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Amphotericin B in Cryptococcal Meningitis: Long-Term Results of Treatment

GEORGE A. SAROSI, M.D.; JAMES D. PARKER, M.D.; IRENE L. DOTO, M.A.; and FRED E. TOSH, M.D.
Ann Intern Med. 1969;71(6):1079-1087. doi:10.7326/0003-4819-71-6-1079
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SUMMARY:

Thirty-one patients with proved cryptococcal meningitis were treated with intravenous amphotericin B, and almost half had intrathecal therapy as well. The case fatality ratio during initial treatment was 9 of 31, or 29%. Outcome of the initial therapy tended to he worse, although not significantly so, in those patients who were older and had coexisting disease. Four of the 22 surviving patients relapsed from 6 weeks to 29 months after the completion of initial therapy. Three of the four patients who relapsed died from cryptococcal meningitis in spite of a second course of therapy. Two additional patients, apparently cured of cryptococcal meningitis, died of other causes shortly after the completion of initial therapy.

The remaining 17 patients have now been followed from 2 to 12 years (average 7½ years). Only four have significant neurological residuals, but none require custodial care.

Frequent follow-up examinations, including examinations of the spinal fluid, are recommended for at least 3 years to recognize all relapses early.

This study is in agreement with other reports supporting the effectiveness of amphotericin B in the treatment of cryptococcal meningitis.

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