Cryptococcal Meningitis & HIV/AIDS

Cryptococcal Meningitis & HIV/AIDS

Cryptococcus is a fungus that lives in the soil and gets into the body when a person breathes in contaminated dust. Cryptococcal meningitis is an infection of the lining of the spinal cord and brain that occurs in patients who have HIV and CD4+ counts lower than 100. Patients who are on antiretroviral therapy rarely develop cryptococcal meningitis.

Symptoms include headache, fever, fatigue, stiff neck, nausea, vomiting, confusion, and vision problems. Headache, which is usually very mild at first, becomes increasingly severe over days or weeks and eventually is present 24 hours a day. Often, pain medications do not relieve the headache.

Cryptococcal meningitis is treated with a potent antibiotic called amphotericin (Fungizone®). In severe cases, a second antibiotic called flucytosine (Ancobon®) is used as well. These antibiotics have many side effects, including kidney problems and an imbalance of salts in the body. Unfortunately, less toxic medications do not effectively treat the infection.

After initial treatment, most patients take a secondary prophylaxis (e.g., fluconazole, itraconazole) to prevent a recurrence of the infection. A patient who has had cryptococcal meningitis, is taking antiretrovirals, and has a CD4 count above 100 to 200 cells per cc may be able to stop taking the secondary prophylaxis. However, medication should not be discontinued without consulting a physician or other health care provider. Discontinuing the secondary prophylaxis for cryptococcus is not considered standard treatment.