Template:ID-Fungal meningitis: Difference between revisions

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* Fungal meningitis
* Fungal meningitis
:* '''Blastomyces dermatitidis'''<ref>{{Cite journal| doi = 10.1086/588300| issn = 1537-6591| volume = 46| issue = 12| pages = 1801–1812| last1 = Chapman| first1 = Stanley W.| last2 = Dismukes| first2 = William E.| last3 = Proia| first3 = Laurie A.| last4 = Bradsher| first4 = Robert W.| last5 = Pappas| first5 = Peter G.| last6 = Threlkeld| first6 = Michael G.| last7 = Kauffman| first7 = Carol A.| last8 = Infectious Diseases Society of America| title = Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2008-06-15| pmid = 18462107}}</ref>
:*1. '''Blastomyces dermatitidis'''<ref>{{Cite journal| doi = 10.1086/588300| issn = 1537-6591| volume = 46| issue = 12| pages = 1801–1812| last1 = Chapman| first1 = Stanley W.| last2 = Dismukes| first2 = William E.| last3 = Proia| first3 = Laurie A.| last4 = Bradsher| first4 = Robert W.| last5 = Pappas| first5 = Peter G.| last6 = Threlkeld| first6 = Michael G.| last7 = Kauffman| first7 = Carol A.| last8 = Infectious Diseases Society of America| title = Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2008-06-15| pmid = 18462107}}</ref>
::* Preferred regimen: [[Liposomal Amphotericin B]] 5 mg/kg/day IV for 4–6 weeks, followed by [[Fluconazole]] 800 mg PO qd {{or}} [[Itraconazole]] 200 mg PO bid–tid {{or}} [[Voriconazole]] 200–400 mg PO bid for ≥12 months until CSF abnl resolves
::* Preferred regimen: [[Liposomal Amphotericin B]] 5 mg/kg/day IV for 4–6 weeks, followed by [[Fluconazole]] 800 mg PO qd {{or}} [[Itraconazole]] 200 mg PO bid–tid {{or}} [[Voriconazole]] 200–400 mg PO bid for ≥12 months until CSF abnl resolves


:* '''Candida spp.'''<ref>{{Cite journal| doi = 10.1086/596757| issn = 1537-6591| volume = 48| issue = 5| pages = 503–535| last1 = Pappas| first1 = Peter G.| last2 = Kauffman| first2 = Carol A.| last3 = Andes| first3 = David| last4 = Benjamin| first4 = Daniel K.| last5 = Calandra| first5 = Thierry F.| last6 = Edwards| first6 = John E.| last7 = Filler| first7 = Scott G.| last8 = Fisher| first8 = John F.| last9 = Kullberg| first9 = Bart-Jan| last10 = Ostrosky-Zeichner| first10 = Luis| last11 = Reboli| first11 = Annette C.| last12 = Rex| first12 = John H.| last13 = Walsh| first13 = Thomas J.| last14 = Sobel| first14 = Jack D.| last15 = Infectious Diseases Society of America| title = Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2009-03-01| pmid = 19191635}}</ref>
:*2. '''Candida spp.'''<ref>{{Cite journal| doi = 10.1086/596757| issn = 1537-6591| volume = 48| issue = 5| pages = 503–535| last1 = Pappas| first1 = Peter G.| last2 = Kauffman| first2 = Carol A.| last3 = Andes| first3 = David| last4 = Benjamin| first4 = Daniel K.| last5 = Calandra| first5 = Thierry F.| last6 = Edwards| first6 = John E.| last7 = Filler| first7 = Scott G.| last8 = Fisher| first8 = John F.| last9 = Kullberg| first9 = Bart-Jan| last10 = Ostrosky-Zeichner| first10 = Luis| last11 = Reboli| first11 = Annette C.| last12 = Rex| first12 = John H.| last13 = Walsh| first13 = Thomas J.| last14 = Sobel| first14 = Jack D.| last15 = Infectious Diseases Society of America| title = Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2009-03-01| pmid = 19191635}}</ref>
::* Preferred regimen: [[Liposomal Amphotericin B]] 3–5 mg/kg/day IV {{withorwithout}} [[Flucytosine]] 25 mg/kg PO qid for several weeks, followed by [[Fluconazole]] 400–800 mg (6–12 mg/kg) PO qd until CSF abnl resolves
::* Preferred regimen: [[Liposomal Amphotericin B]] 3–5 mg/kg/day IV {{withorwithout}} [[Flucytosine]] 25 mg/kg PO qid for several weeks, followed by [[Fluconazole]] 400–800 mg (6–12 mg/kg) PO qd until CSF abnl resolves
::* Alternative regimen: [[Fluconazole]] 400–800 mg PO qd (6–12 mg/kg IV q24h) {{or}} [[Voriconazole]] 400 mg PO bid for 2 doses, followed by 200 mg PO bid {{or}} [[Voriconazole]] 6 mg/kg IV q12h for 2 doses, followed by 3 mg/kg IV q12h
::* Alternative regimen: [[Fluconazole]] 400–800 mg PO qd (6–12 mg/kg IV q24h) {{or}} [[Voriconazole]] 400 mg PO bid for 2 doses, followed by 200 mg PO bid {{or}} [[Voriconazole]] 6 mg/kg IV q12h for 2 doses, followed by 3 mg/kg IV q12h
::: Note: Removal of intraventricular devices is recommended.
::: Note: Removal of intraventricular devices is recommended.


