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Cryptococcal Meningitis

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Meningeal inflammation produced by CRYPTOCOCCUS NEOFORMANS, an encapsulated yeast that tends to infect individuals with ACQUIRED IMMUNODEFICIENCY SYNDROME and other immunocompromised states. The organism enters the body through the respiratory tract, but symptomatic infections are usually limited to the lungs and nervous system. The organism may also produce parenchymal brain lesions (torulomas). Clinically, the course is subacute and may feature HEADACHE; NAUSEA; PHOTOPHOBIA; focal neurologic deficits; SEIZURES; cranial neuropathies; and HYDROCEPHALUS. (From Adams et al., Principles of Neurology, 6th ed, pp721-2)

Also Known As:

Meningitis, Cryptococcal; Cerebral Cryptococcosis; Cerebral Cryptococcoses; Cerebral Cryptococcoses, Granulomous; Cerebral Cryptococcosis, Granulomous; Cryptococcal Meningitides; Cryptococcoses, Cerebral; Cryptococcoses, Granulomous Cerebral; Cryptococcosis, Cerebral; Cryptococcosis, Granulomous Cerebral; Granulomous Cerebral Cryptococcoses; Meningitides, Cryptococcal; Torulomas; Granulomous Cerebral Cryptococcosis; Toruloma

Networked: 676 relevant articles (78 outcomes, 88 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Acquired Immunodeficiency Syndrome (AIDS)
2.	Infection
3.	Candidiasis (Moniliasis)
4.	Aspergillosis
5.	Cryptococcosis

Experts

1.	Harrison, Thomas S: 24 articles (12/2015 - 05/2004)
2.	Meintjes, Graeme: 20 articles (12/2015 - 10/2006)
3.	Jarvis, Joseph N: 17 articles (12/2015 - 04/2009)
4.	Boulware, David R: 16 articles (02/2016 - 06/2008)
5.	Bicanic, Tihana: 16 articles (12/2015 - 10/2006)
6.	Meya, David B: 11 articles (02/2016 - 06/2008)
7.	Wood, Robin: 11 articles (12/2015 - 01/2007)
8.	Loyse, Angela: 8 articles (12/2015 - 07/2008)
9.	Jaffar, Shabbar: 8 articles (07/2012 - 07/2008)
10.	Brouwer, Annemarie E: 7 articles (12/2015 - 05/2004)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Cryptococcal Meningitis:

