Cryptococcosis

Background

Clinical Features

Differential Diagnosis

Headache

Common

Killers

Maimers

Others

Aseptic Meningitis

Evaluation

  • 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
  • Itraconazole 200mg PO q12hrs daily x 6-12 months
  • 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 + Flucytosine 25mg/kg PO q6hrs x 4 weeks
    • Followed by Fluconazole 400mg PO q24hrs x 8 weeks

Meningitis (with AIDS)

  • Amphotericine B 0.7=1mg/kg IV q24hrs + Flycytosine 25mg/kg PO q6hrs x 2 weeks
    • Followed by Fluconazole 400mg PO q24hrs x 8 weeks

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

See Also

References