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Treatment of cryptococcal meningitis in Peruvian AIDS patients using amphotericin B and fluconazole
P Dammert1, B Bustamante, E Ticona
1Department of Medicine, John Stroger Jr. Hospital of Cook County, 1900 West Polk Street, Chicago, IL 60612, USA. pedrodammert@hotmail.com
Objectives:
To describe the mycologic and clinical outcomes and factors associated with failure in Peruvian patients with AIDS-associated cryptococcal meningitis (CM) treated with amphotericin B deoxycholate (Amph B) followed by fluconazole.
Methods:
Patients were treated with intravenous Amph B 0.7 mg/kg/day for 2 or 3 weeks followed by oral fluconazole 400mg/day for 7 or 8 weeks. Clinical and laboratory evaluations including cerebrospinal fluid (CSF) studies were performed at baseline and at weeks 2 and 10.
Results:
The CSF cultures were negative in 25% and 68% of 47 patients at weeks 2 and 10, respectively. In the univariate analysis, baseline low body mass index (BMI), hyponatremia, low serum albumin, positive blood culture and CSF antigen titers >or=1024 were associated with a positive CSF culture at week 2. Baseline positive urine culture, positive blood culture, any positive extraneural culture and CSF opening pressure at week 2 >or=300 mm H2O were associated with a positive CSF culture at week 10. In the multivariate analysis no association was found.
Conclusions:
Therapy with Amph B and fluconazole, combined with aggressive management of elevated intracranial pressure (ICP), results in low CSF sterilization rates at week 2 and acceptable CSF sterilization rates at week 10 when compared with other series.
Insights
Treatment of AIDS-associated cryptococcal meningitis (CM) with amphotericin B (Amph B) and fluconazole showed low cerebrospinal fluid (CSF) sterilization at 2 weeks but acceptable rates by 10 weeks.
Area of Science:
- Infectious Diseases
- Mycology
- Public Health
Background:
- Cryptococcal meningitis (CM) is a significant opportunistic infection in patients with advanced HIV/AIDS.
- Amphotericin B deoxycholate (Amph B) followed by fluconazole is a standard treatment regimen for CM.
- Understanding treatment outcomes and failure factors is crucial for improving patient management in resource-limited settings.
Purpose of the Study:
- To evaluate the mycologic and clinical outcomes of Peruvian patients with AIDS-CM treated with Amph B and fluconazole.
- To identify factors associated with treatment failure in this patient population.
Main Methods:
- A cohort of 47 Peruvian patients with AIDS-CM received intravenous Amph B (0.7 mg/kg/day) for 2-3 weeks, followed by oral fluconazole (400mg/day) for 7-8 weeks.
- Clinical assessments and cerebrospinal fluid (CSF) studies were conducted at baseline, week 2, and week 10.
- Mycologic evaluation included CSF cultures and antigen testing.
Main Results:
- Cerebrospinal fluid (CSF) cultures were negative in 25% of patients at week 2 and 68% at week 10.
- Univariate analysis identified low body mass index, hyponatremia, low serum albumin, positive blood cultures, and high CSF antigen titers as potential indicators of early treatment failure.
- Factors associated with positive CSF cultures at week 10 included positive urine or blood cultures, extraneural infections, and elevated CSF opening pressure at week 2.
- Multivariate analysis did not identify any significant independent factors associated with treatment failure.
Conclusions:
- The combination of Amph B and fluconazole, alongside aggressive management of elevated intracranial pressure, achieved low CSF sterilization rates at week 2.
- Acceptable CSF sterilization rates were observed by week 10, comparable to other reported series.
- Further research is needed to elucidate factors influencing treatment response and optimize management strategies for AIDS-CM.
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