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Fungal Meningitis (AIDS-Related Cryptococcal Meningitis)

Прочитайте:
  1. Aseptic meningitis
  2. Bacterial and viral meningitis
  3. Chronic meningitis
  4. Chronic meningitis
  5. Epidemiology of aseptic meningitis
  6. Epidemiology of bacterial meningitis
  7. Fungal meningitis update
  8. Meningitis caused by Neisseria meningitides
  9. Meningitis overview

For initial therapy, administer amphotericin B (0.7-1 mg/kg/d IV) for at least 2 weeks, with or without flucytosine (100 mg/kg PO) in 4 divided doses. Liposomal preparations of amphotericin B may be used in patients with or who are predisposed to develop renal dysfunction (amphotericin B liposome 3-4 mg/kg/d or amphotericin B lipid complex 5 mg/kg/d).

For consolidation therapy, administer fluconazole (400 mg/d for 8 wk). Itraconazole is an alternative if fluconazole is not tolerated.

For maintenance therapy, long-term antifungal therapy with fluconazole (200 mg/d) is most effective (superior to itraconazole and amphotericin B at 1 mg/kg/wk) to prevent relapse. The risk of relapse is high in patients with AIDS.

In many cases, cryptococcal meningitis is complicated by increased ICP. Measuring the opening pressure during the lumbar puncture is strongly advised. Make an effort to reduce such pressure by repeated lumbar puncture, a lumbar drain, or a shunt. Medical maneuvers, such as administration of mannitol, have also been used.

The role of newer agents, such as voriconazole and posaconazole, has not been investigated. Echinocandins do not have activity against cryptococcus.

For the optimal treatment for HIV-related acute cryptococcal meningitis in resource-limited areas, the agents that are used are amphotericin B and fluconazole. Hence, the treatment would consist of amphotericin and flucytosine, and policy makers and national departments of health in such countries should consider adding drugs that are typically unavailable in such settings (eg, flucytosine) for HIV treatment programs.[29]

Go to HIV-1 Associated CNS Conditions - Meningitis for complete information on this topic.

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