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Treatment of two cases of cryptococcal meningitis with fluconazole
J W van 't Wout1, E R de Graeff-Meeder, L C Paul
1Department of Infectious Diseases, University Hospital, Leiden, The Netherlands.
Abstract:
Two patients with cryptococcal meningitis were treated with the investigational triazole drug fluconazole (UK-49,858). Cerebrospinal fluid (CSF) levels of fluconazole were between 3.0 and 5.4 mg/l 2 h after an oral dose of 50 mg daily in the first patient and between 7.9 and 9.0 mg/l after an oral dose of 100 mg daily in the second patient. These levels were in the same range as plasma levels. The first patient, a 46-year-old renal transplant patient, was both clinically and microbiologically cured after 28 weeks of therapy (follow-up 14 months). In the second patient, a 15-year-old girl with chronic mucocutaneous candidiasis, fluconazole led to clinical cure of the meningitis, but failed to eradicate cryptococci from the CSF. These cases illustrate that fluconazole is useful for the treatment of cryptococcal meningitis, especially when prolonged treatment is indicated as in patients with immunodeficiencies.
Insights
Fluconazole, an investigational antifungal, shows promise in treating cryptococcal meningitis, particularly in immunocompromised patients requiring extended therapy. It achieved clinical cure in both patients, with one also showing microbiological eradication.
Area of Science:
- Mycology
- Infectious Diseases
- Pharmacology
Background:
- Cryptococcal meningitis is a serious fungal infection, often affecting immunocompromised individuals.
- Antifungal drug development is crucial for managing invasive fungal infections.
- Triazole antifungals represent a significant class of medications for fungal diseases.
Observation:
- Two patients with cryptococcal meningitis received the investigational triazole fluconazole.
- Cerebrospinal fluid (CSF) fluconazole levels were comparable to plasma levels after oral administration.
- Dosage varied: 50 mg daily for the first patient and 100 mg daily for the second.
Findings:
- The first patient, a renal transplant recipient, achieved clinical and microbiological cure after 28 weeks of fluconazole therapy.
- The second patient, with chronic mucocutaneous candidiasis, experienced clinical cure but not complete eradication of Cryptococcus from CSF.
- Fluconazole demonstrated effective CSF penetration and therapeutic potential.
Implications:
- Fluconazole is a viable treatment option for cryptococcal meningitis, especially in patients needing prolonged therapy due to immunodeficiency.
- The findings support the use of fluconazole in managing invasive fungal infections affecting the central nervous system.
- Further research into optimal dosing and duration for fluconazole in cryptococcal meningitis is warranted.