Title:Meningitis Due to Cryptococcus neoformans: Treatment with Posaconazole
Volume: 10
Issue: 7
Author(s): Veronica G. Flores, Rosa M. Cervantes Tovar, Patricia G. Zaldivar and Enrique A. Martinez
Affiliation:
Keywords:
Azoles, posaconazole, central nervous system infections, adverse events, immunocompromised patients
Abstract: Background: Central nervous system infections caused by Cryptococcus neoformans remain to be opportunistic
infections with high mortality in severely immunocompromised patients such as patients with AIDS. Amphotericin B
deoxycholate and fluconazole remain to be the drugs of choice; however, in consideration of the intolerance to
amphotericin B deoxycholate and the possible resistance to fluconazole, it is necessary to evaluate other azoles, such as
posaconazole, that have demonstrated lower adverse events. The objective of this study was to describe the characteristics
and clinical and microbiological response of the use of posaconazole in patients with CNS infections caused by C.
neoformans.
Methods: We designed a case study that included eight patients diagnosed with AIDS and cryptococcal meningitis. Seven
patients were treated with 800 mg of posaconazole orally for 28 days.
Results: During the second week of treatment, a cerebrospinal fluid (CSF) culture was performed and was negative for the
development of C. neoformans. The patients showed an improvement in signs and symptoms of impairment of the CNS
such as reduction of cephalea, fever, visual disturbances such as double vision, meningism and papilledema, and
improved alertness and environmental awareness.
Conclusions: CNS fungal infections usually occur in immunocompromised patients. The use of systemic antifungal agents
contributes to the development of fungal resistance. The results of this study suggest that posaconazole is a good
alternative in the treatment of fungal CNS infection due to C. neoformans.
