johnson ES, et al. Amphotericin B lipid complex compared with amphotericin B in the treatment of cryptococcal meningitis in patients with AIDS. Clin Infect Dis 1996 22 315-21. 

E526 Kennedy, C.A., Goetz, M.B. and Mathisen, G. (1989). Artifactual elevation of the serum creatinine in patients receiving flucytosine for cryptococcal meningitis. J, Infect. Dis. 160,1090-1091. 

In immunocompromised patients pulmonary infection can lead to disseminated forms of the disease where the eyes, skin and bones become infected. Cryptococcal meningitis is particularly associated with AIDS patients, where it is a major cause of death. While cryptococcosis may be controlled by antifungal therapy, in AIDS patients there is a danger of relapse unless antifungal therapy is constantly maintained. 

Cryptococcal meningitis is the most common form of fnngal CNS infection in the United States and is a major canse of morbidity and mortality in immnnosnppressed patients. In the United States, 85% of cases occur in HIV-infected patients. C. neoformans is a soil fungus acquired by inhalation of spores from the environment leading to a pneumonia, which is nsnaUy asymptomatic. Most patients present initially with disseminated disease, especially meningoencephalitis. The incubation period in AIDS patients may be very short, as opposed to a relatively normal host, in whom it may be very long. 

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