What is the drug of choice for cryptococcal meningitis?
The drug of choice (DOC) for initial therapy in disseminated or CNS cryptococcosis is amphotericin B. Amphotericin B may be used alone or in combination with flucytosine. Amphotericin B has a rapid onset of action and often leads to clinical improvement more rapidly than either intravenous or oral fluconazole.
How will you diagnose a case of cryptococcal meningitis?
The definitive diagnosis of cryptococcal meningitis is made by culture from the CSF. The opening pressure should be measured along with India ink evaluation, cryptococcal antigen testing, fungal culture, and routine spinal fluid studies.
What is the pathophysiology of cryptococcal meningitis?
The pathophysiology of cryptococcal meningitis depends on a weakened immune system. The yeast takes advantage of poor immunity to reach the lymph nodes — where it multiplies into many cells. From there, these cells spread and most often affect the nervous system. They grow in the meninges, gradually causing symptoms.
When do you start Haart in cryptococcal meningitis?
We hypothesized that ART initiation 1 to 2 weeks after diagnosis of cryptococcal meningitis, during the second week of amphotericin-based therapy in the hospital, would improve the 26-week survival rate, as compared with ART initiation at approximately 5 weeks after diagnosis, provided on an outpatient basis.
What organs does cryptococcosis affect?
After lung and CNS infection, the next most commonly involved organs in disseminated cryptococcosis include the skin, the prostate, and the medullary cavity of bones.
What is the best treatment for fungal meningitis?
Doctors treat fungal meningitis with long courses of high-dose antifungal medications, often given directly into a vein through an IV. After that, patients also need to take antifungal medications by mouth.
How is Cryptococcus treated?
The antifungal arsenal for treatment against cryptococcosis currently is largely limited to three old and off-patent drugs, used singly or in combination: amphotericin B (and its liposomal derivatives), 5-fluorocytosine (5FC) and fluconazole.
Is Cryptococcus Gram positive or negative?
On the Gram stain, cryptococci appear as single, budding, thin-walled, oval to round cells (4-20 microns in diameter) containing Gram positive granular inclusions, surrounded by a capsule that varies in size and appears Gram negative.
How does Cryptococcus spread to CNS?
Cryptococcosis originates by inhalation of aerosolized fungal cells, and there is hematogenous spread from the lung to the brain and other organs. In order to cause meningoencephalitis, the fungal cells must survive in the bloodstream and traverse the blood-brain barrier (BBB).
How is cryptococcosis prevented?
Detecting silent cryptococcal infections in people who have HIV/AIDS. One approach to prevent cryptococcal meningitis is called “targeted screening.” Research suggests that C. neoformans is able to live in the body undetected, especially when a person’s immune system is weaker than normal.
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