Human Immunodeficiency Virus Book

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Cryptococcal Meningitis

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  1. Epidemiology
    1. Occurs in 7-10% of HIV infected patients
    2. Initially occult in 50% of these patients
  2. Risks
    1. Usually in patients with advanced disease (CD4 < 50)
  3. Organ Involvement
    1. Neurologic involvement (Meningitis) (85-90%)
    2. Lung or skin involvement (25%)
  4. 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)
  5. 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)
  6. 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)
ConceptsDisease or Syndrome (T047)
ICD9321.0
MSHD016919
EnglishCryptococcal Meningitides, Cryptococcal meningitis, MENINGITIS CRYPTOCOCCAL, Meningitis due to Cryptococcus, MENINGITIS TORULA
Spanishmeningitis criptococica, meningitis por criptococos, meningitis por Cryptococcus
Parent ConceptsMeningitis due to organism NOS (C0154644), Infection by Cryptococcus neoformans (C0010414), Meningitis, Fungal (C0085438), Cryptococcus infection of the central nervous system (C1320178), Duplicate concept (C1274013)
SourcesCST, ICD9CM, MSH, NDFRT, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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