title: [Cryptococcal meningitis].
abstract: Immunocompromised patients are at increased risk of disseminated cryptococcal infection, often presenting as a primary respiratory infection with yeast cells originating from bird excreta. Because Cryptococcus neoformans has a tropism for cerebrospinal fluid, most patients suffer from meningitis or meningoencephalitis. Symptoms of cryptococcal meningitis are non-specific: headache, fever, nausea, or altered mental state and behaviour. Case descriptions of a renal transplant recipient and an HIV patient illustrate the non-specific presentation of cryptococcal meningitis. Lumbar puncture seemed to be critical in establishing the diagnosis. Cerebrospinal fluid, blood and other tissues were tested for C. neoformans by microscopy, culture and antigen tests. The patients were successfully treated with amphotericin B or liposomal amphotericin B intravenously and flucytosine intravenously or orally, followed by long-term fluconazole. The mortality rate for cryptococcal meningitis is 41% among renal transplant recipients and 20% in HIV patients.
authors.affiliation: Rijnstate Ziekenhuis, Arnhem.
authors.forename: W E Erwin
authors.initials: WE
authors.lastname: van Spil
authors.forename: Suzan
authors.initials: S
authors.lastname: Nooijen
authors.forename: Peter Y P
authors.initials: PY
authors.lastname: de Jong
authors.forename: Riena P
authors.initials: RP
authors.lastname: Aliredjo
authors.forename: Ruud G L
authors.initials: RG
authors.lastname: de Sévaux
authors.forename: Jacobien C
authors.initials: JC
authors.lastname: Verhave
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D003455:Cryptococcus neoformans / Q000276:immunology / Q000302:isolation & purification*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D005437:Flucytosine / Q000627:therapeutic use; D015658:HIV Infections / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D013129:Spinal Puncture; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine