Retrospective Study on Six Cases of Cryptococcal Meningitis

Six cases of cryptococcal meningitis occurring during the past 17 years were retrospectively analyzed. Five of the patients improved, while one died during the first admission. Among the five improved cases, one patient died six months later following a flare-up of cryptococcal meningitis and the onset of adult T cell leukemia (ATL). Two cases were complicated by hydrocephalus and one by loss of vision. Only one patient was cured without any complications. We investigated the time required to eliminate Cryptococcus neoformans from the cerebrospinal fluid (CSF). When two months or more was required, the patient suffered relapse and complications, and when it was one year or more, the patient died. Besides amphotericin B (AMPH) and flucytosin 5-FC, we have recently used two new antifungal agents, miconazole (MCZ) and fluconazole (FLCZ). All cases were treated with a combination of antifungal agents, and in five cases the new azole derivatives were used. The Ommayas procedure was used in four cases. We studied the CSF concentration of FLCZ in one case. After 20 hours, the level was 70% of the serum level when the route was oral and 90% when the drug was intravenously administered. In spite of the use of new agents or new theraputic procedures, however, cryptococcal meningitis remains a serious disease because the prognosis depends heavily on rapid diagnosis, the host defense mechanism and underlying diseases.