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. 1985 Sep;48(9):853–858. doi: 10.1136/jnnp.48.9.853

Cryptococcal meningitis.

T L Tjia, Y K Yeow, C B Tan
PMCID: PMC1028483  PMID: 4045478

Abstract

Cryptococcosis is a systemic fungal disease and meningitis is the most serious complication. The purpose of this study is to define problems related to its diagnosis and treatment. This is a retrospective analysis of 25 patients admitted from January 1978 to December 1981. All patients had cryptococcal neoformans meningitis proven by culture of cerebrospinal fluid. One patient had a predisposing illness, being on immunosuppressant therapy after a renal transplant 2 years ago. A progressively severe headache of recent onset was the most striking presentation. Fever was frequently absent as a symptom. Cranial nerve palsies were commonly seen. Impairment of consciousness and areflexia signified a poor prognosis as all four patients who died early in the course of treatment were comatose and two of them were areflexic on admission. In newly suspected cases at least 3 separate lumbar punctures are recommended as initial smears or cultures may be negative. Cerebral CT scans were abnormal in 12 patients and those with cerebral oedema or hydrocephalus had a poorer prognosis. Combined amphotericin B and 5-fluorocytosine therapy was the treatment of choice. If there is no relapse 3 years after completion of treatment, patients are considered as cured. Positive smears may remain for years after completion of treatment and retreatment is only indicated if the cultures are positive. Twenty patients are alive today and none of them have relapsed. One patient had vasculitis of both anterior cerebral arteries as a result of cryptococcal meningitis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BIGGS R. H., WEBB W. R. Pulmonary cryptococcosis. Dis Chest. 1956 Dec;30(6):659–668. doi: 10.1378/chest.30.6.659. [DOI] [PubMed] [Google Scholar]
  2. Bennett J. E., Dismukes W. E., Duma R. J., Medoff G., Sande M. A., Gallis H., Leonard J., Fields B. T., Bradshaw M., Haywood H. A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptoccal meningitis. N Engl J Med. 1979 Jul 19;301(3):126–131. doi: 10.1056/NEJM197907193010303. [DOI] [PubMed] [Google Scholar]
  3. Block E. R., Jennings A. E., Bennett J. E. 5-fluorocytosine resistance in Cryptococcus neoformans. Antimicrob Agents Chemother. 1973 Jun;3(6):649–656. doi: 10.1128/aac.3.6.649. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cornell S. H., Jacoby C. G. The varied computed tomographic appearance of intracranial cryptococcosis. Radiology. 1982 Jun;143(3):703–707. doi: 10.1148/radiology.143.3.7079496. [DOI] [PubMed] [Google Scholar]
  5. Diamond R. D., Bennett J. E. A subcutaneous reservoir for intrathecal therapy of fungal meningitis. N Engl J Med. 1973 Jan 25;288(4):186–188. doi: 10.1056/NEJM197301252880405. [DOI] [PubMed] [Google Scholar]
  6. Diamond R. D., Bennett J. E. Prognostic factors in cryptococcal meningitis. A study in 111 cases. Ann Intern Med. 1974 Feb;80(2):176–181. doi: 10.7326/0003-4819-80-2-176. [DOI] [PubMed] [Google Scholar]
  7. Fujita N. K., Reynard M., Sapico F. L., Guze L. B., Edwards J. E., Jr Cryptococcal intracerebral mass lesions: the role of computed tomography and nonsurgical management. Ann Intern Med. 1981 Mar;94(3):382–388. doi: 10.7326/0003-4819-94-3-382. [DOI] [PubMed] [Google Scholar]
  8. GOLDSTEIN E., RAMBO O. N. Cryptococcal infection following steroid therapy. Ann Intern Med. 1962 Jan;56:114–120. doi: 10.7326/0003-4819-56-1-114. [DOI] [PubMed] [Google Scholar]
  9. Kauffman C. A., Bergman A. G., Severance P. J., McClatchey K. D. Detection of cryptococcal antigen. Comparison of two latex agglutination tests. Am J Clin Pathol. 1981 Jan;75(1):106–109. doi: 10.1093/ajcp/75.1.106. [DOI] [PubMed] [Google Scholar]
  10. LOURIA D. B., FEDER N., MITCHELL W., EMMONS C. W. Influence of fungus strain and lapse of time in experimental histoplasmosis and of volume of inoculum in cryptococcosis upon recovery of the fungi. J Lab Clin Med. 1959 Feb;53(2):311–317. [PubMed] [Google Scholar]
