amphotericin-b and Tuberculosis--Meningeal

Phaeohyphomycosis causes a wide spectrum of systemic manifestations and can affect even the immunocompetent hosts. Involvement of the central nervous system is rare. A 48-year-old farmer presented with chronic headache, fever, and impaired vision and hearing. Serial MRIs of the brain showed enhancing exudates in the basal cisterns, and lesions in the sella and perichiasmatic and cerebellopontine angle regions along with enhancement of the cranial nerves and leptomeninges. Cerebrospinal fluid (CSF) showed lymphocytic pleocytosis with elevated protein and decreased glucose on multiple occasions. Clinical, imaging, and CSF abnormalities persisted despite treatment with antitubercular drugs and steroids for 2 years. Biopsy of the dura mater at the cervicomedullary junction revealed necrotizing granulomatous lesions, neutrophilic abscesses, and giant cells containing slender, pauci-septate, pigmented fungal hyphae. Fungal culture showed growth of

Topics: Amphotericin B; Antifungal Agents; Antitubercular Agents; Ascomycota; Brain; Brain Abscess; Diagnosis, Differential; Humans; Male; Meningitis; Meningitis, Fungal; Middle Aged; Phaeohyphomycosis; Steroids; Tuberculosis, Meningeal; Voriconazole

Simultaneous central nervous system (CNS) infection with Cryptococcus and tuberculosis (TB) is very rare. Despite improved therapeutic options, treatment of CNS cryptococcosis is still difficult and needs invasive treatment modalities, such as intrathecal or intraventricular amphotericin B, in refractory cases. We describe a patient with systemic lupus erythematosus diagnosed with simultaneous cryptococcal and TB meningitis who had a poor response to intravenous liposomal amphotericin B and fluconazole, but was successfully treated with intraventricular amphotericin B, in addition to anti-TB therapy.

Topics: Administration, Intravenous; Amphotericin B; Antifungal Agents; Antitubercular Agents; Female; Fluconazole; Humans; Infusions, Intraventricular; Lupus Erythematosus, Systemic; Meningitis, Cryptococcal; Middle Aged; Treatment Outcome; Tuberculosis, Meningeal

Topics: Amphotericin B; Antibodies, Fungal; Antifungal Agents; Brain Damage, Chronic; Brain Edema; Child; Delayed Diagnosis; Deoxycholic Acid; Diagnostic Errors; Drug Combinations; Histoplasma; Histoplasmosis; Humans; Hydrocephalus; Immunocompetence; Itraconazole; Liposomes; Male; Meningitis; Meningitis, Viral; Prognosis; Stroke, Lacunar; Tuberculosis, Meningeal; Ventriculoperitoneal Shunt

Topics: Amphotericin B; Antifungal Agents; Central Nervous System Fungal Infections; Diagnostic Errors; Epiglottis; Female; Granuloma; Histoplasmosis; Humans; Middle Aged; Recurrence; Spinal Cord; Tuberculosis, Meningeal

Cryptococcal infection of the brain is commonly seen in immunocompromised patients but rarely considered as the differential diagnosis in immunocompetent patients. We present two cases of cryptococcosis involving the brain in immunocompetent patients, which strongly mimicked tuberculous infection in both conventional as well as advanced magnetic resonance (MR) imaging, and the disease was only confirmed after histopathological/cerebrospinal fluid serological study. One patient was a 52-year-old woman, and the second patient was a 23-year-old man. These two cases highlight the need for workup of fungal infections in immunocompetent patients from the tuberculous endemic regions, even when the imaging is highly suspicious of tuberculous lesions. The imaging findings in advanced MR imaging techniques such as diffusion, perfusion, susceptibility-weighted imaging and MR spectroscopy are discussed.

Topics: Amphotericin B; Antifungal Agents; Cerebellar Diseases; Cryptococcus neoformans; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Flucytosine; Humans; Immunocompetence; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Meninges; Meningitis, Cryptococcal; Middle Aged; Tomography, X-Ray Computed; Tuberculosis, Meningeal; Young Adult

To compare the differences in presentation and outcome of patients with tuberculous meningitis (TBM) and cryptococcal meningitis (CCM).. Case series.. The Aga Khan University Hospital, Karachi, from December 1995 to December 2005.. Patients with a confirmed diagnosis of TBM or CCM were included in this study. The signs and symptoms, laboratory findings and other variables of patients were entered and analyzed by Statistical Package for Social Sciences (SPSS) Software version 14.. We compared 16 patients of TBM with 11 of CCM. None of the patients with TBM were Human Immunodeficiency Virus (HIV) positive while 4 patients with CCM had HIV. The common initial signs and symptoms in patients with TBM were fever, altered mental status and headache; and in patients with CCM were fever, headache and cough. The mean CSF glucose level decreased according to the Medical Research Council (MRC) stage in TBM. The mean CSF RBCs, WBCs, glucose and protein in TBM were 2010/mm3, 228/mm3, 52.32 mg/dL and 289.48 mg/dl respectively and in CCM were 178.54/mm3, 529.54/mm3, 32.63 mg/dL and 432.18 mg/dL respectively.. TBM and CCM should be suspected in all cases that present with symptoms of chronic meningitis. Patients with TBM are more likely to have altered mental status and higher CSF RBCs; those with CCM are more likely to have headache, cough and higher CSF WBCs.

