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Cryptococcal Meningitis
1Albuquerque Veterans Affairs Medical Center, 1501 San Pedro Drive, SE, Albuquerque, NM 87108, USA. Lourdes.Irizarry@med.va.gov
Abstract:
Cryptococcal meningitis, often seen in immunocompromised hosts, is also a disease of the immune-competent individual. The diagnosis of cryptococcal meningitis requires a lumbar puncture with measurement of the opening pressure, standard laboratory assessment including cell count, protein and glucose, fungal culture, and cryptococcal polysaccharide antigen. Serum cryptococcal antigen is of great diagnostic value in individuals infected with HIV. Hospital admission for initial therapy with amphotericin B desoxycholate is required. Adjuvant oral therapy with flucytosine for the first 2 weeks of therapy is strongly recommended. If flucytosine is not well tolerated, it may be discontinued with close monitoring and follow-up of cerebrospinal fluid (CSF) response to therapy. Good hydration and appropriate premedication concomitant to the use of amphotericin B are useful interventions preventing side effects. Occasionally, amphotericin B needs to be discontinued due to intolerance or side effects. After CSF sterilization is completed, therapy can be switched to oral fluconazole. Fluconazole is well absorbed orally. There is rarely a need to give intravenous fluconazole.
Insights
Cryptococcal meningitis requires prompt diagnosis and treatment, often involving lumbar puncture and antifungal medications like amphotericin B and flucytosine. Early diagnosis and management are crucial for both immunocompromised and immunocompetent patients.
Area of Science:
- Infectious Diseases
- Mycology
- Neurology
Background:
- Cryptococcal meningitis affects both immunocompromised and immunocompetent individuals.
- Accurate diagnosis is essential for effective treatment.
Purpose of the Study:
- To outline the diagnostic and therapeutic strategies for cryptococcal meningitis.
- To emphasize the importance of early intervention and appropriate medication selection.
Main Methods:
- Diagnosis involves lumbar puncture for cerebrospinal fluid (CSF) analysis, including opening pressure, cell count, protein, glucose, fungal culture, and cryptococcal antigen testing.
- Serum cryptococcal antigen is valuable for HIV-infected individuals.
- Initial treatment requires hospitalization with amphotericin B desoxycholate.
Main Results:
- Adjuvant oral flucytosine for two weeks is recommended alongside amphotericin B.
- Management includes supportive care like hydration and premedication to mitigate amphotericin B side effects.
- Therapy can transition to oral fluconazole after CSF sterilization.
Conclusions:
- Cryptococcal meningitis necessitates a comprehensive diagnostic approach and a structured treatment plan.
- Intravenous fluconazole is rarely needed, with oral administration being preferred once the infection is controlled.