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- This is an infection caused by the fungus Cryptococcus neoformans. It may affect any organ in the body, but its most serious form of disease is cryptococcal meningitis. Cryptococcosis most often occurs in persons who are immunocompromised (their immune systems do not work properly), such as those with HIV and Hodgkin's disease, those taking cancer chemotherapy, or those who are on chronic corticosteroid therapy (e.g., Rheumatoid Arthritis).
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- Meningitis -- headaches, confusion,
neck stiffness, nausea/vomiting, cranial nerve abnormalities
- Lungs -- cough, shortness of
breath, or wheezing
- Other organs -- depends on the
organ
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- Lumbar puncture (spinal tap) shows
increased pressure, increased wbc count, increased protein,
and decreased glucose. An India ink stain will show
encapsulated organisms.
- Cryptococcal antigen and
cryptococcal cultures are checked
- Serum (blood) cryptococcal antigen
level is checked
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- Amphotericin B intravenously for
high risk patients and more severe cases
- Another regimen often used is
initial amphotericin B plus Flucytosine for the initial 2
weeks, followed by Fluconazole for 8 weeks.
- There is a "lipid" preparation of
Amphotericin B that has less side effects and is often used
in those without HIV (those without HIV tend to generally be
more ill, because they are often cancer patients)
- Ventricular shunting may be
necessary if hydrocephalus (cerebral spinal fluid build up
in the brain) occurs
- Maintenance treatment -- in
patients with HIV disease, there is a lower maintenance dose
Fluconazole, because they will be taking it throughout their
lifetime, while those without the HIV diseases will only be
on the drug for three months.
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