RESUMEN
We conducted a prospective, open trial to establish the efficacy of itraconazole 400 mg/d as maintenance treatment for cryptococcal meningitis in AIDS patients. Between February 1996 and May 1997, 50 patients were included for analysis. After a mean follow-up of 326 days, 2 of 38 patients (5.3 per cent) had relapses of symptomatic cryptococcal meningitis. Hepatotoxicity occurred in 2 cases. In conclusion, maintenance therapy with itraconazole 400 mg/d is effective in preventing recurrent cryptococcal meningitis.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adulto , Antifúngicos/uso terapéutico , Femenino , Humanos , Itraconazol/uso terapéutico , Masculino , Meningitis Criptocócica/tratamiento farmacológico , Estudios Prospectivos , RecurrenciaRESUMEN
We compared amphotericin B (0.3 mg/kg/d) plus flucytosine (150 mg/kg/d) plus itraconazole (400 mg/d) (study group) with amphotericin B plus flucytosine (control group) by an open-randomized trial. In the study group, after CSF mycological cultures disclosed nothing, itraconazole was administrated alone through six weeks of treatment. Treatment was considered successful if the patient had two consecutive negative CSF cultures by the end of the 6-week treatment period. Fifty patients were enrolled in each group. There were significant differences between the study group and the control group in the successful treatment (100% vs 90%; P = 0.03), the mean length of time until normal body temperature after treatment (5.9 +/- 3.7 days vs 8.8 +/- 5.1 days; P = 0.02) and the adverse effects. The mean length of time to the first negative CSF culture was 13.9 +/- 6.1 days in the study group and 13.3 +/- 6.5 days in the control group (P = 0.66). Relapse rate with itraconazole 200 mg/day was higher in the study group.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adolescente , Adulto , Anfotericina B/administración & dosificación , Antifúngicos/administración & dosificación , Antifúngicos/administración & dosificación , Distribución de Chi-Cuadrado , Cryptococcus neoformans/aislamiento & purificación , Quimioterapia Combinada , Femenino , Flucitosina/administración & dosificación , Humanos , Itraconazol/administración & dosificación , Masculino , Meningitis Criptocócica/tratamiento farmacológico , Persona de Mediana EdadRESUMEN
We report two cases of Burkholder meningitis. Case 1 presented with subacute lymphocytic meningitis, low sugar profile in CSF and positive culture for Burkholder. Case 2 presented with purulent meningitis that emerged during treatment of cryptococcal meningitis which, to our knowledge, has not been reported. Thus, Burkholder should be considered as one of the etiologic agents in this clinical setting.