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[New trends in the therapy of cryptococcosis in AIDS patients]
A Parisi1, A Malfitano, R Bruno
1Divisione di Malattie Infettive e Tropicali, Universita degli Studi di Pavia-IRCCS, Policlinico San Matteo.
Abstract:
The Authors report the clinical and microbiological findings about a 6-months follow up of 9 AIDS-patients with Cryptococcosis. Among these, 7 patients suffered from meningo-encephalitis and 2 from haematogenous infection. The fungicidal treatment during acute illness, included the administration of Amphotericin B (0.6 mg/Kg/die i.v.) plus Flucytosine (100 mg/kg/die i.v.) during the first 15 days followed from itraconazole at doses of 400 mg/die in a single administration, during the following 15 days. The chronic suppressive therapy included itraconazole at doses of 200 mg/die p.o. indefinitely. During the 6-months follow up, one patient died of polymicrobial pneumonia and another of hepatic failure related to a reactivation of a previous HCV hepatitis. In 2 patients the presence of multiple nodular lesions in the cerebral CT scan, related to cryptococcal granulomas, was associated to a persistence of positive liquoral cultures and to a poor prognosis. In 3 patients with meningo-encephalitis, the three drugs regimen was quite effective in eradicating the neurological infection and no relapses were observed during the 6-months follow up. The 2 patients with hematogenous infection alone, didn't relapse during the 6-months follow up.
Insights
This study followed nine patients with AIDS and cryptococcosis. A combination antifungal treatment showed effectiveness in eradicating neurological infections and preventing relapses in most patients.
Area of Science:
- Infectious Diseases
- Mycology
- Immunocompromised Hosts
Context:
- Cryptococcosis is a significant opportunistic infection in patients with Acquired Immunodeficiency Syndrome (AIDS).
- Meningoencephalitis and hematogenous spread are severe clinical presentations of cryptococcosis in AIDS patients.
- Effective treatment strategies are crucial for managing cryptococcosis in this vulnerable population.
Purpose:
- To report clinical and microbiological findings from a 6-month follow-up of AIDS patients with cryptococcosis.
- To evaluate the efficacy of a specific antifungal regimen including Amphotericin B, Flucytosine, and Itraconazole.
- To assess treatment outcomes, including relapse rates and prognostic factors.
Summary:
- Nine patients with AIDS and cryptococcosis were treated with Amphotericin B plus Flucytosine, followed by Itraconazole for acute illness, and then chronic suppressive Itraconazole.
- Seven patients had meningoencephalitis, and two had hematogenous infection.
- While three meningoencephalitis cases showed eradication and no relapse, two patients with cerebral granulomas had poor prognosis. Two non-neurological cases did not relapse.
Impact:
- The findings highlight the potential efficacy of a multi-drug regimen for treating cryptococcosis in AIDS patients, particularly for neurological forms.
- Identifying prognostic factors like cerebral granulomas is crucial for patient management.
- This study contributes to understanding long-term outcomes and guiding therapeutic approaches for cryptococcosis in immunocompromised individuals.