CRYPTOCOCCAL MENINGITIS - DIAGNOSIS AND TREATMENT

In the last decade, largely due to the increasing number of immunocomp romised patients, particularly those with AIDS, there has been a drama tic increase in the incidence of cryptococcosis. The majority of human cryptoccoccal infections are caused by C. neoformans. Pulmonary crypt ococcosis is the commonest form of infection and meningitis is the mos t severe, being fatal in most cases. Diagnosis is usually by culture a nd/or serology. Combined therapy with amphotericin B and flucytosine r emains the initial treatment of choice, although a short course of amp hotericin B alone followed by high dose fluconazole or itraconazole an d the combination of flucytosine with fluconazole or with itraconazole may be effective alternatives. Both azoles, given as single agent mai ntenance therapy, have been shown to be beneficial as they are more ef fective and less toxic than the weekly infusion of amphotericin B. Pri mary prophylaxis with fluconazole has been advocated but problems of r esistance are a concern. To date, itraconazole has not been associated with problems of resistance.