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Related Experiment Videos

[Cryptococcal meningitis in AIDS: successful long-term prophylaxis with fluconazole].

T Glück1, P Weber, K H Wiedmann

  • 1Abteilung Innere Medizin I, Medizinische Universitätsklinik Tübingen.

Deutsche Medizinische Wochenschrift (1946)
|December 20, 1991
PubMed
Summary

This case study highlights cryptococcal meningitis in an HIV-positive man, successfully treated with amphotericin B and flucytosine. Amphotericin B nephrotoxicity led to fluconazole prophylaxis, preventing recurrence.

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Area of Science:

  • Infectious Diseases
  • Mycology
  • Nephrology

Background:

  • Cryptococcal meningitis is a serious opportunistic infection in immunocompromised individuals, particularly those with advanced HIV.
  • Recurrent or refractory infections necessitate careful management of treatment toxicities.

Observation:

  • A 30-year-old HIV-positive male presented with symptoms suggestive of cryptococcal meningitis after prior amphotericin B treatment for oral thrush.
  • Cerebrospinal fluid analysis revealed a high cell count with 90% encapsulated yeast, and elevated cryptococcal antigen titers in serum and CSF confirmed the diagnosis.

Findings:

  • Initial treatment with intravenous amphotericin B and flucytosine led to clinical and microbiological remission within 4 weeks.
  • Amphotericin B-induced nephrotoxicity (creatinine 2.5 mg/dl) necessitated discontinuation of the drug after a cumulative dose of 2g.

Related Experiment Videos

  • Prophylactic fluconazole (100 mg twice daily) was initiated, resulting in normalization of cryptococcal antigen titers within one year and no recurrence over three years.

    • Implications:

    • This case underscores the importance of monitoring for and managing amphotericin B nephrotoxicity during cryptococcal meningitis treatment.
    • Long-term fluconazole prophylaxis appears effective in preventing cryptococcal meningitis recurrence in HIV-positive patients.
    • Optimal management strategies are crucial for improving outcomes in patients with complex fungal infections and comorbidities.