Robert A. Larsen, MD; Samuel Bozzette, MD; J. Allen McCutchan, MD; Joseph Chiu, MD; Mary Ann Leal, MD; Douglas D. Richman, MD; California Collaborative Treatment Group
Study Objective: To assess the frequency of persistent Cryptococcus neoformans infection in patients with the acquired immunodeficiency syndrome (AIDS) after receiving apparently adequate treatment for meningitis.
Design: Blood, urine, and cerebrospinal fluid were cultured at the conclusion of primary therapy to assess the adequacy of treatment.
Setting: Outpatient clinics at three medical centers.
Patients: Patients had C. neoformans grown in culture from cerebrospinal fluid. Primary therapy consisted of either 2.0 g of amphotericin B alone; 6 weeks of combination therapy with flucytosine; or, if flucytosine was poorly tolerated, an adjusted minimum total amphotericin B dose. To meet criteria for adequate treatment of meningitis all patients had two sequential cerebrospinal fluid samples which were culture negative.
Measurements and Main Results: Nine of forty-one patients grew C. neoformans from urine after completion of primary treatment, but none had urinary symptoms. Fungi were visualized in expressed prostatic secretions in 4 of these patients. One patient refused further treatment and developed cryptococcemia within 5 weeks. Three patients received additional amphotericin B; all had persistent funguria without systemic relapse. Six patients received fluconazole; 4 became urine culture negative, and 2 had systemic relapse.
Conclusion: The persistence of urinary C. neoformans after adequate therapy for meningitis suggests that the urinary tract (probably the prostate) is a sequestered reservoir of infection from which systemic relapse may occur.
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Larsen RA, Bozzette S, McCutchan JA, Chiu J, Leal MA, Richman DD, et al. Persistent Cryptococcus neoformans Infection of the Prostate after Successful Treatment of Meningitis. Ann Intern Med. 1989;111:125-128. doi: 10.7326/0003-4819-111-2-125
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Published: Ann Intern Med. 1989;111(2):125-128.
CNS Infections, Infectious Disease, Neurology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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