1.	Fluconazole (Zonal)FDA LinkGeneric 03/01/1992 - "Fluconazole is highly effective in suppressing relapses of cryptococcal meningitis. " 01/01/2011 - "Improved strategies for earlier diagnosis and treatment of HIV, implementation of fluconazole pre-emptive treatment for high-risk patients and acquisition of better resources for treatment of cryptococcal meningitis are needed." 07/01/1994 - "Eight patients (6, cryptococcal meningitis; 2, high-titer cryptococcal antigenemia) were treated with 800 mg/day fluconazole to assess the safety and efficacy of high-dose fluconazole as primary therapy. " 03/01/1992 - "Fluconazole, an orally active antifungal agent, has been shown to be clinically beneficial for maintenance therapy of cryptococcal meningitis. " 03/04/1995 - "Although the optimum dose and duration of fluconazole could not be determined, our results suggest that less than daily use was effective in the prevention of cryptococcal meningitis."
2.	Amphotericin B (Amphotericin)FDA LinkGeneric 07/15/2010 - "It is generally acknowledged that amphotericin B is the most effective treatment for cryptococcal meningitis. " 03/01/1990 - "Although the introduction of amphotericin B has greatly improved the prognosis of patients with cryptococcal meningitis, 30 years of experience have revealed important clinical limitations, including modest efficacy, nephrotoxicity, other clinically significant toxicities, and the inconvenience of intravenous dosing. " 01/01/2011 - "Efficacy of intravenous amphotericin B-polybutylcyanoacrylate nanoparticles against cryptococcal meningitis in mice." 06/26/1993 - "[Efficacy of liposomal amphotericin in the treatment of cryptococcal meningitis in a cirrhotic patient with intolerance to conventional amphotericin]." 01/01/1963 - "The improved prognosis of cryptococcal meningitis with amphotericin B therapy."
3.	Flucytosine (Ancobon)FDA Link 10/01/2007 - "The present study demonstrated the substantial increasing of survival time of HIV-infected patients with cryptococcal meningitis by initiated ART even in a resource limited setting (no flucytosine, local combined antiretroviral drugs with NVP based regimens)." 09/01/2014 - "Access to flucytosine for HIV-infected patients with cryptococcal meningitis – an urgent need." 03/01/2012 - "Herein, we present a case of cryptococcal meningitis from China, which was caused by an azole and flucytosine resistant Filobasidium uniguttulatum. " 07/01/2008 - "Sixty-four HIV-seropositive, antiretroviral therapy-naive patients in Cape Town, South Africa, who experienced their first episode of cryptococcal meningitis during the period May 2005-June 2006 were randomized to receive either (1) AmB, 0.7 mg/kg per day, plus flucytosine, 25 mg/kg 4 times per day (group 1; 30 patients); or (2) AmB, 1 mg/kg per day, plus flucytosine, 25 mg/kg 4 times per day (group 2; 34 patients). " 03/01/2007 - "Oral versus intravenous flucytosine in patients with human immunodeficiency virus-associated cryptococcal meningitis."
4.	Itraconazole (Sporanox)FDA LinkGeneric 12/01/1997 - "In conclusion, maintenance therapy with itraconazole 400 mg/d is effective in preventing recurrent cryptococcal meningitis." 02/01/1992 - "Itraconazole is, therefore, suggested as a new treatment for cryptococcal meningitis." 02/01/1992 - "The results of an open study of the efficacy of oral itraconazole therapy in 8 patients with cryptococcal meningitis are reported. " 07/01/1993 - "Consequently, itraconazole has been considered a valid candidate for studies in patients with cryptococcal meningitis. " 10/12/2015 - "One possible application of itraconazole loaded PBCA-NSP could be to treat cryptococcal meningitis. "
5.	liposomal amphotericin B FDA Link 12/01/2010 - "To the best of our knowledge, in Japan, the combination of L-AMB and VRCZ has rarely been reported to be effective for the treatment of cryptococcal meningitis. " 02/01/2003 - "Nine cases of cryptococcal meningitis or menigoencephalitis treated with Ambisome were clinically cured with an effective rate of 100%, within a mean course of 50 days, which was shorter than that of C-Amb, by a mean cumulative dose of 1807.2 mg, which was not statistically significant in comparison with C-Amb. " 01/01/1994 - "In this study, we examined the efficacy of amphotericin B lipid complex (ABLC) on experimental cryptococcal meningitis and disseminated candidosis. " 01/01/2006 - "We investigated the influence of the progression of cryptococcal meningitis on the brain penetration and efficacy of AmBisome. " 01/01/2006 - "Influence of the progression of cryptococcal meningitis on brain penetration and efficacy of AmBisome in a murine model."