  11. Littman M. L., Walter J. E. Cryptococcosis: current status. Am J Med. 1968 Dec;45(6):922–932. doi: 10.1016/0002-9343(68)90190-3. [DOI] [PubMed] [Google Scholar]
  12. Maccani J. E. Detection of cryptococcal polysaccharide using counterimmunoelectrophoresis. Am J Clin Pathol. 1977 Jul;68(1):39–44. doi: 10.1093/ajcp/68.1.39. [DOI] [PubMed] [Google Scholar]
  13. Martin R. A., Bates D., Shaw D. A. Cryptococcal meningoencephalitis. Br Med J. 1975 Jul 12;3(5975):75–76. doi: 10.1136/bmj.3.5975.75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. McGinnis M. R. Detection of fungi in cerebrospinal fluid. Am J Med. 1983 Jul 28;75(1B):129–138. doi: 10.1016/0002-9343(83)90084-0. [DOI] [PubMed] [Google Scholar]
  15. Medoff G., Comfort M., Kobayashi G. S. Synergistic action of amphotericin B and 5-fluorocytosine against yeast-like organisms. Proc Soc Exp Biol Med. 1971 Nov;138(2):571–574. doi: 10.3181/00379727-138-35943. [DOI] [PubMed] [Google Scholar]
  16. Ommaya A. K. Subcutaneous reservoir and pump for sterile access to ventricular cerebrospinal fluid. Lancet. 1963 Nov 9;2(7315):983–984. doi: 10.1016/s0140-6736(63)90681-0. [DOI] [PubMed] [Google Scholar]
  17. Perfect J. R., Durack D. T., Hamilton J. D., Gallis H. A. Failure of ketoconazole in cryptococcal meningitis. JAMA. 1982 Jun 25;247(24):3349–3351. [PubMed] [Google Scholar]
  18. Richardson P. M., Mohandas A., Arumugasamy N. Cerebral cryptococcosis in Malaysia. J Neurol Neurosurg Psychiatry. 1976 Apr;39(4):330–337. doi: 10.1136/jnnp.39.4.330. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. SPICKARD A., BUTLER W. T., ANDRIOLE V., UTZ J. P. The improved prognosis of cryptococcal meningitis with amphotericin B therapy. Ann Intern Med. 1963 Jan;58:66–83. doi: 10.7326/0003-4819-58-1-66. [DOI] [PubMed] [Google Scholar]
  20. Schacter L. P., Owellen R. J., Rathbun H. K., Buchanan B. Letter: Antagonism between miconazole and amphotericin B. Lancet. 1976 Aug 7;2(7980):318–318. doi: 10.1016/s0140-6736(76)90774-1. [DOI] [PubMed] [Google Scholar]
  21. Shadomy S., Wagner G., Espinel-Ingroff E., Davis B. A. In vitro studies with combinations of 5-fluorocytosine and amphotericin B. Antimicrob Agents Chemother. 1975 Aug;8(2):117–121. doi: 10.1128/aac.8.2.117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Stamm A. M., Polt S. S. False-negative cryptococcal antigen test. JAMA. 1980 Sep 19;244(12):1359–1359. [PubMed] [Google Scholar]
  23. Sung J. P., Campbell G. D., Grendahl J. G. Miconazole therapy for fungal meningitis. Arch Neurol. 1978 Jul;35(7):443–447. doi: 10.1001/archneur.1978.00500310045009. [DOI] [PubMed] [Google Scholar]
  24. Tay C. H., Chew W. L., Lim L. C. Cryptococcal meningitis: its apparent increased incidence in the Far East. Brain. 1972;95(4):825–832. doi: 10.1093/brain/95.4.825. [DOI] [PubMed] [Google Scholar]
  25. Tobias J. S., Wrigley P. F., Shaw E. Combination antifungal therapy for cryptococcal meningitis. Postgrad Med J. 1976 May;52(607):305–308. doi: 10.1136/pgmj.52.607.305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Tress B., Davis S. Computed tomography of intracerebral toruloma. Neuroradiology. 1979 Apr 26;17(4):223–226. doi: 10.1007/BF00342753. [DOI] [PubMed] [Google Scholar]
  27. Utz J. P., Garriques I. L., Sande M. A., Warner J. F., Mandell G. L., McGehee R. F., Duma R. J., Shadomy S. Therapy of cryptococcosis with a combination of flucytosine and amphotericin B. J Infect Dis. 1975 Oct;132(4):368–373. doi: 10.1093/infdis/132.4.368. [DOI] [PubMed] [Google Scholar]
  28. Watkins J. S., Campbell M. J., Gardner-Medwin D., Ingham H. R., Murray I. G. Two cases of cryptococcal meningitis, one treated with 5-fluorocytosine. Br Med J. 1969 Jul 5;3(5661):29–31. doi: 10.1136/bmj.3.5661.29. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. ZIMMERMAN L. E., RAPPAPORT H. Occurrence of Cryptococcosis in patients with malignant disease of reticuloendothelial system. Am J Clin Pathol. 1954 Sep;24(9):1050–1072. doi: 10.1093/ajcp/24.9.1050. [DOI] [PubMed] [Google Scholar]

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