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We reviewed the records of 106 patients with cyptococcal infections and the acquired immunodeficiency syndrome(AIDS)treated at San Francisco General Hospital.We examined four issues:the efficacy of treatment with amphotericin plus flucytosine as compared with amphotericin alone,The efficacy of suppressive therapy,the prognostic clinical characteristics, and the course of nonmeningeal cryptococcosis.In 48 of the 106 patients(45 percent),cryptococcosis was the first manifestation of AIDS.Among the 89 patients with cryptococal meningitis confirmed by culture,survival did not differ significantly between those treated with amphotericin plus flucytosine(n=49)and those treated with amphotericin alone(n=40). Flucytosine had to be discontinued in over half the patients because of cytopenia.Long-term suppressive therapy with either ketoconazole or amphotericin was associated with improved survival as compared with survival in the absence of suppressive therapy(median survival,greater than or equal to 238 vs.141 days;P.<0.004).The only clinical features independently associated with a shorter cumulative survival were hyponatremia and a positive culture for cryptococcus from an extrameningeal source.The 14 patients with nonmeningeal cryptococcosis had a median survival(187 days)and rate of relapse(20 percent)similar to those in the patients with meningitis(165 days and 17 percent,respectively).From this retrospective study of cryptococcal infections in patients with AIDS we conclude that the addition of flucytosine to amphotericin neither enhances survival nor prevents relapse,but long-term suppressive therapy appears to benefit these patients. |
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acquired immunodeficiency syndrome
amphotericin B
CAT scan
CAT scan,abnormal
cerebrospinal fluid
cerebrospinal fluid,abnormal
cerebrospinal fluid,proteincytologic dissociation
cryptococcal meningitis
cryptococcosis
fever
fungal infection,CNS
headache
hyponatremia
hyponatremia with cerebral disorders
malaise
meningitis
meningitis,CSF cell count-normal
meningitis,CSF findings in
nausea and vomiting
opportunistic infection
opportunistic infection,CNS
pleocytosis of cerebrospinal fluid
prognosis
seizure
treatment of neurologic disorder
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