Hunainover 3 years ago
cryptococcal meningitis
Cryptococcal meningitis is a type of meningitis caused by a fungus called Cryptococcus. This type of meningitis mainly affects people with weakened immune systems due to another illness. If not treated, cryptococcal meningitis can have lasting consequences and can even be fatal.
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*Treatment of Cryptococcal Meningitis*
In my setup-Kenya. Share your views.
ADULTS
_Induction (2 weeks)_
Ampho B 0.7-1 mg/kg/day +
Fluconazole 800 mg/day
_Consolidation (8 weeks)_
Fluconazole 400-800 mg/day
_Maintenance_
Fluconazole 200 mg/day till CD4 count
> 200 cells/ml for at least 6 consecutive months
*Alternatively give:*
_Induction (2 weeks)_
Fluconazole 1200 mg daily
_Consolidation (8 weeks)_
Fluconazole 800mg daily
_Maintenance_
Fluconazole 200 mg/day till CD4 count
> 200 cells/ml for at least 6 consecutive months
CHILDREN
_Induction (2 weeks)_
Ampho B 0.7-1mg/kg/day +
Fluconazole 12mg/kg/day (upto max 800 mg/day)
_Consolidation (8 weeks)_
Fluconazole 6-12mg/kg/day up to 400 to 800 mg/day
_Maintenance_
Fluconazole
6mg/kg/day up to 200mg/day
*Alternatively give:*
_Induction (2 weeks)_
Fluconazole 12mg/kg/day (upto max 1200 mg/day)
_Consolidation (8 weeks)_
Fluconazole 12mg/kg/day up to 800 mg/day
_Maintenance_
Fluconazole 6mg/kg/day up to 200mg/day
*When to start ART*
In both children and adults....Defer ART until after completing
5 weeks of CM
treatment and symptoms have resolved.
*Managing and Monitoring for Amphotericin B Therapy*
*_Adults*_
• Give 1 L of normal saline with 20 mmol of KCl over 2-4 hours before each controlled infusion of Ampho B given with 1 litre of 5% dextrose. Add 1-2 8 mEq KCl tablets orally twice daily. Very key.
You can add one 8 mEq KCl tablets twice daily in the second week.
Include magnesium supplementation at 250 mg tablets of magnesium trisilicate twice daily
*_Adolescents and Children_*
• Give 1 L of normal saline with 20 mmol of KCl over 2-4 hours before each controlled infusion of Ampo B. Darrows or *Ringer’s solutions* can also be used.
• Avoid KCl replacement in patients with pre-existing renal impairment or hyperkalaemia
*Managing hypokalaemia and raised creatinine levels*
• Obtain a routine baseline and twice weekly potassium creatinine.
- If K < 3.3 mmol/L, administer KCL 40 mmol in normal saline or 1-2 tablets of KCl 8
hourly. Add magnesium. Monitor potassium daily
- If creatinine level increases > 2 fold, omit dose of Ampho B, increase hydration to 1L 8
hourly. If there’s improvement, re-start Ampho B at 0.7 mg/kg/day on alternate days. If no improvement, discontinue Ampho B, give Fluconazole 1200 mg/day. Monitor creatinine daily
*Therapeutic lumbar punctures*
• For all patients with symptomatic CM: perform daily theraputic lumbar punctures
• If opening pressure is ≤ 40 cm: draw only enough CSF to reduce pressure to 20 cm
• If opening pressure is > 40 cm: draw only enough CSF to reduce pressure by 50%
• Continue daily LPs until pressure is normal for 3 consecutive days
• Restart LPs if symptoms return
• *Perform daily therapeutic LPs until severe headache subsides, removing 10-20ml of CSF each time if measurements of csf pressures isn't possible.*Cryptococcus neoformans MeningoencephalitisCryptococcal Meningitis: OverviewFrictional keratosisCyclosporine induced gingival enlargementGranulomatous cheilitisGranulomatous cheilitisTypes of lichen planus
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