What is recommended regarding prophylaxis for cryptococcal meningitis?

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Conclusions. Fluconazole was safe and effective as primary prophylaxis against cryptococcal disease, both before and during early antiretroviral treatment. Cryptococcal infection was less common than anticipated because of the rapid commencement of antiretroviral therapy and exclusion of those with positive CrAg.

When should you start art with cryptococcal meningitis?

We hypothesized that ART initiation 1 to 2 weeks after diagnosis of cryptococcal meningitis, during the second week of amphotericin-based therapy in the hospital, would improve the 26-week survival rate, as compared with ART initiation at approximately 5 weeks after diagnosis, provided on an outpatient basis.

How long is CrAg positive?

It is also affordable and quick. Results are available within 10 minutes. CrAg tests (LFA, CLAT and EIA) remain positive for weeks to months after cryptococcal meningitis has been treated.

What is the best treatment for cryptococcal meningitis?

Current guidelines recommend 2 weeks of amphotericin B (0.7–1.0 mg/kg per day) intravenously in combination with flucytosine 100mg/kg/day as first line therapy for treatment of cryptococcal meningitis (22).

How is cryptococcosis prevented?

The best way to prevent cryptococcosis is to not inhale the fungus. This is difficult to do if you live in areas where the fungus resides, although some researchers say that some masks (ones that filter particles that are as small as 3 micrometers) may help prevent inhalation.

How is cryptococcosis transmitted?

Cryptococcosis is caused by the fungus Cyptococcus neoformans. It is spread by contact with pigeon droppings, unwashed raw fruit or by infected individuals.

What is immune reconstitution syndrome?

The term “immune reconstitution inflammatory syndrome” (IRIS) describes a collection of inflammatory disorders associated with paradoxical worsening of preexisting infectious processes following the initiation of antiretroviral therapy (ART) in HIV-infected individuals [1-6].

What is Crag positive?

The CRAG test is an extremely important diagnostic procedure; CSF CRAG is locally produced in the subarachnoid space by the invading C. neoformans, not by active or passive diffusion from the serum. Positive CRAG in either serum or CSF has more than 95% sensitivity and more than 95% specificity in the diagnosis of CM.

What does a negative cryptococcal antigen mean?

Falsely negative results can occur in patient with high organism loads due to the high dose hook effect, which is also referred to as prozone. This occurs when excess analyte, such as high concentrations of the cryptococcal antigen, result in decreased visual intensity of the test lines and negative test results.

Does cryptococcal meningitis ever go away?

Cryptococcal meningitis infections tend to recur after treatment. Because of this, many people who have had the illness will take antifungal medications to prevent a recurrence.

How long do you treat cryptococcal meningitis?

Patients are usually treated with two antifungal agents and the treatment duration can be as long as 6-24 months. Patients who are immunocompromised as well as those with neurological symptoms tend to have poor outcomes despite optimal treatment.

What organs does cryptococcosis affect?

Cryptococcosis may appear in various forms depending on how the infection is acquired. In most cases, the infection begins in the lungs (pulmonary form) and may then spread to the brain, urinary tract, skin, and/or bones (disseminated form).

What are the recent advances in the diagnosis and management of cryptococcal meningitis?

Recent advances in the diagnosis and management of cryptococcal meningitis are promising and have been improving long-term survival. Point of care testing has made diagnosing cryptococcal meningitis rapid, practical, and affordable.

How is cryptococcal meningitis diagnosed?

Specifically, for those with suspected meningitis, a point-of-care fingerstick CrAg LFA was performed prior to lumbar puncture and compared to subsequent plasma and CSF CrAg LFA. The positive predictive value of fingerstick LFA for the detection of CrAg in the blood was 100%, with 93% detection for cryptococcal meningitis (Fig. 2).

Do therapeutic lumbar punctures improve survival in cryptococcal meningitis?

The effect of therapeutic lumbar punctures on acute mortality from cryptococcal meningitis. Clin Infect Dis. 2014;59(11):1607–14. Therapeutic lumbar puncture, regardless of opening pressure, improves survival.