6.	AntigensIBA 04/01/2009 - "Cryptococcal antigen screening before initiation of ART in patients with a CD4 cell count <or=100 cells/microL is highly effective for identifying those at risk of cryptococcal meningitis and death and might permit implementation of a targeted preemptive treatment strategy." 05/01/1982 - "10 normal volunteers and 8 patients who had been cured of cryptococcal meningitis and who had been cured of cryptococcal meningitis and who had no serious underlying diseases were immunized with both antigens. " 03/01/2003 - "[A clinical study of cryptococcal meningitis--sequential changes of cryptococcal antigen titers]." 01/01/1999 - "Of 100 patients enrolled in this study, 58 patients had cryptococcal meningitis and serum cryptococcal antigen was detectable in 60 patients. " 09/01/2015 - "LATERAL FLOW ASSAY FOR CRYPTOCOCCAL ANTIGEN: AN IMPORTANT ADVANCE TO IMPROVE THE CONTINUUM OF HIV CARE AND REDUCE CRYPTOCOCCAL MENINGITIS-RELATED MORTALITY."
7.	Ketoconazole (Nizoral)FDA LinkGeneric 04/01/1985 - "[A case of cryptococcal meningitis improved in the treatment of high dose ketoconazole]." 03/01/1990 - "Ketoconazole has not proved useful in treating cryptococcal meningitis. " 06/25/1982 - "Failure of ketoconazole in cryptococcal meningitis." 06/01/1982 - "The detection of biologically active drug in the brain, and the prolongation of survival afforded by ketoconazole, suggest a potential role for this agent in the theory of cryptococcal meningitis." 06/01/1982 - "Ketoconazole therapy of murine cryptococcal meningitis."
8.	phospholipid emulsion soybean oil (Intralipid)IBA 04/01/2007 - "Intralipid (AmB-IL), in 37 AIDS patients with cryptococcal meningitis (CM). " 01/01/1996 - "Use of intralipid as a vehicle for amphotericin B in the treatment of cryptococcal meningitis in a renal transplant recipient." 07/01/1996 - "We determined the safety and efficacy of deoxycholate-amphotericin B (d-AmB) mixed with Intralipid (IL) as the initial treatment of AIDS-associated cryptococcal meningitis in a phase II, multicentre, non-comparative open study, assessing two dosages of ILd-AmB: 1 mg/kg (group A, n = 9) and 1.5 mg/kg (group B, n = 6). " 09/01/1996 - "We conducted a randomized, open-labeled clinical trial to compare the tolerability and efficacy of amphotericin B deoxycholate, prepared in 5% dextrose or Intralipid (Kabi Pharmacia, Saint-Quentin-en-Yvelines, France), in the treatment of AIDS-associated cryptococcal meningitis in Burundi. " 09/01/1996 - "Randomized comparison of amphotericin B deoxycholate dissolved in dextrose or Intralipid for the treatment of AIDS-associated cryptococcal meningitis."
9.	Deoxycholic Acid (Sodium Deoxycholate)IBA 04/01/2010 - "A patient with cryptococcal meningitis and SLE, who responded well to amphotericin deoxycholate therapy, is reported. " 07/01/1996 - "We determined the safety and efficacy of deoxycholate-amphotericin B (d-AmB) mixed with Intralipid (IL) as the initial treatment of AIDS-associated cryptococcal meningitis in a phase II, multicentre, non-comparative open study, assessing two dosages of ILd-AmB: 1 mg/kg (group A, n = 9) and 1.5 mg/kg (group B, n = 6). " 07/15/2010 - "This double-blind study, performed before the routine availability of highly active antiretroviral therapy, was designed to compare the efficacy and safety of liposomal amphotericin B to conventional amphotericin deoxycholate in patients with acquired immunodeficiency syndrome (AIDS) and acute cryptococcal meningitis. "
10.	LatexIBA 08/15/2010 - "However, ELISPOT outcomes improved when other rapid tests were concurrently used to exclude bacterial (Gram stain) and cryptococcal meningitis (latex-agglutination test) within the non-TBM group. " 01/01/2015 - "This paper aims to discuss the early diagnosis value of latex agglutination test in Cryptococcal meningitis. " 02/01/2011 - "The cryptococcal latex agglutination test of cerebrospinal fluid is valuable for the quick and early diagnosis of cryptococcal meningitis; however, the decision of withdrawal of antifungal treatment should not rely on the results of the test." 02/01/2011 - "To evaluate the value of cryptococcal latex agglutination test in the diagnosis and treatment of cryptococcal meningitis in children. " 02/01/2011 - "[Value of latex agglutination test in the diagnosis and treatment of cryptococcal meningitis in children]."

Therapies and Procedures

1.	Transplants (Transplant) 12/01/2002 - "However, additional studies of recipients of other organ transplants suggested that these patients might be at low risk for cryptococcal meningitis. " 06/01/2014 - "Cryptococcal meningitis following autologous stem cell transplant (SCT) has been described previously in only 1 patient, 4 months post SCT and while off antifungal prophylaxis. " 01/01/2014 - "The third, a 10-year transplant vintage patient, presented with cryptococcal meningitis. " 03/01/2011 - "Early onset of paucisymptomatic cryptococcal meningitis in a kidney transplant patient: a case report and review of the literature." 01/01/2010 - "Subsequent investigation report revealed swollen of 3rd ventricle on CT scan brain and growth of Cryptococcus in CSF culture and diagnosis was made post renal transplant cryptococcal meningitis. "
2.	Intraventricular Infusions 11/15/2015 - "To establish the efficacy of the intraventricular infusion of antifungal drugs through Ommaya reservoirs for cryptococcal meningitis, a prospective investigation should be designed to compare those treated according to the updated guidelines and those treated with antifungal drugs through the Ommaya reservoirs." 11/15/2015 - "The usefulness of intraventricular infusion of antifungal drugs through Ommaya reservoirs for cryptococcal meningitis treatment has been unconfirmed. " 11/15/2015 - "Usefulness of intraventricular infusion of antifungal drugs through Ommaya reservoirs for cryptococcal meningitis treatment." 12/01/1982 - "[A case of cryptococcal meningitis successfully treated with intraventricular infusion of miconazole]."
3.	Combination Drug Therapy (Combination Chemotherapy) 01/01/2013 - "Combination drug therapies are employed to treat patients with HIV, cancer, or tuberculosis, and has considerable promise in the treatment of fungal infections like cryptococcal meningitis and C. " 01/01/2000 - "The authors report the occurrence of a cryptococcal meningitis in a patient treated by corticosteroids and polychemotherapy for a chronic lymphocytic leukemia. "
4.	Intravenous Injections 02/01/2014 - "Although amphotericin B is the "gold standard" treatment for cryptococcal meningitis, the toxicity and inconvenience of intravenous injection emphasize a need for development of new anticryptocccal drugs. "
5.	Highly Active Antiretroviral Therapy (HAART) 10/01/2008 - "The objective of this study was to evaluate outcomes among adults with a first episode of cryptococcal meningitis (CM), comparing those on highly active antiretroviral therapy (HAART) with those not on HAART. " 05/15/2003 - "Discontinuation of secondary prophylaxis for cryptococcal meningitis in human immunodeficiency virus-infected patients treated with highly active antiretroviral therapy: a prospective, multicenter, randomized study." 07/01/2013 - "While the previous review of CNS-IRIS in the HIV-infected patient on highly active antiretroviral therapy (Part 1) dealt with an overview of the biology, pathology, and neurologic presentation of this condition and a discussion of the atypical imaging findings in PML-IRIS and cryptococcal meningitis-IRIS due to the robust inflammatory response, the current review (Part 2) discusses the imaging findings in other commonly encountered organisms seen in association with CNS-IRIS, namely, VZV, CMV, HIV, Candida organisms, Mycobacterium tuberculosis, and Toxoplasma gondii. " 06/01/2013 - "Here, we present the case of an HIV-positive man, who developed cryptococcal meningitis two months after having started HAART and experienced several meningeal relapses and a "paradoxical" C-IRIS during the following year." 01/01/2013 - "To compare the clinical and immunologic outcomes for early initiation ART (less than four weeks after starting antifungal treatment) versus later initiation of HAART (four weeks or more after starting antifungal treatment) in HIV-positive patients with concurrent cryptococcal meningitis. "