PMID- 23697747
OWN - NLM
STAT- MEDLINE
DCOM- 20140207
LR  - 20130724
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Linking)
VI  - 57
IP  - 4
DP  - 2013 Aug
TI  - Antifungal therapy and management of complications of cryptococcosis due to 
      Cryptococcus gattii.
PG  - 543-51
LID - 10.1093/cid/cit341 [doi]
AB  - BACKGROUND: We describe antifungal therapy and management of complications due to 
      Cryptococcus gattii infection in 86 Australian patients followed for at least 12 
      months. METHODS: Patient data from culture-confirmed cases (2000-2007) were 
      recorded at diagnosis, 6 weeks, 6 months, and 12 months. Clinical, laboratory, 
      and treatment variables associated with raised intracranial pressure (ICP) and 
      immune reconstitution inflammatory syndrome (IRIS) were determined. RESULTS: 
      Seven of 10 patients with lung infection received amphotericin B (AMB) induction 
      therapy (6 with 5-flucytosine [5-FC] for a median of 2 weeks); median duration of 
      therapy including azole eradication therapy was 41 weeks, with a complete/partial 
      clinical response in 78%. For neurologic disease, 88% of patients received AMB, 
      78% with 5-FC, for a median of 6 weeks. The median total course was 18 months. 
      Nine patients receiving fluconazole induction therapy were reinduced with AMB 
      plus 5-FC for clinical failure. Raised ICP (31 patients) was associated with 
      initial abnormal neurology, and neurologic sequelae and/or death at 12 months 
      (both P = .02); cerebrospinal fluid drains/shunts were placed in 58% of patients 
      and in 64% of 22 patients with hydrocephalus. IRIS developed 2-12 months after 
      starting antifungals in 8 patients, who presented with new/enlarging brain 
      lesions. Risk factors included female sex, brain involvement at presentation, and 
      higher median CD4 counts (all P < .05); corticosteroids reduced 
      cryptococcoma-associated edema. CONCLUSIONS: Induction AMB plus 5-FC is indicated 
      for C. gattii neurologic cryptococcosis (6 weeks) and when localized to lung (2 
      weeks). Shunting was often required to control raised ICP. IRIS presents with 
      cerebral manifestations.
FAU - Chen, Sharon C-A
AU  - Chen SC
AD  - Centre for Infectious Diseases and Microbiology and The Sydney Institute for 
      Emerging Infections and Biosecurity, Sydney Medical School, University of Sydney, 
      Australia. sharon.chen@swahs.health.nsw.gov.au
FAU - Korman, Tony M
AU  - Korman TM
FAU - Slavin, Monica A
AU  - Slavin MA
FAU - Marriott, Deborah
AU  - Marriott D
FAU - Byth, Karen
AU  - Byth K
FAU - Bak, Narin
AU  - Bak N
FAU - Currie, Bart J
AU  - Currie BJ
FAU - Hajkowicz, Krispin
AU  - Hajkowicz K
FAU - Heath, Christopher H
AU  - Heath CH
FAU - Kidd, Sarah
AU  - Kidd S
FAU - McBride, William J H
AU  - McBride WJ
FAU - Meyer, Wieland
AU  - Meyer W
FAU - Murray, Ronan
AU  - Murray R
FAU - Playford, E Geoffrey
AU  - Playford EG
FAU - Sorrell, Tania C
AU  - Sorrell TC
CN  - Australia and New Zealand Mycoses Interest Group (ANZMIG) Cryptococcus Study
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130522
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
RN  - 0 (Antifungal Agents)
RN  - 7XU7A7DROE (Amphotericin B)
RN  - 8VZV102JFY (Fluconazole)
RN  - D83282DT06 (Flucytosine)
SB  - IM
CIN - Clin Infect Dis. 2013 Aug;57(4):552-4. PMID: 23697746
MH  - Adult
MH  - Amphotericin B/therapeutic use
MH  - Antifungal Agents/*therapeutic use
MH  - Australia
MH  - Cryptococcosis/*diagnosis/*drug therapy/pathology
MH  - Cryptococcus gattii/drug effects/*isolation & purification
MH  - Female
MH  - Fluconazole/therapeutic use
MH  - Flucytosine/therapeutic use
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Cryptococcus gattii
OT  - IRIS
OT  - antifungal therapy
OT  - neurologic complications
EDAT- 2013/05/24 06:00
MHDA- 2014/02/08 06:00
CRDT- 2013/05/24 06:00
PHST- 2013/05/24 06:00 [entrez]
PHST- 2013/05/24 06:00 [pubmed]
PHST- 2014/02/08 06:00 [medline]
AID - cit341 [pii]
AID - 10.1093/cid/cit341 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2013 Aug;57(4):543-51. doi: 10.1093/cid/cit341. Epub 2013 May 
      22.