Topics: Amphotericin B; Anti-Bacterial Agents; Biomarkers; Cerebrospinal Fluid; Diuretics, Osmotic; Female; HIV Infections; Humans; Male; Mannitol; Meningitis, Cryptococcal; Middle Aged; Pakistan; Prevalence; Treatment Outcome; Tuberculosis; Tuberculosis, Meningeal

Six months after an attack of pyelonephritis, adnexitis and candida colpitis an 18-year-old girl developed some clouding of consciousness. On neurological examination she showed organic behavioural changes, discrete anisocoria and possible meningism. Computed tomography revealed hydrocephalus and signs of increased cerebrospinal fluid (CSF) pressure. CSF contained 2336/3 cells, while total protein was raised to 7.0 g/l and lactate concentration to 6.85 mmol/l. Glucose concentration in CSF was 51 mg/dl and 75 mg/dl in serum. As tuberculous meningitis was suspected, treatment was started with four tuberculostatic drugs, but there was no improvement. Five weeks later microscopic CSF examination showed fungal spores and nonbranching hyphae. The maximal candida haemagglutination titre in CSF was 1:2048. CSF culture grew Candida albicans. The further course was complicated by side effects to the antimycotic drugs (amphotericin B between 4.5 and 45 mg daily; flucytosine 1.7 g four times daily) and recurrent obstruction in the ventricular system requiring repeated neurosurgical interventions. However, full cure was achieved after seven months' hospital treatment.

Topics: Adolescent; Amphotericin B; Antitubercular Agents; Brain Diseases; Candida albicans; Candidiasis; Candidiasis, Vulvovaginal; Cerebrospinal Fluid; Diagnosis, Differential; Female; Flucytosine; Humans; Hydrocephalus; Pelvic Inflammatory Disease; Pyelonephritis; Tomography, X-Ray Computed; Tuberculosis, Meningeal

Cryptococcus neoformans (Torula histolytica) is an uncommon cause of infection in the central nervous system. We review 15 cases from all over Queensland which have presented in the last 6 years. Computed tomography (CT) studies were abnormal in 73.5%, with mass lesions and hydrocephalus being the commonest findings. Notable findings were: the disproportionate severity of clinical signs and symptoms as compared with the CT findings, which often were either normal or demonstrated only small granulomas without significant mass effect, absence of enhancement in granulomas in two cases and observation of calcification during treatment in one patient.

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain Diseases; Brain Neoplasms; Cryptococcosis; Diagnosis, Differential; Female; Humans; Immune Tolerance; Male; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Tomography, X-Ray Computed; Tuberculosis, Meningeal

Topics: Adult; Amphotericin B; Cryptococcosis; Diagnosis, Differential; Drug Therapy, Combination; Female; Flucytosine; Humans; Meningitis; Tuberculosis, Meningeal

Topics: Amphotericin B; Candidiasis; Child; Ethambutol; Flucytosine; Humans; Isoniazid; Male; Meningitis; Streptomycin; Tuberculosis, Meningeal

A retrospective review of cryptococcal meningitis in Papua New Guinea adults showed that the condition is at least as common as tuberculous meningitis. The majority of the patients were young and all were previously healthy. A mortality rate of more than 50% was observed despite amphotericin B therapy. Cryptococcal aetiology should be suspected and looked for in every patient with chronic meningitis in Papua New Guinea. Examining the cerebrospinal fluid for cryptococcal antigen is of value when Indian ink smear and culture are negative.

Topics: Adolescent; Adult; Amphotericin B; Cryptococcosis; Diagnosis, Differential; Female; Humans; Male; Meningitis; Middle Aged; New Guinea; Retrospective Studies; Tuberculosis, Meningeal

Topics: Adult; Amphotericin B; Cryptococcosis; Diagnosis, Differential; Female; Humans; Lung Diseases, Fungal; Meningitis; Natamycin; Tuberculosis, Meningeal

Topics: Adolescent; Adult; Amphotericin B; Animals; Asian People; Cerebrospinal Fluid Proteins; Child; Columbidae; Cryptococcosis; Cryptococcus neoformans; Cytosine; Evaluation Studies as Topic; Female; Glucose; Humans; Hypertension; Lung Diseases; Male; Meningitis; Middle Aged; Myasthenia Gravis; Peptic Ulcer; Prognosis; Schizophrenia; Singapore; Tuberculosis, Meningeal

Topics: Age Factors; Amphotericin B; Anti-Bacterial Agents; Cryptococcus; Escherichia coli Infections; Humans; Injections, Intravenous; Injections, Spinal; Intracranial Pressure; Leptospira; Meningitis; Meningitis, Haemophilus; Meningitis, Listeria; Meningitis, Meningococcal; Meningitis, Pneumococcal; Meningitis, Viral; Microbial Sensitivity Tests; Penicillins; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Sulfonamides; Tuberculosis, Meningeal

Topics: Adrenal Cortex Hormones; Amphotericin B; Anti-Bacterial Agents; Antitubercular Agents; Ethionamide; Humans; Isoniazid; Meningitis; Meningitis, Viral; Mycoses; Prognosis; Sarcoidosis; Streptodornase and Streptokinase; Streptomycin; Syphilis; Tuberculosis, Meningeal

Topics: Amphotericin B; Anti-Bacterial Agents; Cerebrospinal Fluid; Chloramphenicol; Humans; Influenza, Human; Leptospirosis; Meningitis; Meningitis, Pneumococcal; Meningitis, Viral; Mycoses; Neurosyphilis; Penicillins; Pseudomonas Infections; Staphylococcal Infections; Streptococcus pneumoniae; Streptomycin; Tuberculosis; Tuberculosis, Meningeal