Meningitis Due to Cryptococcus neoformans: Treatment with Posaconazole

Flores, Verónica Gaona; Tovar, Rosa M. Cervantes; Zaldivar, Patricia G.; Martínez, Enrique A.

doi:10.2174/157016212803305970

Cited by 14 publications

(8 citation statements)

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“…The most common manifestation of cryptococcal infection in immunocompromised hosts is meningoencephalitis. 372,381,382 Clinical manifestations include headache, altered mentation, lethargy, cranial neuropathies, and focal neurological defects; symptoms may progress over several weeks prior to diagnosis. 362 Complications include hydrocephalus, brain abscess, and increased intracranial pressure.…”

Section: Clinical Featuresmentioning

confidence: 99%

Fungal Infections Complicating Lung Transplantation

Clark

Weigt

Fishbein³

et al. 2018

Semin Respir Crit Care Med

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Lung transplantation is an increasingly utilized modality for treating advanced lung disease. However, lung transplant recipients (LTRs) experience high rates of infection-related mortality and, compared with other solid organ transplant recipients, are at increased risk of infectious complications given the intensity of immunosuppression employed, the presence of airway abnormalities after surgery and exposure of the allograft to the environment. Fungal infections, particularly mold infections, are problematic after transplantation as they are often associated with limited treatment options and poor outcomes. We describe the non- fungal infections occurring in LTRs, including their epidemiology, clinical features, and treatment.

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Section: Clinical Featuresmentioning

confidence: 99%

Fungal Infections Complicating Lung Transplantation

Clark

Weigt

Fishbein³

et al. 2018

Semin Respir Crit Care Med

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“…The latter includes induction therapy with a combination of an amphotericin B formulation and 5-flucytosine, 79 followed by a period of consolidation and maintenance with oral fluconazole. Patients intolerant of fluconazole may be given itraconazole 200 to 400 mg/day, though there is growing experience with the use of posaconazole 80 and voriconazole. 81…”

Section: Antifungal Therapy For Pulmonary Cryptococcosismentioning

confidence: 99%

Pulmonary Cryptococcosis

Chang

Sorrell

Chen

2015

Semin Respir Crit Care Med

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Inhalation of Cryptococcus into the respiratory system is the main route of acquisition of human infection, yet pulmonary cryptococcosis goes mostly unrecognized by many clinicians. This delay in diagnosis, or misdiagnosis, of lung infections is due in part to frequently subtle clinical manifestations such as a subacute or chronic cough, a broad differential of diagnostic possibilities for associated pulmonary masses (cryptococcomas) and, on occasion, negative respiratory tract cultures. Hematogenous dissemination from the lung can result in protean manifestations, the most severe of which is meningoencephalitis. There are few clinical studies of pulmonary cryptococcosis and its pathogenesis is poorly understood. The main purpose of this review is to describe the epidemiology, clinical presentation, diagnosis, and treatment of pulmonary cryptococcosis to increase clinician's awareness of this diagnostic possibility and to enhance clinical management. Useful pointers to the approach and management of pulmonary cryptococcosis and the implications of disseminated disease are included, together with recommendations for future research.

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“…(4). Recently, voriconazole (VRC), which exhibits fungistatic activity against resistant strains of Cryptococcus (5,6), has been recognized as a novel therapeutic option for the treatment of cryptococcal meningitis (7)(8)(9)(10), but there are scarce studies focusing on its pharmacokinetic/pharmacodynamic (PK/PD) behavior during the infectious process in the brain.…”

mentioning

confidence: 99%

Influence of Experimental Cryptococcal Meningitis in Wistar Rats on Voriconazole Brain Penetration Assessed by Microdialysis

Alves

Staudt

Silva

et al. 2017

Antimicrob Agents Chemother

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To make advances in the treatment of cryptococcal meningitis, it is crucial to know a given drug's free fraction that reaches the biophase. In the present study, we applied microdialysis (D) as a tool to determine the free levels reached by voriconazole (VRC) in the brains of healthy and Cryptococcus neoformans-infected rats. The infection was induced by the intravenous (i.v.) administration of 1 ϫ 10 5 CFU of yeast. The dose administered was 5 mg/kg (of body weight) of VRC, given i.v. Plasma and microdialysate samples were analyzed by liquid chromatographytandem mass spectrometry (LC-MS/MS) and LC-UV methods. The free brain/free plasma ratio (fT) and population pharmacokinetic (popPK) analyses were performed to evaluate the impact of infection on PK parameters of the drug. The brain penetration ratio showed an increase on brain exposure in infected animals (fT healthy ϭ 0.85 versus fT infected ϭ 1.86). The structural PK model with two compartments and Michaelis-Menten (MM) elimination describes the VRC concentration-time profile in plasma and tissue simultaneously. The covariate infection was included in volume of distribution in the peripheral compartment in healthy animals (V 2 ) and maximum rate of metabolism (V M ). The levels reached in infected tissues were higher than the values described for MIC of VRC for Cryptococccus neoformans (0.03 to 0.5 g ml Ϫ1 ), indicating its great potential to treat meningitis associated with C. neoformans.

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Meningitis Due to Cryptococcus neoformans: Treatment with Posaconazole

Cited by 14 publications

References 0 publications

Fungal Infections Complicating Lung Transplantation

Fungal Infections Complicating Lung Transplantation

Pulmonary Cryptococcosis

Influence of Experimental Cryptococcal Meningitis in Wistar Rats on Voriconazole Brain Penetration Assessed by Microdialysis

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