Persistent Cryptococcus neoformans infection of the prostate after successful treatment of meningitis. California Collaborative Treatment Group.
OBJECTIVE
To assess the frequency of persistent Cryptococcus neoformans infection in patients with the acquired immunodeficiency syndrome (AIDS) after receiving apparently adequate treatment for meningitis.


METHODS
Blood, urine, and cerebrospinal fluid were cultured at the conclusion of primary therapy to assess the adequacy of treatment.


METHODS
Outpatient clinics at three medical centers.


METHODS
Patients had C. neoformans grown in culture from cerebrospinal fluid. Primary therapy consisted of either 2.0 g of amphotericin B alone; 6 weeks of combination therapy with flucytosine; or, if flucytosine was poorly tolerated, an adjusted minimum total amphotericin B dose. To meet criteria for adequate treatment of meningitis all patients had two sequential cerebrospinal fluid samples which were culture negative.


RESULTS
Nine of forty-one patients grew C. neoformans from urine after completion of primary treatment, but none had urinary symptoms. Fungi were visualized in expressed prostatic secretions in 4 of these patients. One patient refused further treatment and developed cryptococcemia within 5 weeks. Three patients received additional amphotericin B; all had persistent funguria without systemic relapse. Six patients received fluconazole; 4 became urine culture negative, and 2 had systemic relapse.


CONCLUSIONS
The persistence of urinary C. neoformans after adequate therapy for meningitis suggests that the urinary tract (probably the prostate) is a sequestered reservoir of infection from which systemic relapse may occur.
Larsen
R A
RA
Los Angeles County-University of Southern California Medical Center.
Bozzette
S
S
McCutchan
J A
JA
Chiu
J
J
Leal
M A
MA
Richman
D D
DD
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003453:Cryptococcosis / Q000188:drug therapy / Q000209:etiology*; D003455:Cryptococcus neoformans / Q000302:isolation & purification; D004359:Drug Therapy, Combination; D015725:Fluconazole; D006801:Humans; D008297:Male; D008581:Meningitis / Q000150:complications* / Q000188:drug therapy / Q000209:etiology; D011469:Prostatic Diseases / Q000382:microbiology*; D012008:Recurrence; D014230:Triazoles / Q000627:therapeutic use; D014556:Urine / Q000382:microbiology
D000935:Antifungal Agents; D014230:Triazoles; D000666:Amphotericin B; D015725:Fluconazole