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Sandbox fungal meningitis

From Wikidoc - Reading time: 3 min

Meningitis Main Page

Patient Information

Overview

Causes

Classification

Viral Meningitis
Bacterial Meningitis
Fungal Meningitis

Differential Diagnosis

Diagnosis

Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;Sheng Shi, M.D. [2]


fungal meningitis

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Blastomyces

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Blastomyces
Preferred Regimen
▸ Liposomal amphotericin B 5 mg/kg/day IV for 4–6 weeks
Followed By
▸ Fluconazole 800 mg/day PO
OR
▸ Itraconazole 200 mg PO bid or tid
OR
▸ Voriconazole 200–400 mg IV q12h


Candidiasis

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Candidiasis
Preferred Regimen
▸ lipid-based ampho B 3–5 mg/kg/day
PLUS OR NOT
▸ 5-Fluorocytosine 25 mg/kg PO qid
Alternative Regimen
▸ Fluconazole 400–800 mg (6–12 mg/kg) IV or PO


Histoplasma

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Histoplasma
Preferred Regimen
▸ Liposomal ampho B 5 mg/kg/d, for a total of 175 mg/kg over 4-6 wk
Followed By
▸ Itraconazole 200 mg/day PO bid or tid for at least 12 month


Coccidioides[1]

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Coccidioides
Preferred Regimen
▸ FLuconazole 400 mg/day PO
OR
▸ Itraconazole 400–600 mg/day PO


Cryptococcus HIV/AIDS[2]

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Cryptococcus, HIV/AIDS
Induction Phrase(for 2 wks)
▸ Amphotericin B deoxycholate 0.7 mg/kg/day IV
PLUS
▸ 5-Fluorocytosine 100 mg/kg/day PO
Consolidation phase(for 8 wks)
▸ Fluconazole 400 mg/day PO
OR
▸ Itraconazole 400 mg/day PO
Maintenance phase
▸ Fluconazole 200 mg/day PO


Cryptococcus Immunocompetent[3]

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Cryptococcus, Immunocompetent
Induction Phrase(for 2 wks)
▸ Amphotericin B 0.7-1 mg/kg/day IV
OR
▸ Liposomal amphotericin B 5 mg/kg/day PO
PLUS
▸ 5-Fluorocytosine 25 mg/kg PO q6h
Consolidation phase(for 8 wks)
▸ Fluconazole 400 mg/day PO qd
Maintenance phase(for 12 mo)
▸ Fluconazole 200 mg PO qd



Viral Meningitis[4]

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Herpes simplex Meningitis
Preferred Regimen
▸ Aciclovir IV
OR
▸ Valaciclovir PO


Parasitic Meningitis

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Angiostrongyliasis

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Angiostrongyliasis
Preferred Regimen
▸ albendazole 60 kg or greater： 400 mg twice daily PO with

meals
OR
less than 60 kg:7.5 mg/kg PO bid with meals (maximum total daily dose 800 mg)

Amebic meningoencephalitis

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Amebic meningoencephalitis
Preferred Regimen
▸ Miltefosine

Eosinophilic myeloencephalitis, Meningitis

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Eosinophilic myeloencephalitis, Meningitis
Preferred Regimen
▸ albendazole


Toxoplasma gondii, Meningitis

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Toxoplasma gondii, Meningitis
Preferred Regimen
▸ albendazole

M. tuberculosis Meningitis Adapted from Treatment of Tuberculosis guidelines[5]

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M. tuberculosis
▸ Rifampicin 8-12 mg/kg/day PO daily max: 600mg
OR
8-12mg/kg/day PO 3 times per week x:600mg
PLUS
▸ Isoniazid 4-6 mg/kg/day PO daily max: 300mg
OR
8-12mg/kg/day PO 3 times per week daily max:900mg
PLUS
▸ Pyrazinamide 20-30 mg/kg/day PO
OR
30-40mg/kg/day PO 3 times per week
PLUS
▸ Streptomycin 12-18 mg/kg/day IM
OR
25-35mg/kg/day PO 3 times per week daily max:1000mg
Continuation Phase
▸ Rifampicin 8-12 mg/kg/day PO daily max: 600mg
OR
8-12mg/kg/day PO 3 times per week daily max:600mg
PLUS
▸ Isoniazid 4-6 mg/kg/day PO daily max: 300mg
OR
8-12mg/kg/day PO 3 times per week daily max:900mg

References

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  1. ↑ Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Johnson RH, Stevens DA et al. (2005) Coccidioidomycosis. Clin Infect Dis 41 (9):1217-23. DOI:10.1086/496991 PMID: 16206093
  2. ↑ Antinori S (2013) New Insights into HIV/AIDS-Associated Cryptococcosis. ISRN AIDS 2013 ():471363.http://dx.doi.org/10.1155/2013/471363 DOI:10.1155/2013/471363] PMID: 24052889
  3. ↑ Jackson A, van der Horst C (2012) New insights in the prevention, diagnosis, and treatment of cryptococcal meningitis. Curr HIV/AIDS Rep 9 (3):267-77. DOI:10.1007/s11904-012-0127-7 PMID: 22763808
  4. ↑ Studahl M, Lindquist L, Eriksson BM, Günther G, Bengner M, Franzen-Röhl E et al. (2013) Acute viral infections of the central nervous system in immunocompetent adults: diagnosis and management. Drugs 73 (2):131-58. DOI:10.1007/s40265-013-0007-5 PMID: 23377760
  5. ↑ "http://whqlibdoc.who.int/publications/2010/9789241547833_eng.pdf?ua=1" (PDF). Retrieved 22 January 2014. External link in |title= (help)
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