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Cryptococcal meningitis is a brain infection caused by a fungus called cryptococcus neoformans, which is found mainly in dirt and bird droppings. Many people have been exposed to the cryptococcus fungus at some time during their lives, but the immune system usually stops the fungus from causing illness.
When the immune system is weakened by HIV, the fungus can cause illness. The most common illness caused by the cryptococcus fungus is cryptococcal meningitis. Meningitis means swelling of the meninges. The meninges are membranes that cover the brain and spinal cord. Cryptococcal meningitis is a serious infection.
The symptoms can be similar to other conditions, but it is important to be aware of the possibility of cryptococcal meningitis. Watch for fever, vomiting, headache, nausea, fatigue, loss of appetite, and a general feeling of not being well. Sometimes symptoms include a stiff neck and seizures. You may experience all or just a few of these symptoms.
Treatment
and Prevention: The standard treatment for cryptococcal meningitis is amphotericin B, which must be given
by intravenous injection. This is usually done in hospital until the
infection is brought under control - this part of the treatment is
called induction treatment and usually takes less than two weeks.
Fliuconazole is sometimes used for milder cases. The doctor checks the
spinal fluid using a procedure called a lumbar puncture (spinal tap),
and measures what's called "the cryptococcal titer" to see if the
infection is under control. Unfortunately, amphotericin B is well known for causing many side
effects, including fevers, chills, headache, anorexia, nausea, vomiting,
dry mouth, diarrhea, kidney damage, and suppression of bone marrow which
can lead to anemia. Despite these side effects, amphotericin B is the
best drug for bringing cryptococcal infections under control, so it's
important to try and get through the induction treatment. There are
several drugs that can be used to lessen the side effects as well. Once the infection is under control, fluconazole (Diflucan) is used to
prevent the cryptococcal infection from coming back. This is called
maintenance treatment. Fluconazole is a pill. Compared to amphotericin
B, fluconazole has few side effects. The most common are headache,
nausea, vomiting, abdominal discomfort, and diarrhea. Elevations in
liver function tests are possible, but rare. There have recently been
reports of reversible hair loss after long term use of fluconazole. For
people who can't tolerate fluconazole, a drug called itraconazole may be
an alternative. A recent important finding is that severe headache and nausea in
people with cryptococcal meningitis can be a sign of pressure build-up
around the brain. This pressure, which is known as the intracranial
pressure, can be checked by the doctor. If the intracranial pressure is
high, it can be relieved by the removal of small amounts of spinal fluid
and the administration of a drug called acetazolamide. Alternatives to standard amphotericin B are currently being studied.
Liposome encapsulated amphotericin B is a newer form of amphotericin B.
The drug is put inside microscopic fat bubbles called liposomes, and
hopefully causes fewer side effects when given this way. There are now
three versions of liposome encapsulated amphotericin B available:
Abelcet, Ambisome and Amphotec. All of these drugs are approved for
people who can't take standard amphotericin B due to side effects. Last
modified: 8/28/2006
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