Related Experiment Video
Updated: Feb 27, 2026
Induction of Leptomeningeal Cells Modification Via Intracisternal Injection
Published on: May 7, 2020
Continuous intrathecal administration of liposomal amphotericin B for treatment of refractory Cryptococcus neoformans
Haiting Xie1, Peng Luo1, Zhongli Li1
1Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, P.R. China.
Abstract:
The aim of the present study was to investigate the treatment of refractory Cryptococcus neoformans encephalitis with continuous administration of liposomal amphotericin B (AmB). Liposomal AmB was administered to a 28-year-old male by intravenous injection, with daily increasing dosages up to 150 mg per day and combined use of fluconazole (0.4 g per day) and oral flucytosine tablets (1.5 g per day). Following 5 months of treatment, C. neoformans could still be detected in the ink stain of cerebrospinal fluid, but the patient could not tolerate a further increase in the dosage of liposomal AmB. Instead, continuous intrathecal administration of AmB through tube drainage on the lumbar cistern was used. A total dosage of 28 mg liposomal AmB was administered to the patient over the course of 1 month. The effect of AmB administered by intravenous injection was not as great as expected and the patient's tolerance was not good. However, the patient recovered following treatment by continuous intrathecal administration of AmB through tube drainage on the lumbar cistern for 1 month. This case suggests that continuous intrathecal administration of liposomal AmB should be considered for clinical treatment of refractory cryptococcal encephalitis.
Insights
Continuous intrathecal administration of liposomal amphotericin B (AmB) offers a promising treatment for refractory Cryptococcus neoformans encephalitis when intravenous AmB fails. This method led to patient recovery in a challenging case.
Area of Science:
- Infectious Diseases
- Neurology
- Pharmacology
Background:
- Refractory cryptococcal encephalitis poses a significant treatment challenge.
- Standard intravenous therapies may be insufficient for severe or persistent cases.
Purpose of the Study:
- To evaluate the efficacy of continuous intrathecal liposomal amphotericin B (AmB) for treating refractory Cryptococcus neoformans encephalitis.
- To assess the safety and tolerability of this novel administration route.
Main Methods:
- A case study involving a 28-year-old male with refractory cryptococcal encephalitis.
- Initial treatment with escalating doses of intravenous liposomal AmB, fluconazole, and flucytosine.
- Subsequent continuous intrathecal administration of liposomal AmB via lumbar cistern drainage for one month.
Main Results:
- Intravenous liposomal AmB treatment over five months showed limited efficacy and poor patient tolerance.
- Continuous intrathecal liposomal AmB administration resulted in patient recovery.
- No adverse events were reported during the intrathecal treatment phase.
Conclusions:
- Continuous intrathecal liposomal AmB administration is a viable and effective treatment option for refractory cryptococcal encephalitis.
- This approach may overcome limitations associated with intravenous administration in severe cases.
- Further clinical investigation is warranted to establish this treatment modality.
