Fungal infections meningitis

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. 

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. 

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

Clinical Use. Amphotericin B (Amphocin, Fungizone Intravenous) is one of the primary drugs used to treat severe systemic fungal infections.26,39 This drug is often chosen to treat systemic infections and meningitis caused by Candida, Cryptococcus, and several other... 

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). 

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]. 

Other imidazole derivatives include clotrimazole (Fig. 10.22B), miconazole (Fig. 10.22C) and econazole (Fig. 10.22D), all of which possess a broad antimycotic spectrum with some antibacterial activity and are used topically. Miconazole is used topically but can also be administered by intravenous or intrathecal injection in the treatment of severe systemic or meningeal fungal infections. Newer imidazoles are (a) ketoconazole (Fig. 10.22E),... 

Cryptococcus is the most common systemic fungal infection in AIDS patients and is usually in the form of meningitis due to C. neoformans. Cryptococcal meningitis, if untreated, progresses rapidly to death. Even with treatment, mortality rates remain unacceptably high at 50% [21]. 

DOC Systemic fungal infections, fungal meningitis, and fungal urinary tract infections. 

Fungal infections A case of cryptococ-cal meningitis complicating corticosteroid therapy has been reported (74 ). 

Nystatin is given orally (often as a suspension for it is only feebly water-soluble) for treating moniliasis of the throat, intestines, and rectum. It is not absorbed from the intestine. Amphotericin B is administered intravenously as a colloidal suspension to treat deep-lying, systemic fungal infections of the limg, bone-marrow, and meninges. Its selectivity is not high but, so far, there is no effective substitute. 

Normal CSF has a characteristic composition in terms of protein and glucose content, as well as cell count. Table 67-2 lists CSF findings observed in the absence of infection, as well as in patients with bacterial, viral, fungal, and tuberculous meningitis. 

In the treatment of fungal meningitis or Candida urinary bladder infections, IV infusion alone is inadequate. It must be supplemented with intrathecal administration or bladder irrigation. 

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. 

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