Human Immunodeficiency Virus Book

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Cryptococcal Meningitis

Aka: Cryptococcal Meningitis, Cryptococcal Meningoencephalitis
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  1. Etiology
    1. Crytococcus neoformans
  2. Epidemiology
    1. Occurs in 7-10% of HIV infected patients
    2. Initially occult in 50% of these patients
  3. Risk Factors
    1. Usually in patients with advanced disease (CD4 < 50/mm3)
  4. Symptoms
    1. Headache
    2. Confusion
    3. Fever
    4. Altered Level of Consciousness
  5. Signs: Organ Involvement
    1. Neurologic involvement (Meningitis) (85-90%)
    2. Lung or skin involvement (25%)
  6. Labs
    1. CSF Exam
      1. Glucose usually normal
      2. Protein mildly elevated
      3. White Blood Cell Count usually less than 20
      4. India Ink stain usually shows organism
      5. Cryptococcal Ag test (>95% sensitive, specific)
      6. CSF Pressure
        1. High pressure responsible for adverse sequelae
        2. Treat with serial LPs, lumbar drain or VP shunt
    2. Blood Cultures positive (>75%)
    3. Serum cryptococcal Antigen positive (98%)
      1. High titer (>1024:1)
  7. Management: Acute (CNS and extraneural involvement)
    1. Amphotericin B (High dose): 0.7 mg/kg/day
      1. Flucytosine (100 mg/kg/day) may be added
    2. Fluconazole (200 to 400 mg/day) Indications
      1. Normal Mental Status at baseline
      2. Time to sterilization of CSF is slower
      3. Prefer amphotericin B (short course first)
  8. Management: Prophylaxis
    1. General
      1. Relapse occurs in >80% if no suppression given
    2. Fluconazole 200 mg/day

Meningitis, Cryptococcal (C0085436)

Definition (MSH) Meningeal inflammation produced by CRYPTOCOCCUS NEOFORMANS, an encapsulated yeast that tends to infect individuals with ACQUIRED IMMUNODEFICIENCY SYNDROME and other immunocompromised states. The organism enters the body through the respiratory tract, but symptomatic infections are usually limited to the lungs and nervous system. The organism may also produce parenchymal brain lesions (torulomas). Clinically, the course is subacute and may feature HEADACHE; NAUSEA; PHOTOPHOBIA; focal neurologic deficits; SEIZURES; cranial neuropathies; and HYDROCEPHALUS. (From Adams et al., Principles of Neurology, 6th ed, pp721-2)
Concepts Disease or Syndrome (T047)
MSH D016919
ICD9 321.0
ICD10 B45.1
SnomedCT 187092002, 14232007
English Cryptococcal Meningitides, Meningitides, Cryptococcal, Meningitis, Cryptococcal, Cryptococcal Meningitis, MENINGITIS CRYPTOCOCCAL, CRYPTOCOCCAL MENINGITIS, MENINGITIS TORULA, crypto meningitis, cryptococcal meningitis, cryptococcal meningitis (diagnosis), Meningitis cryptococcal, Cryptococcal neoformans meningitis, Meningitis torula, Meningitis, Cryptococcal [Disease/Finding], meningitis cryptococcal, Cryptococcal meningitis, Meningitis due to cryptococcus, Cryptococcal meningitis (disorder), Meningitis due to Cryptococcus
Italian Meningite criptococcica, Meningite da Criptococcus neoformans, Meningite torula, Meningite da criptococco, Meningite da Cryptococcus neoformans
Dutch Cryptococcus neoformans meningitis, cryptokokkenmeningitis, Torula-meningitis, cryptokokkenhersenvliesontsteking, Cryptokokkenmeningitis, Meningitis, cryptokokken-
French Méningite à Cryptococcus, Méningite à Cryptococcus neoformans, Méningite à torula, Méningite à cryptocoque, Méningite cryptococcique, Méningite à cryptocoques
German Cryptococcus neoformans Meninigitis, Torulameningitis, Meningitis durch Kryptokokken, Meningitis, Kryptokokken-, Kryptokokkenmeningitis
Portuguese Meningite por Cryptococcus neoformans, Meningite a torula, Meningite por criptococo, Meningite criptocócica, Meningite Criptocócica
Spanish Meningitis torula, Meningitis por Cryptococcus neoformans, Cryptococcal meningitis, meningitis criptocócica, meningitis por Cryptococcus, meningitis por criptococos (trastorno), meningitis por criptococos, Meningitis criptocócica, Meningitis Criptocócica, Meningitis Criptococica
Japanese クリプトコッカス・ネオフォルマンス性髄膜炎, 酵母菌性髄膜炎, ｸﾘﾌﾟﾄｺｯｶｽｾｲｽﾞｲﾏｸｴﾝ, ｸﾘﾌﾟﾄｺｯｶｽﾈｵﾌｫﾙﾏﾝｽｾｲｽﾞｲﾏｸｴﾝ, ｺｳﾎﾞｷﾝｾｲｽﾞｲﾏｸｴﾝ, クリプトコッカス性髄膜炎, 髄膜炎-クリプトコッカス, クリプトコッカス髄膜炎
Swedish Hjärnhinneinflammation, kryptokock
Czech meningitida kryptokoková, Torulózní meningitida, Kryptokoková meningitida, Meningitida způsobená kvasinkou Cryptococcus neoformans
Finnish Kryptokokin aiheuttama aivokalvotulehdus
Russian MENINGIT KRIPTOKOKKOVYI, МЕНИНГИТ КРИПТОКОККОВЫЙ
Polish Zapalenie opon mózgowych kryptokokowe, Zapalenie opon kryptokokowe
Hungarian Cryptococcalis meningitis, Cryptococcus neoformans meningitis, cryptococcus meningitis, Torula meningitis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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