Weinke T, Rogler G, Ortmann C, Pohle HD; International Conference on AIDS.

Int Conf AIDS. 1989 Jun 4-9; 5: 355 (abstract no. W.B.P.19).

Universitatsklinikum Rudolf Virchow, Freie Universitat Berlin, West-Germany

OBJECTIVE: Cryptococcus neoformans is a dangerous pathogen in AIDS patients and usually leads to disseminated disease. Prognosis depends on early diagnosis and early onset of proper treatment. We report an attempt at identifying characteristics that facilitate earlier recognition of cryptococcosis and describe the effectiveness of therapeutic approaches. METHODS: All AIDS patients were screened for cryptococcal antigen in serum; if indicated sputum, CSF, blood, urine and stool were taken for culture on selective media. Clinical symptoms were determined and the response to therapy was judged by means of cultures of the affected site. RESULTS: 9 out of 184 (4,9%) patients with AIDS had evidence of cryptococcal disease. 8 patients had disseminated cryptococcosis and cryptococci could be cultured from various body sites; one individual had still localized disease in the lungs. The main presenting features were very unspecific and consisted of headache, fever, and nausea. Laboratory data confirmed advanced immunosuppression (mean CD4-value 42). Meningism and elevated CSF leucocyte counts were present in only three patients. Cryptococcal serum antigen titers correlated with the severity of the disease: One patient with advanced disease and the highest titer (1:100.000) died 3 weeks after onset of treatment. Therapy with amphotericin B and flucytosine over 6 weeks was very effective and 7 of 9 patients were cured. Life expectancy was reduced by other AIDS-related opportunistic infections, since only one patient died because of cryptococcosis. CONCLUSION: Routine screening for cryptococcal antigen in HIV-infected persons is essential for early diagnosis of cryptococcosis since clinical symptoms are very subtle. Early diagnosis and rapid onset of therapy improves prognosis. From our experience amphotericin B and flucytosine is the treatment of first choice.

Publication Types:

• Meeting Abstracts

Keywords:

• AIDS-Related Opportunistic Infections
• Acquired Immunodeficiency Syndrome
• Amphotericin B
• Cryptococcosis
• Cryptococcus neoformans
• Drug Therapy, Combination
• Flucytosine
• HIV
• HIV Seropositivity
• Humans
• Meningism
• Prognosis
• drug therapy
• psychology
• therapy

Other ID:

• 00174789

UI: 102177653

From Meeting Abstracts