Cryptococcosis: Difference between revisions
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*Once the CD4 count > 200 and the patient is asymptomatic therapy x 6 months, therapy can be discontinued | *Once the CD4 count > 200 and the patient is asymptomatic therapy x 6 months, therapy can be discontinued | ||
*Some patients can require longer durations of therapy depending on symptom persistence | *Some patients can require longer durations of therapy depending on symptom persistence | ||
==See Also== | |||
*[[Fungal infections]] | |||
==References== | ==References== | ||
Revision as of 14:46, 4 May 2015
Background
- Can produce focal cerebral lesions or diffuse meningoencephalitis
Clinical Features
Differential Diagnosis
Diagnosis
- Neuroimaging usually normal
- CSF Studies
- Crypto antigen (100% Sn & Sp)
- Crypto culture (95%-100% Sn)
- India Ink (60-80% Sn)
- Opening pressure
- Usually elevated; drain CSF until pressure is <20 or 50% of opening presure
- Serum
- Cryptococcal antigen testing (95% Sn)
Management
Pulmonary (not AIDS associated)
- Fluconazole 400mg PO IV q24hrs x 6-12 months OR
- Itraconazole 200mg PO q12hrs daily x 6-12 months OR
- Voriconazole 200mg PO q12hrs x 6-12 months
Pulmonary (with AIDS)
- Fluconazole 400mg PO q24hrs x 6-12 months
Meningitis (not AIDs associated)
- Amphotericin B 0.7-1mg/kg IV q24hrs AND Flucytosine 25mg/kg PO q6hrs x 4 weeks
- Followed by Fluconazole 400mg PO q24hrs x 8 weeks
Meningitis (with AIDS)
- Amphotericin B 0.7-1mg/kg IV q24hrs AND Flucytosine 25mg/kg PO q6hrs x 2 weeks
- Followed by Fluconazole 400mg PO q24hrs x 8 weeks
- Initiation of HAART is delayed by 2 to 10 weeks to minimize the risk of immune reconstitution syndrome
Disposition
- Admit to Medicine with ID consult
- Once the CD4 count > 200 and the patient is asymptomatic therapy x 6 months, therapy can be discontinued
- Some patients can require longer durations of therapy depending on symptom persistence