:* '''Coccidioides immitis'''
:*3. '''Coccidioides immitis'''<ref>{{Cite journal| doi = 10.1086/496991| issn = 1537-6591| volume = 41| issue = 9| pages = 1217–1223| last1 = Galgiani| first1 = John N.| last2 = Ampel| first2 = Neil M.| last3 = Blair| first3 = Janis E.| last4 = Catanzaro| first4 = Antonino| last5 = Johnson| first5 = Royce H.| last6 = Stevens| first6 = David A.| last7 = Williams| first7 = Paul L.| last8 = Infectious Diseases Society of America| title = Coccidioidomycosis| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2005-11-01| pmid = 16206093}}</ref>
::* Preferred regimen: [[Fluconazole]] 400 mg PO qd
::* Preferred regimen: [[Fluconazole]] 400 mg PO qd
::* Alternative regimen: [[Itraconazole]] 200 mg PO bid–tid
::* Alternative regimen: [[Itraconazole]] 200 mg PO bid–tid


:*4. '''Cryptococcus neoformans'''<ref>{{Cite journal| doi = 10.1086/649858| issn = 1537-6591| volume = 50| issue = 3| pages = 291–322| last1 = Perfect| first1 = John R.| last2 = Dismukes| first2 = William E.| last3 = Dromer| first3 = Francoise| last4 = Goldman| first4 = David L.| last5 = Graybill| first5 = John R.| last6 = Hamill| first6 = Richard J.| last7 = Harrison| first7 = Thomas S.| last8 = Larsen| first8 = Robert A.| last9 = Lortholary| first9 = Olivier| last10 = Nguyen| first10 = Minh-Hong| last11 = Pappas| first11 = Peter G.| last12 = Powderly| first12 = William G.| last13 = Singh| first13 = Nina| last14 = Sobel| first14 = Jack D.| last15 = Sorrell| first15 = Tania C.| title = Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2010-02-01| pmid = 20047480}}</ref>
::*4.1 '''Non–HIV/AIDS hosts, non–transplant recipients'''
:::* Induction therapy: ([[Amphotericin B]] 0.7–1.0 mg/kg IV q24h for 4–6 weeks {{or}} [[Liposomal Amphotericin B]] 3–4 mg/kg IV q24h for 4–6 weeks {{or}} [[Amphotericin B lipid complex]] 5 mg/kg IV q24h for 4–6 weeks) {{and}} [[Flucytosine]] 25 mg/kg PO q6h for 4–6 weeks
:::* Consolidation therapy: [[Fluconazole]] 400–800 mg PO q24h for 8 weeks
:::* Maintenance therapy: [[Fluconazole]] 200 mg PO q24h for 6–12 months


