Treatment of cryptococcal meningitis in Peruvian AIDS patients using amphotericin B and fluconazole.
OBJECTIVE
To describe the mycologic and clinical outcomes and factors associated with failure in Peruvian patients with AIDS-associated cryptococcal meningitis (CM) treated with amphotericin B deoxycholate (Amph B) followed by fluconazole.


METHODS
Patients were treated with intravenous Amph B 0.7 mg/kg/day for 2 or 3 weeks followed by oral fluconazole 400mg/day for 7 or 8 weeks. Clinical and laboratory evaluations including cerebrospinal fluid (CSF) studies were performed at baseline and at weeks 2 and 10.


RESULTS
The CSF cultures were negative in 25% and 68% of 47 patients at weeks 2 and 10, respectively. In the univariate analysis, baseline low body mass index (BMI), hyponatremia, low serum albumin, positive blood culture and CSF antigen titers >or=1024 were associated with a positive CSF culture at week 2. Baseline positive urine culture, positive blood culture, any positive extraneural culture and CSF opening pressure at week 2 >or=300 mm H2O were associated with a positive CSF culture at week 10. In the multivariate analysis no association was found.


CONCLUSIONS
Therapy with Amph B and fluconazole, combined with aggressive management of elevated intracranial pressure (ICP), results in low CSF sterilization rates at week 2 and acceptable CSF sterilization rates at week 10 when compared with other series.
Dammert
P
P
Department of Medicine, John Stroger Jr. Hospital of Cook County, 1900 West Polk Street, Chicago, IL 60612, USA. pedrodammert@hotmail.com
Bustamante
B
B
Ticona
E
E
Llanos-Cuentas
A
A
Huaroto
L
L
Chávez
V M
VM
Campos
P E
PE
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001769:Blood / Q000382:microbiology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D003454:Cryptococcus / Q000302:isolation & purification; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy*; D010568:Peru; D012307:Risk Factors; D016896:Treatment Outcome; D014556:Urine / Q000382:microbiology
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole