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Symptoms and Diagnosis
Cryptococcal meningitis affects about 10
percent of people with AIDS. The first symptoms of this infection
are usually fever, fatigue, nausea, vomiting, and headache.
Cryptococcal meningitis may cause a person to become confused and
have memory loss. Family members or friends may note small changes
in personality or behavior. If people with cryptococcal meningitis
are not treated, they may lapse into a coma and die.
Doctors diagnose cryptococcal meningitis by
detecting the cryptococcal organism or one of its proteins in a
sample of blood or of spinal fluid, which is removed from the
spine through a needle.
Treatment
Acute. People with cryptococcal
meningitis are usually treated with the antifungal drug
amphotericin B. Many people are also given the antifungal drug
flucytosine for at least two weeks. Another treatment option is
the antifungal agent fluconazole, which can be taken by mouth or
given through the veins.
Amphotericin B has many side effects,
including kidney damage, high fever, low blood pressure, decreased
numbers of red or white blood cells, nausea, vomiting, and chills.
A newer formulation of the drug, in which the active compound is
encased in a fatty substance, is under study and may have fewer
side effects. However, more research is needed to assess the
safety and effectiveness of this new form of amphotericin B.
Flucytosine also may cause serious side effects, including
decreased numbers of red or white blood cells, liver damage,
nausea, diarrhea, seizures, abdominal discomfort, or rash.
Fluconazole causes fewer, less severe side
effects, including skin rashes and liver enzyme abnormalities.
Maintenance. About four out of
five people survive the initial phase of meningitis. However, half
of those with AIDS treated for cryptococcal meningitis will
experience a relapse of the disease within one year unless they
receive further treatment to prevent it. This is called
maintenance therapy.
To prevent relapses, most doctors recommend
that people who have had cryptococcal meningitis take fluconazole
daily. Other drugs used include intravenous amphotericin B taken
weekly or biweekly.
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