National Institutes of Health; National Institute of Allergy and Infectious Diseases - April 1994

Symptoms and Diagnosis

Cryptococcal meningitis is the most common cryptococcal infection in people with AIDS, affecting about one out of every ten patients. The first symptoms of this infection are fever, fatigue, nausea, vomiting and headache. Cryptococcal meningitis may cause a person to become confused and have memory loss. Family members or friends may note small changes in personality or behavior. If people with cryptococcal meningitis are not treated, they may lapse into a coma and die.

Doctors diagnose cryptococcal meningitis by detecting the cryptococcal organism or one of its proteins in a sample of blood or of spinal fluid, which is removed from the spine through a needle.

Treatment

Acute. Patients with cryptococcal meningitis are usually treated with the antifungal drug amphotericin B. Many patients are also given the antifungal drug flucytosine for at least two weeks. Another treatment option is the antifungal agent fluconazole, which can be taken by mouth or given through the veins.

Amphotericin B has many side effects including kidney damage, high fever, low blood pressure, decreased numbers of red or white blood cells, nausea, vomiting and chills. A newer formulation of the drug, in which the active compound is encased in a fatty substance, is under study and may have fewer side effects. However, more research is needed to assess the safety and effectiveness of this new form of amphotericin B. Flucytosine also may cause serious side effects, including decreased numbers of red or white blood cells, liver damage, nausea, diarrhea, seizures, abdominal discomfort or rash.

Fluconazole causes fewer, less severe side effects including skin rashes and liver enzyme abnormalities.

Maintenance. About four out of five patients survive the initial phase of meningitis. However, half of AIDS patients treated for cryptococcal meningitis will experience a relapse of the disease within one year unless they receive further treatment to prevent it. This is called maintenance therapy.

To prevent relapses, most doctors recommend that people who have had cryptococcal meningitis take fluconazole daily. Other durgs used include intravenous amphotericin B taken weekly or biweekly. Another drug under investigation for maintenance therapy to prevent cryptococcal disease is intraconazole.

Research

The National Institute of Allergy and Infectious Diseases (NIAID) funds research aimed at finding new drugs or drug combinations for the treatment or prevention of cryptococcal meningitis, as well as better ways to administer currently available drugs. Several new therapies for cryptococcal disease are being evaluated for safety or effectiveness in NIAID-sponsored clinical trials.

For information on these or other studies, call the AIDS Clinical Trials Information Services:

1-800-TRIALS-A (1-800-874-2572)

NIAID, a component of the National Institutes of Health, supports research on AIDS and other infectious diseases as well as allergies and immunology. NIH is an agency of the U.S. Public Health Service, U.S. Department of Health and Human Services.

Prepared by:

Office of Communications National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda, MD 20892

Public Health Service U.S. Department of Health and Human Services

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