::*4.2 '''HIV/AIDS hosts'''
:::* Induction therapy (1): ([[Amphotericin B]] 0.7–1.0 mg/kg IV q24h for ≥ 2 weeks {{or}} [[Liposomal Amphotericin B]] 3–4 mg/kg IV q24h for ≥ 2 weeks {{or}} [[Amphotericin B lipid complex]] 5 mg/kg IV q24h for ≥ 2 weeks) {{and}} [[Flucytosine]] 25 mg/kg PO q6h for ≥ 2 weeks
:::* Induction therapy (2): [[Amphotericin B]] 0.7–1.0 mg/kg IV q24h for 4–6 weeks {{or}} [[Liposomal Amphotericin B]] 3–4 mg/kg IV q24h for 4–6 weeks {{or}} [[Amphotericin B lipid complex]] 5 mg/kg IV q24h for 4–6 weeks
:::* Induction therapy (3): [[Amphotericin B]] 0.7–1.0 mg/kg IV q24h for 2 weeks {{and}} [[Fluconazole]] 800 mg PO q24h for 2 weeks
:::* Induction therapy (4): [[Fluconazole]] 1200 mg PO q24h for 6 weeks {{and}} [[Flucytosine]] 100 mg/kg PO q24h for 6 weeks
:::* Induction therapy (5): [[Fluconazole]] 800–2000 mg PO q24h for 10–12 weeks
:::* Induction therapy (6): [[Itraconazole]] 200 mg PO q12h for 10–12 weeks
:::* Consolidation therapy: [[Fluconazole]] 400 mg PO q24h for 8 weeks
:::* Maintenance therapy: [[Fluconazole]] 200 mg PO q24h for ≥ 1 year {{or}} [[Itraconazole]] 400 mg PO q24h for ≥ 1 year {{or}} [[Amphotericin B]] 1.0 mg/kg/week IV for ≥ 1 year


::*4.3 '''Transplant recipients'''
:::* Induction therapy (1): ([[Liposomal Amphotericin B]] 3–4 mg/kg IV q24h for ≥ 2 weeks {{or}} [[Amphotericin B lipid complex]] 5 mg/kg IV q24h for ≥ 2 weeks) {{and}} [[Flucytosine]] 25 mg/kg PO q6h for ≥ 2 weeks
:::* Induction therapy (2): [[Liposomal Amphotericin B]] 3–4 mg/kg IV q24h for 4–6 weeks {{or}} [[Amphotericin B lipid complex]] 5 mg/kg IV q24h for 4–6 weeks
:::* Consolidation therapy: [[Fluconazole]] 400–800 mg PO q24h for 8 weeks
:::* Maintenance therapy: [[Fluconazole]] 200–400 mg PO q24h for 6–12 months


 
:*5. '''Histoplasma capsulatum'''<ref>{{Cite journal| doi = 10.1086/521259| issn = 1537-6591| volume = 45| issue = 7| pages = 807–825| last1 = Wheat| first1 = L. Joseph| last2 = Freifeld| first2 = Alison G.| last3 = Kleiman| first3 = Martin B.| last4 = Baddley| first4 = John W.| last5 = McKinsey| first5 = David S.| last6 = Loyd| first6 = James E.| last7 = Kauffman| first7 = Carol A.| last8 = Infectious Diseases Society of America| title = Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2007-10-01| pmid = 17806045}}</ref>
:* '''C. neoformans, HIV–infected'''
::* Preferred regimen: [[Liposomal Amphotericin B]] 5 mg/kg IV q24h for 4–6 weeks, followed by [[Itraconazole]] 200 mg PO bid–tid for ≥ 12 months
Induction Therapy: Preferred Regimen 1
▸ Amphotericin B 0.7–1.0 mg/kg IV q24h for ≥2 weeks
OR
▸ Liposomal Amphotericin B 3–4 mg/kg IV q24h for ≥2 weeks
OR
▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥2 weeks
PLUS
▸ Flucytosine 25 mg/kg PO q6h for ≥2 weeks
Induction Therapy: Preferred Regimen 2
▸ Amphotericin B 0.7–1.0 mg/kg IV q24h for 4–6 weeks
OR
▸ Liposomal Amphotericin B 3–4 mg/kg IV q24h for 4–6 weeks
OR
▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4–6 weeks
Induction Therapy: Alternative Regimen 1
▸ Amphotericin B 0.7 mg/kg IV q24h for 2 weeks
PLUS
▸ Fluconazole 800 mg PO q24h for 2 weeks
Induction Therapy: Alternative Regimen 2
▸ Fluconazole 1200 mg PO q24h for 6 weeks
PLUS
▸ Flucytosine 100 mg/kg PO q24h for 6 weeks
Induction Therapy: Alternative Regimen 3
▸ Fluconazole 800–2000 mg PO q24h for 10–12 weeks
Induction Therapy: Alternative Regimen 4
▸ Itraconazole 200 mg PO q12h for 10–12 weeks
Consolidation Therapy
▸ Fluconazole 400 mg PO q24h for 8 weeks
Maintenance Therapy
▸ Fluconazole 200 mg PO q24h for ≥1 year
OR
▸ Itraconazole 400 mg PO q24h for ≥1 year
OR
▸ Amphotericin B 1.0 mg/kg/week IV for ≥1 year
 
