Treatments for Cryptococcal Meningitis

Cryptococcal meningitis is a fungal infection that attacks the meninges (lining) of the brain and spinal cord. The fungus, cryptococcus neoformans, which is commonly found in the soil containing bird droppings, causes cryptococcal meningitis. According to Cecilia Kanyama, cryptococcal meningitis is usually fatal if not treated. Early diagnosis and treatment is essential for survival.

Significance

Most healthy people are not affected by cryptococcal infections. However, for those who are immunocompromised, such as transplant patients, alcoholics, cancer and those affected with AIDS, the cryptococcus fungus can cause cryptococcal meningitis (Thompson, 2008). According to Dr. Neil M. Ampel, this infection was once rare prior to the HIV epidemic. It is now one of the most common life-threatening infections for those with AIDS.

Symptoms

It is important to know the symptoms to get appropriate treatment. Symptoms include a stiff neck, headache, nausea and vomiting, fever and lethargy. Diagnosis is made via a spinal tap in which the health care provider inserts a needle between the lumbar vertebrae to obtain and analyze spinal fluid.

Treatment

Acute (immediate) and long-term treatments (maintenance) are the focus of patient care, since this disease can reoccur in those who have had it previously. Cryptococcal meningitis is treated with antifungals, primarily amphotericin B, fluconazole or itraconazole.

Amphotericin B

Amphotericin B may be taken intravenously. According to a study in the New England Journal of Medicine, high doses of amphotericin B (0.7 milligrams/kilogram/day) resulted in a higher survival rate than with low dose amphotericin B (0.4 milligrams/kilogram/day). A substance summary by PubChem says that amphotericin B works by preventing the cryptococcus fungus from reproducing or growing. Amphotericin B can cause serious side effects such as nausea and vomiting, low blood pressure and kidney damage.

Fluconazole

A PubChem substance summary sheet says that fluconazole may be taken orally or intravenously to prevent the cryptococcus fungus from reproducing or growing. The recommended dose is 400 milligrams the first day and then 200 milligrams every day for up to 12 weeks. 200 milligrams every day is recommended to prevent relapse. The side effects of fluconazole, which include headache, nausea, and rash, are less serious than amphotericin B and, therefore, may be taken by those who cannot tolerate amphotericin B.

Combination Therapy

Dr. William G. Powderly recommends combining both amphotericin B and fluconazole in patients who are resistant to therapy. He also suggests managing cerebral edema (swelling of the brain) with MRI, CT and lumbar punctures or surgical intervention to reduce the pressure in the brain.

References

• Cryptococcal Meningitis In Africa, PowerPoint Presentation, Cecilia Kanyama, UNC Project-Lilongwe
• Not Your "Typical Patient": Cryptococcal Meningitis in an Immunocompetent Patient, Hilaire I. Thompson, April 30, 2008
• Emerging Disease Issues and Fungal Pathogens Associated with HIV Infection, Neil M. Ampel, M.D., April 22, 1996

Resources

• Treatment of Cryptococcal Meningitis Associated with the Acquired Immunodeficiency Syndrome
• Amphotericin B - Substance Summary, PubChem Substance
• Managing HIV-Related Cryptococcal Meningitis? William G. Powderly, MD, 04/24/2002