Sandbox fungal meningitis

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

▸ Itraconazole 200 mg PO bid or tid

▸ 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

▸ 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

▸ 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

▸ 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

▸ 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

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

8-12mg/kg/day PO 3 times per week x:600mg
PLUS
▸ Isoniazid 4-6 mg/kg/day PO daily max: 300mg

8-12mg/kg/day PO 3 times per week daily max:900mg
PLUS
▸ Pyrazinamide 20-30 mg/kg/day PO

30-40mg/kg/day PO 3 times per week
PLUS
▸ Streptomycin 12-18 mg/kg/day IM

25-35mg/kg/day PO 3 times per week daily max:1000mg
Continuation Phase
▸ Rifampicin 8-12 mg/kg/day PO daily max: 600mg

8-12mg/kg/day PO 3 times per week daily max:600mg
PLUS
▸ Isoniazid 4-6 mg/kg/day PO daily max: 300mg

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)