Cryptococcal meningitis

Description:

Cryptococcal meningitis  (cryptococcal meningitis, cryptococcosis) – an inflammation of covers of a head and spinal cord as a result of infection with Cryptococcus neoformans fungus. Infection occurs in the airborne way. Cryptococcal meningitis arises at the low immune status. Characteristic simtoma of a disease – a headache, hardening of occipital muscles, a visual disturbance and other sense bodys. In the absence of the corresponding treatment there can come coma and death.
Cryptococcal meningitis – a widespread opportunistic infection and a cause of death of patients with AIDS.

Symptoms of Cryptococcal meningitis:

Symptoms can vary from a slight headache to heavy clinical meningitis and a coma.
Sometimes patients address with abnerval manifestations, such as damages of lungs or skin. The remaining headache at the HIV-seropositive patient is always the indication to performance of a lumbar puncture if at a computer tomography of a brain do not find a sufficient explanation for complaints. Irrespective of cellular number, a kontsetration of protein and glucose in liquor (the patient with cryptococcal meningitis can have normal these three indicators) at the patient with AIDS quantitative definition of cryptococcal antigens in liquor as this test has high sensitivity and specificity always has to be carried out. Approximately in 75% of cases cryptococci can become seen when coloring by the east Indian ink drug.

Reasons of Cryptococcal meningitis:

Cryptococcus neoformans - everywhere the found barmy fungus which can be isolated mainly from excrement of birds. The meningitis caused by S. neoformans is observed only at patients with reduced T-cellular immunity. In the past this infection was observed at patients after transplantations which received treatment by glucocorticosteroids or timotsitarny immunoglobulin; at a part of patients it was impossible to specify the contributing factors. Now cryptococcal meningitis is observed, mainly at HIV infection.
Cryptococcal meningitis occurs in Holland at 4-10% of patients with AIDS and is a disease indicator for diagnosis of AIDS. The infection arises aerogenno, however primary pulmonic infection often proceeds asymptomatically. A soft meninx and a brain are the place of preferential localization, just as a prostate from where there can often take place be recurrence.

Treatment of Cryptococcal meningitis:

The initial, average or acute infection (when there are symptoms connected with activity of a brain) is treated by Amphotericinum In or liposomal (the covered fat) Amphotericinum of Century. Treatment is made through the central line (Hikmana or Portakat) in a deep vein. This more difficult treatment which can continue up to 6 weeks. Intake of fluconazole or an itrakonazol it is efficient against a cryptococcus, but is not so effective therefore it is applied only in case of easy course of a disease. If meningitis causes the increased intracranial pressure, its decrease becomes a part of treatment that reduces danger of injury of a brain. After treatment of an infection secondary prevention which is vital in order to avoid return of an infection is carried out. Such prevention is carried out by intake of capsules of fluconazole on 400 mg/day in the first eight weeks, then the dose decreases to 200 mg/day until the CD4 level remains lower than 200-100. The maintenance therapy can be stopped after successful reaction of immune system to ARV-therapy when the CD4 level rises higher than 100. As well as with other options of the supporting treatment if the CD4 level in the future falls, secondary prevention will need to be repeated.
If you are in the country in which the frequency of infection of cryptococcomas is high, and your CD4 level lower than 100, prevention by fluconazole (200 mg/day) or itrakonazoly can help you to avoid an infection. It has to be balanced in order to avoid danger of development of resistance. If it is possible, ARV-therapy is the best way of prevention as it is capable to support at the high level your cells by CD4.