Document Detail


Liposomal amphotericin B for a case of intractable cryptococcal meningoencephalitis and immune reconstitution syndrome.
MedLine Citation:
PMID:  18797146     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We examined the efficacy of liposomal amphotericin B (L-AMB) for intractable cryptococcal meningoencephalitis in a patient with acquired immunodeficiency syndrome (AIDS) and the presence of immune reconstitution syndrome (IRS) caused by the treatment. A 34-year-old patient presented with meningitis. Cryptococcal organisms were detected microscopically in the cerebrospinal fluid (CSF) with Indian ink staining, and were then cultured from the CSF. Initial treatment with amphotericin B and flucytosine (5-FC) or voriconazole and/or fluconazole failed to eradicate cryptococcal organisms from the CSF. Secondary treatment with L-AMB and 5-FC following seven months of antiretroviral therapy was successful. Simultaneously, treatment with L-AMB caused severe brain edema likely due to IRS. There were large differences in immune function improvement and liposomalization of the fungicide between the initial and secondary treatments. In conclusion, differences in immune status should be considered when administering L-AMB, in order to prevent IRS-related complications.
Authors:
Atsushi Sasakawa; Yoshihiko Yamamoto; Keishiro Yajima; Mio Sakai; Tomoko Uehira; Takuma Shirasaka; Toshio Makie
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The journal of medical investigation : JMI     Volume:  55     ISSN:  1349-6867     ISO Abbreviation:  J. Med. Invest.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-09-17     Completed Date:  2009-01-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9716841     Medline TA:  J Med Invest     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  292-6     Citation Subset:  IM    
Affiliation:
AIDS Medical Center; National Hospital Organization, Osaka National Hospital, Osaka, Japan.
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections / complications*,  drug therapy*,  immunology
Adult
Amphotericin B / administration & dosage*,  adverse effects
Antifungal Agents / administration & dosage*,  adverse effects
Antiretroviral Therapy, Highly Active / adverse effects
Female
Humans
Immune Reconstitution Inflammatory Syndrome / complications*,  etiology,  immunology,  prevention & control
Liposomes
Meningitis, Cryptococcal / complications*,  drug therapy*,  immunology
Chemical
Reg. No./Substance:
0/Antifungal Agents; 0/Liposomes; 1397-89-3/Amphotericin B

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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