title: Meningitis due to Cryptococcus neoformans: treatment with posaconazole.
abstract: BACKGROUND
  Central nervous system infections caused by Cryptococcus neoformans remain to be opportunistic infections with high mortality in severely immunocompromised patients such as patients with AIDS. Amphotericin B deoxycholate and fluconazole remain to be the drugs of choice; however, in consideration of the intolerance to amphotericin B deoxycholate and the possible resistance to fluconazole, it is necessary to evaluate other azoles, such as posaconazole, that have demonstrated lower adverse events. The objective of this study was to describe the characteristics and clinical and microbiological response of the use of posaconazole in patients with CNS infections caused by C. neoformans.
  
  
  METHODS
  We designed a case study that included eight patients diagnosed with AIDS and cryptococcal meningitis. Seven patients were treated with 800 mg of posaconazole orally for 28 days.
  
  
  RESULTS
  During the second week of treatment, a cerebrospinal fluid (CSF) culture was performed and was negative for the development of C. neoformans. The patients showed an improvement in signs and symptoms of impairment of the CNS such as reduction of cephalea, fever, visual disturbances such as double vision, meningism and papilledema, and improved alertness and environmental awareness.
  
  
  CONCLUSIONS
  CNS fungal infections usually occur in immunocompromised patients. The use of systemic antifungal agents contributes to the development of fungal resistance. The results of this study suggest that posaconazole is a good alternative in the treatment of fungal CNS infection due to C. neoformans.
authors.affiliation: Hospital de Infectología, CMN La Raza, México, D.F., Mexico. vgaona2@yahoo.com.mx
authors.forename: Veronica G
authors.initials: VG
authors.lastname: Flores
authors.forename: Rosa M Cervantes
authors.initials: RM
authors.lastname: Tovar
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Zaldivar
authors.forename: Enrique A
authors.initials: EA
authors.lastname: Martinez
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000382:microbiology; D000284:Administration, Oral; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003455:Cryptococcus neoformans / Q000187:drug effects* / Q000472:pathogenicity; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000382:microbiology; D008800:Mexico; D008826:Microbial Sensitivity Tests; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole; D000666:Amphotericin B