Meningitis fungal

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),... 

Lyme disease Tuberculous meningitis Fungal meningitis Rocky Mountain spotted fever Cat scratch disease... 

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. 

Fungal meningitis CSF culture, CSF and serum cryptococcal antigen titers, microscopic examination of CSF specimens... 

In the United States, cryptococcal meningitis is the most common form of fungal meningitis and is a major cause of morbidity and mortality in immunosuppressed patients. 

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. 

Intrathecal Administer undiluted solution by various intrathecal routes (20 mg/dose) as an adjunct to IV treatment in fungal meningitis. Succeeding intrathecal injections may be alternated between lumbar, cervical, and cisternal punctures every 3 to 7 days. 

Do not use ketoconazole for fungal meningitis because it penetrates poorly into the CSF. 

Hypersensitivity to ketoconazole. Do not use ketoconazole for the treatment of fungal meningitis because it penetrates poorly into the CSF. Concomitant administration of ketoconazole with oral triazolam is contraindicated. 

Lactate <2.1 nunol Acute bacterial, fungal, and tuberculosis meningitis CNS tissue destruction... 

Combinations of amphotericin-B with flucytosine are sometimes used to reduce the occurrence of resistance. Amphotericin-B is not absorbed from the gastrointestinal tract which necessitates intravenous administration. It is 90% protein bound and widely distributed, except for the CNS. For the treatment of fungal meningitis therefore only intrathecal drug administrations can be effective. Amphotericin-B is eliminated very slowly in urine, mainly in an inactive form, with an elimination half-life of about 24 hours which can increase to up to 15 days with repeated doses. 

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. 

Reductions in renal and hepatic function do not alter plasma drug concentrations, and ketoconazole is not removed by hemodialysis or peritoneal dialysis. Penetration into cerebrospinal fluid is negligible, so that ketoconazole is ineffective in the treatment of fungal meningitis. Since only small amounts of active drug appear in the urine, ketoconazole is not effective in the treatment of Candida cystitis. 

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. 

Fluconazole, voriconazole, posaconazole Fluconazole has excellent CNS penetration, used in fungal meningitis ... 

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... 

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