[Cryptococcal meningoencephalitis in HIV infected immigrants. Diagnostic and therapeutic aspects with reference to evidence-based medicine"--an overview].
Cryptococcal meningitis is one of the most frequent forms of meningoencephalitis in AIDS patients. Before the introduction of triazole antibiotics like difluconazole, the frequency of this meningitis among AIDS patients was 5-10%, yet declined during the last years. Clinically, nonspecific signs of a meningeal inflammation predominate while focal neurological signs are rare. Rapid institution of high-dose antimycotic therapy is the keystone to improve prognosis and decrease mortality. Antimycotics of choice are amphotericin B, fluconazole, and flucytosin. Diagnosis is established by detection of cryptococcal antigen in cerebrospinal fluid, microscopic demonstration of cryptococci using India-ink, and cryptococcal cultures. Recent developments aim to improve antimycotic therapies. During the last years, lifelong secondary prevention with difluconazole was established. Cryptococci which are resistant against fluconazole and amphotericin B are a special challenge, yet fortunately are rare. Longterm outcome of patients is determined by the progression of the underlying immunosuppression. Therefore, combination of secondary prophylaxis with modern antiviral substances is important. Clinical decision analysis in patients with suspected cryptococcal meningitis is presented using methods from evidence-based medicine.
Weltermann
B M
BM
Klinik und Poliklinik für Neurologie, Westfälische Wilhelms-Universität Münster.
Röttgers
H R
HR
Lüdemann
P
P
Evers
S
S
Reichelt
D
D
Husstedt
I W
IW
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy*; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D018432:Drug Resistance, Multiple; D004641:Emigration and Immigration; D019317:Evidence-Based Medicine; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016919:Meningitis, Cryptococcal / Q000175:diagnosis / Q000188:drug therapy*; D008590:Meningoencephalitis / Q000175:diagnosis / Q000188:drug therapy*; D009460:Neurologic Examination
D000935:Antifungal Agents