PMID- 29604972
OWN - NLM
STAT- MEDLINE
DCOM- 20180904
LR  - 20180904
IS  - 0072-9752 (Print)
IS  - 0072-9752 (Linking)
VI  - 152
DP  - 2018
TI  - Cryptococcal meningitis in AIDS.
PG  - 139-150
LID - B978-0-444-63849-6.00011-6 [pii]
LID - 10.1016/B978-0-444-63849-6.00011-6 [doi]
AB  - Cryptococcal meningitis remains a significant cause of morbidity and mortality 
      amongst patients living with human immunodeficiency virus (HIV). The prevalence 
      in the developed world has decreased as HIV is being diagnosed earlier, but is 
      still significant, and the prevalence in resource-limited settings is exceedingly 
      high. The presenting symptoms usually include a headache, fever, and, less often, 
      cranial nerve abnormalities. Space-occupying lesions do occur, but are rare. Once 
      diagnosed, patients should be treated with a combination of amphotericin and 
      flucytosine, with step-down therapy to fluconazole for a minimum of a year, or 
      until the CD4 count is above 100 cells/muL, whichever is longer. In the acute 
      phase of treatment increased opening pressure is common, which should be managed 
      aggressively with frequent lumbar punctures, or through neurosurgical 
      interventions (lumbar drains, ventriculoperitoneal shunts) if those fail. 
      Antiretrovirals should be delayed at least 2 weeks, but maybe as many as 10 
      weeks, after initiation of antifungal therapy in order to prevent clinical or 
      subclinical immune reconstitution inflammatory syndrome (IRIS), which may lead to 
      increased mortality. However, if IRIS does develop, there is no role for 
      antiretroviral interruption, and the condition should be managed supportively by 
      use of anti-inflammatories and aggressive management of elevated opening 
      pressure, if present. Steroids should be administered for specific indications 
      only (IRIS or cryptococcoma with cerebral edema and risk of herniation) as 
      routine use of steroids increases mortality in cryptococcal meningitis.
CI  - Copyright (c) 2018 Elsevier B.V. All rights reserved.
FAU - Spec, Andrej
AU  - Spec A
AD  - Division of Infectious Diseases, Department of Medicine, Washington University 
      School of Medicine, St. Louis, MO, United States.
FAU - Powderly, William G
AU  - Powderly WG
AD  - Division of Infectious Diseases, Department of Medicine, Washington University 
      School of Medicine, St. Louis, MO, United States. Electronic address: 
      wpowderly@wustl.edu.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Netherlands
TA  - Handb Clin Neurol
JT  - Handbook of clinical neurology
JID - 0166161
RN  - 0 (Antifungal Agents)
SB  - IM
MH  - AIDS-Related Opportunistic Infections/*diagnosis/drug therapy/*epidemiology
MH  - Acquired Immunodeficiency Syndrome/*diagnosis/drug therapy/*epidemiology
MH  - Animals
MH  - Antifungal Agents/therapeutic use
MH  - Humans
MH  - Meningitis, Cryptococcal/*diagnosis/drug therapy/*epidemiology
MH  - Spinal Puncture/methods
OTO - NOTNLM
OT  - Africa
OT  - amphotericin
OT  - cryptococcal meningitis
OT  - cryptococcus
OT  - fluconazole
OT  - flucytosine
OT  - lymphocytic meningitis
EDAT- 2018/04/02 06:00
MHDA- 2018/09/05 06:00
CRDT- 2018/04/02 06:00
PHST- 2018/04/02 06:00 [entrez]
PHST- 2018/04/02 06:00 [pubmed]
PHST- 2018/09/05 06:00 [medline]
AID - B978-0-444-63849-6.00011-6 [pii]
AID - 10.1016/B978-0-444-63849-6.00011-6 [doi]
PST - ppublish
SO  - Handb Clin Neurol. 2018;152:139-150. doi: 10.1016/B978-0-444-63849-6.00011-6.