Most cases are . Systemic complications of acute bacterial meningitis must be treated, including the following: Hypotension or shock Hypoxemia Hyponatremia (from syndrome of inappropriate antidiuretic hormone. CSF results can be variable, and decisions about treatment with antibiotics while awaiting culture results can be challenging. Costs. Most patients with cryptococcal meningoencephalitis are immunocompromised. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Cryptococcosis is a pulmonary or disseminated infection acquired by inhalation of soil contaminated with the encapsulated yeasts Cryptococcus neoformans or C. gattii. A lumbar puncture is recommended after 2 weeks of treatment to assess the status of CSF sterilization. Such testing is generally best used in cases of relapse or in cases of refractory disease. If your tests come back negative for CM for two weeks, your doctor will probably ask you to stop taking amphotericin B and flucytosine. (PDF) Cryptococcal meingitis - ResearchGate Beginning in the 1980s, orally bioavailable azole antifungal agents with activity against C. neoformans were introduced, in particular, itraconazole and fluconazole. Meningitis - Knowledge @ AMBOSS However, patients with nonpulmonary, extraneural (e.g., bone or skin) disease require specific antifungal therapy. Thus, itraconazole should be used in cases where the patient is intolerant of fluconazole or has failed fluconazole therapy (BI). The most troublesome toxic side effect is renal injury, including elevation of the serum creatinine, hypokalemia, hypomagnesemia, and renal tubular acidosis. Studies evaluating the effectiveness of amphotericin B, with or without flucytosine, have elucidated the optimal length of therapy for HIV-negative, immunocompromised and immunocompetent hosts. Cookies used to make website functionality more relevant to you. Induction therapy beginning with an azole alone is generally discouraged. The prevalence of cryptococcosis in these studies was too low to provide direct evidence or confirm that antiretroviral therapy affects cryptococcal disease, but there is no biological basis to suspect that control of cryptococcosis in AIDS patients would not be improved by the use of HAART. For immunocompetent hosts with isolated pulmonary disease, careful observation may be warranted; in the case of symptomatic infection, indicated treatment is fluconazole, 200400 mg/day for 36 months. Therefore, the specific treatment of choice has not been fully elucidated. Serum procalcitonin, serum C-reactive protein, and CSF lactate levels can be useful in distinguishing between aseptic and bacterial meningitis.2833 C-reactive protein has a high negative predictive value but a much lower positive predictive value.28 Procalcitonin is sensitive (96%) and specific (89% to 98%) for bacterial causes of meningitis.29,30 CSF lactate also has a high sensitivity (93% to 97%) and specificity (92% to 96%).3133 CSF latex agglutination testing for common bacterial pathogens is rapid and, if positive, can be useful in patients with negative Gram stain if LP was performed after antibiotics were administered.
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