Persistent Cryptococcus neoformans infection of the prostate after successful treatment of meningitis

Article Abstract:

Male patients with AIDS (acquired immunodeficiency syndrome) who have been effectively treated for meningitis caused by the fungus Cryptococcus neoformans, can develop a persistent infection of the prostate gland by the fungus, without any immediate clinical symptoms. This occurred in 9 out of 41 (29 percent) patients with meningitis caused by C. neoformans. The fungus was detected in urine specimens of the patients and in prostate secretions in four of the patients. Three patients who were treated with amphotericin B, one of the drugs used in the original treatment regimen for the meningitis, had persistent infection but it did not become systemic. Six of the patients were treated with fluconazole, another drug that was used to treat the original meningitis; four of those patients no longer have the infection and two suffered a relapse, which was systemic. The presence of C. neoformans in the urine after adequate treatment for meningitis indicates that the fungus can sequester in the urinary tract, probably in the prostate gland. Infection of the prostate gland is often difficult to treat, since many drugs do not reach high enough levels in the prostate gland to be effective. The fungi can cause a systemic relapse that can affect the central nervous system, making the infection very serious. The use of alternatives to fluconazole, which did not inhibit systemic infections in a proportion of the patients, and longer treatment with amphotericin B, which did not allow systemic infections but was not effective in eradicating the urinary tract infection, are being investigated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diagnosis, Physiological aspects, Meningitis, Urinary tract infections, Opportunistic infections, Fungi, Pathogenic, Pathogenic fungi, Flucytosine

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Treatment of disseminated Mycobacterium avium complex infection in AIDS with amikacin, ethambutol, rifampin, and ciprofloxacin

Article Abstract:

In the United States, the most common type of mycobacterial infection in patients with AIDS is disseminated or widespread Mycobacterium avium complex infection. This infection is associated with bacteremia, or infection of the blood, and symptoms of weight loss, night sweats, chills, diarrhea, and fever. Agents commonly used to treat tuberculosis, an infectious disease caused by Mycobacterium tuberculosis, are ineffective in treating M. avium complex infection. The effects of combined treatment with the antibiotics amikacin, ethambutol, rifampin, and ciprofloxacin were assessed in 17 AIDS patients with disseminated M. avium complex infection. Amikacin was administered intravenously for 4 weeks and the remaining antibiotics were taken by mouth for 12 weeks. Fifteen patients completed at least four weeks of drug therapy. The combined antibiotic regimen decreased the colony count, or number of bacteria in the blood, from 537 per milliliter (mL) to 14 per mL after four weeks of treatment. The decrease in numbers of bacteria was maintained during drug treatment and was associated with an improvement in the symptoms of M. avium complex infection. Seven of 17 patients discontinued drug treatment early, at less than 12 weeks, due to gastrointestinal intolerance and adverse effects on the liver. These findings demonstrate that the combined antibiotic regimen of amikacin, ethambutol, rifampin, and ciprofloxacin is effective in decreasing bacterial numbers and symptoms associated with M. avium complex infection in patients with AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mycobacterial infections, Mycobacterium infections, Mycobacterium avium, Rifampin, Ciprofloxacin, Ethambutol, Amikacin

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Fluconazole treatment of persistent Cryptococcus neoformans prostatic infection in AIDS

Article Abstract:

Cryptococcus neoformans is a fungus that is not commonly found to infect people with AIDS. The most common site of infection is the central nervous system; it is known as cryptococcal meningitis. This disease is commonly treated with the antifungal drug amphotericin B. Unfortunately, this drug has many potential side effects, and the total dose of the drug given to patients is often limited by these side effects. Some male patients with AIDS who have been treated with amphotericin B for cryptococcal infections have later been found to have cryptococcal prostatitis. This means that despite apparent adequate treatment of their primary cryptococcal infection, they develop infections of their prostate glands with C. neoformans. A group of 14 AIDS patients with cryptococcal prostatitis were treated with fluconazole, a newer antifungal drug. Seven of these patients responded to the fluconazole treatment, while seven did not, yielding a 50 percent response rate. Why some of the men responded while others did not is unclear, as all received comparable doses of first amphotericin B, and then of fluconazole. Given the seriousness of cryptococcal prostatitis, treatment with fluconazole after completion of amphotericin B therapy for cryptococcal meningitis is probably prudent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fluconazole, Cryptococcus

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