title: Cryptococcus neoformans meningitis at 2 hospitals in Washington, D.C.: adherence of health care providers to published practice guidelines for the management of cryptococcal disease.
abstract: Meningitis due to Cryptococcus neoformans may be associated with elevated intracranial pressure (ICP), but management of this complication is often overlooked. We retrospectively analyzed 39 consecutive patients with cases of culture-proven, community-acquired meningitis and ascertained adherence to Infectious Diseases Society of America (IDSA) practice guidelines for management of cryptococcal meningitis. Of these 39 patients, 26 (67%) had infection due to C. neoformans. Cerebrospinal fluid opening pressure had been measured for 13 (50%) of these 26 patients, and major deviations from the guidelines with respect to ICP management were observed in the care of 14 (54%). Seven (50%) of these 14 patients developed neuropathies during therapy, compared with 1 of the 5 patients whose care had minor or no deviations from the guidelines (P=.024). Major departures from the IDSA guidelines for management of ICP due to C. neoformans meningitis are common and can be associated with neurological injury during therapy.
authors.affiliation: Washington Hospital Center, Washington, DC 20010, USA. shmuel.shoham@medstar.net <shmuel.shoham@medstar.net>
authors.forename: Shmuel
authors.initials: S
authors.lastname: Shoham
authors.forename: Cameron
authors.initials: C
authors.lastname: Cover
authors.forename: Nancy
authors.initials: N
authors.lastname: Donegan
authors.forename: Eric
authors.initials: E
authors.lastname: Fulnecky
authors.forename: Princy
authors.initials: P
authors.lastname: Kumar
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D004219:District of Columbia; D019983:Guideline Adherence / Q000592:standards*; D006282:Health Personnel / Q000592:standards*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D019586:Intracranial Hypertension / Q000628:therapy; D016919:Meningitis, Cryptococcal / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D013129:Spinal Puncture
chemical_list: D000935:Antifungal Agents