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Cryptococcal meningitis accounts for about 68% of meningitis cases in those with HIV and has a mortality rate of 10-25%, with delays in diagnosis and treatment being especially common and associated with a poor prognosis. [5] The treatment for chronic infectious meningitis is directed at the underlying infectious agent.
Cryptococcal meningitis is a primary contributor to mortality among individuals with HIV/AIDS in sub-Saharan Africa. [63] Approximately 160,000 cases of cryptococcal meningitis are reported in West Africa, resulting in 130,000 deaths in sub-Saharan Africa. [64] Uganda is reported to have the highest occurrence of cryptococcus meningitis. [54]
Meningitis is an unusual manifestation of blastomycosis and can be very difficult to diagnose. Cryptococcus (Cryptococcal meningitis) - it is thought to be acquired through inhalation of soil contaminated with bird droppings. C. neoformans is the most common pathogen to cause fungal meningitis.
Fungal meningitis, such as cryptococcal meningitis, is treated with long courses of high dose antifungals, such as amphotericin B and flucytosine. [55] [82] Raised intracranial pressure is common in fungal meningitis, and frequent (ideally daily) lumbar punctures to relieve the pressure are recommended, [55] or alternatively a lumbar drain. [53]
Cryptococcal antigen from cerebrospinal fluid is thought to be the best test for diagnosis of cryptococcal meningitis in terms of sensitivity, though it might be unreliable in HIV-positive patients. [12] The first genome sequence for a strain of C. neoformans (var. neoformans; now C. deneoformans) was published in 2005. [5]
People who have C. gattii infection need to take prescription antifungal medication for at least 6 months; usually the type of treatment depends on the severity of the infection and the parts of the body that are affected. For people who have asymptomatic infections or mild-to-moderate pulmonary infections, the treatment is usually fluconazole.
Management generally involves symptom control and treatment of the underlying infection. In severe cases of IRIS, corticosteroids are commonly used. Important exceptions to using corticosteroids include Cryptococcal meningitis and Kaposi’s sarcoma, as they have been associated with poorer outcomes. [3] [4]
Guidelines for proper dosing exist. Serum level determinations are mandatory for these patients. All patients receiving flucytosine should be under strict medical supervision. Hematological, renal and liver function studies should be done frequently during therapy (initially daily, twice a week for the rest of treatment).