CM is more common in people who have compromised immune systems, such as people who have AIDS. Diagnosis of meningitis is mainly based on clinical presentation and cerebrospinal fluid analysis. Classic signs of meningeal irritation commonly are absent on physical examination, and routine laboratory assessment is rarely revealing. The Advisory Committee on Immunization Practices recently added a category B recommendation (individual clinical decision making) for consideration of vaccination with serogroup B vaccines in healthy patients 16 to 23 years of age (preferred age of 16 to 18 years).60,61 The serogroup B vaccines are not interchangeable, so care should be taken to ensure completion of the series with the same brand that was used for the initial dose. Centers for Disease Control and Prevention. Saving Lives, Protecting People, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP), Part I: Review of Scientific Data Regarding Transmission of Infectious Agents in Healthcare Settings, Part II: Fundamental Elements Needed to Prevent Transmission of Infectious Agents in Healthcare Settings, Part III: Precautions to Prevent Transmission of Infectious Agents, Table 3. 2023 Healthline Media LLC. With the advent of polyene antifungal agents, particularly amphotericin B, successful outcomes were achieved in as much as 60%70% of patients with cryptococcal meningitis, depending on the status of the host at the time of presentation [1]. The desired outcome is resolution of symptoms, such as cough, shortness of breath, sputum production, chest pain, fever, and resolution or stabilization of abnormalities (infiltrates, nodules, masses, etc.) In cases where fluconazole is not an option, an acceptable alternative regimen is itraconazole, 200400 mg/d, for 612 months [9] (BIII). Antifungal medicine treats meningitis in those who have it, and can prevent meningitis in those who do not. In conjunction with antiretroviral therapy, long-term maintenance antifungal therapy should be administered. In patients with more severe disease, amphotericin B should be used until symptoms are controlled, then an oral azole agent, preferably fluconazole, can be substituted (BIII). These tissues are called meninges. Few studies have been conducted that specifically evaluate outcomes among HIV-negative patients with pulmonary or non-CNS disease. However, in people with weakened immune systems, such as those living with HIV, Cryptococcus can stay hidden in the body and later cause a serious (but not contagious) brain infection called cryptococcal meningitis. Some reports describe the successful use of flucytosine (100 mg/kg/d for 612 months) as therapy for pulmonary cryptococcal disease; however, concern about the development of resistance to flucytosine when used alone limits its use in this setting [2, 5] (DII). Authors Anil A Panackal 1 , Kieren A Marr 2 , Peter R Williamson 3 Affiliations 1 National . Treatment decisions should not be based routinely or exclusively on cryptococcal polysaccharide antigen titers in either the serum or CSF [31, 34] (AI). Additional costs are accrued for the biweekly monitoring of therapies during acute induction therapy and every-other-week monitoring during consolidation therapy. Medical approaches, including the use of corticosteroids, acetazolamide, or mannitol, have not been shown to be effective in the setting of cryptococcal meningitis. However, failing eradication, which is common in HIV disease, long-term control of infection and resolution of clinical evidence of disease are the principal goals. Taking this medication helps prevent relapses. Common manifestations in this setting include papilledema, hearing loss, loss of visual acuity, pathological reflexes, severe headache, and abnormal mentation. Abstract. Cryptococcal antigen can be found in the body weeks before symptoms of meningitis. Most common causes are viral or autoimmune. Whether the CNS disease is associated with involvement of other body sites, treatment remains the same. Copyright 2023 American Academy of Family Physicians. Appropriate antibiotics should be given to identified contacts within 24 hours of the patient's diagnosis and should not be given if contact occurred more than 14 days before the patient's onset of symptoms.63 Options for chemoprophylaxis are rifampin, ceftriaxone, and ciprofloxacin, although rifampin has been associated with resistant isolates.62,63, This article updates a previous article on this topic by Bamberger.9. Three antifungal drugs are of benefit in the treatment of cryptococcal meningitis in patients with AIDS: amphotericin B, fluconazole, and flucytosine. GBS meningitis typically affects newborns but can affect adults too. Improving access to these tests is a key step in reducing deaths from cryptococcal meningitis. Because of the potential for mass lesions within the brain among patients with AIDS, imaging of the CNS should be performed before CSF sampling. After 10 weeks of therapy, the fluconazole dosage may be reduced to 200 mg/d, depending on the patient's clinical status. Recommendations. Toxicity associated with use of fluconazole/flucytosine combination therapy is substantial [15]. You can review and change the way we collect information below. (2005). Most patients with cryptococcal meningoencephalitis are immunocompromised. Objectives. Length of treatment varies based on the pathogen identified (Table 67 ). Ketoconazole has in vitro activity against C. neoformans, but is generally ineffective in the treatment of cryptococcal meningitis and should be used rarely, if at all, in this setting [10] (CIII). CM usually occurs in people who have a compromised immune system. What are the symptoms of cryptococcal meningitis? Control Management of Cases: Enteric precautions are indicated for seven days after onset, unless a non-enteroviral diagnosis is established. However, it is also important to exclude cryptococcal meningitis in patients with seizures, bizarre behavior, confusion, progressive dementia, or unexplained fever. Your doctor will monitor you closely while youre on this drug to watch for nephrotoxicity (meaning the drug can be toxic to your kidneys). Objective: This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of CM. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Intravenous antibiotics should be used to complete the full treatment course, but outpatient management can be considered in persons who are clinically improving after at least six days of therapy with reliable outpatient arrangements (i.e., intravenous access, home health care, reliable follow-up, and a safe home environment).7, Corticosteroids are traditionally used as adjunctive treatment in meningitis to reduce the inflammatory response. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. These essential medications are often unavailable in areas of the world where they are most needed. Latent Tuberculosis Infection Treatment: Still a Long Road Ahead, A Systematic Review and Meta-Analysis of Tuberculous Preventative Therapy Adverse Events, Efficacy of a 4-Antigen Staphylococcus aureus Vaccine in Spinal Surgery: The STRIVE Randomized Clinical Trial, Durlobactam, a Broad-Spectrum Serine -lactamase Inhibitor, Restores Sulbactam Activity Against Acinetobacter Species, The Pharmacokinetics/Pharmacodynamic Relationship of Durlobactam in Combination With Sulbactam in In Vitro and In Vivo Infection Model Systems Versus Acinetobacter baumannii-calcoaceticus Complex, Mycoses Study Group Cryptococcal Subproject, About the Infectious Diseases Society of America, Guidelines for the Treatment of Cryptococcosis in Patients without HIV Infection, Guidelines for the Treatment of Pulmonary and CNS Cryptococcosis in Patients with HIV Infection, Guidelines from the Infectious Diseases Society of America, Receive exclusive offers and updates from Oxford Academic, Antifungal Therapy and Management of Complications of Cryptococcosis due to, Identification of Patients with Acute AIDS-Associated Cryptococcal Meningitis Who Can Be Effectively Treated with Fluconazole: The Role of Antifungal Susceptibility Testing, Early Mycological Treatment Failure in AIDS-Associated Cryptococcal Meningitis.