 
 
:* '''C. neoformans, Organ Transplant Recipients'''
 
Induction Therapy: Preferred Regimen
▸ Liposomal Amphotericin B 3–4 mg/kg IV q24h for ≥2 weeks
OR
▸ Amphotericin B lipid complex 5 mg/kg IV q24h for ≥2 weeks
PLUS
▸ Flucytosine 25 mg/kg PO q6h for ≥2 weeks
Induction Therapy: Alternative Regimen
▸ Liposomal Amphotericin B 3–4 mg/kg IV q24h for 4–6 weeks
OR
▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4–6 weeks
Consolidation Therapy
▸ Fluconazole 400–800 mg PO q24h for 8 weeks
Maintenance Therapy
▸ Fluconazole 200–400 mg PO q24h for 6–12 months
 
 
 
:* '''C. neoformans, Non–HIV-Infected and Nontransplant Hosts'''
Induction Therapy: Preferred Regimen
▸ Amphotericin B 0.7–1.0 mg/kg IV q24h for 4–6 weeks
OR
▸ Liposomal Amphotericin B 3–4 mg/kg IV q24h for 4–6 weeks
OR
▸ Amphotericin B lipid complex 5 mg/kg IV q24h for 4–6 weeks
PLUS
▸ Flucytosine 25 mg/kg PO q6h for 4–6 weeks
Consolidation Therapy
▸ Fluconazole 400–800 mg PO q24h for 8 weeks
Maintenance Therapy
▸ Fluconazole 200 mg PO q24h for 6–12 months
Adapted from Clin Infect Dis. 2010;50(3):291-322.[10]
 
:* '''Histoplasma capsulatum'''
Preferred Regimen
▸ Liposomal Amphotericin B 5 mg/kg IV q24h for 4–6 weeks
FOLLOWED BY
▸ Itraconazole 200 mg PO bid–tid for ≥12 months
Adapted from Clin Infect Dis. 2007;45(7):807-25.[11]

Latest revision as of 18:21, 31 July 2015

  • Fungal meningitis
  • 1. Blastomyces dermatitidis[1]
  • 2. Candida spp.[2]
  • Preferred regimen: Liposomal Amphotericin B 3–5 mg/kg/day IV ± Flucytosine 25 mg/kg PO qid for several weeks, followed by Fluconazole 400–800 mg (6–12 mg/kg) PO qd until CSF abnl resolves
  • Alternative regimen: Fluconazole 400–800 mg PO qd (6–12 mg/kg IV q24h) OR Voriconazole 400 mg PO bid for 2 doses, followed by 200 mg PO bid OR Voriconazole 6 mg/kg IV q12h for 2 doses, followed by 3 mg/kg IV q12h
Note: Removal of intraventricular devices is recommended.
  • 3. Coccidioides immitis[3]
  • 4. Cryptococcus neoformans[4]
  • 4.1 Non–HIV/AIDS hosts, non–transplant recipients
  • 4.2 HIV/AIDS hosts
  • 4.3 Transplant recipients
  • 5. Histoplasma capsulatum[5]
  1. ↑ Chapman, Stanley W.; Dismukes, William E.; Proia, Laurie A.; Bradsher, Robert W.; Pappas, Peter G.; Threlkeld, Michael G.; Kauffman, Carol A.; Infectious Diseases Society of America (2008-06-15). "Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 46 (12): 1801–1812. doi:10.1086/588300. ISSN 1537-6591. PMID 18462107.
  2. ↑ Pappas, Peter G.; Kauffman, Carol A.; Andes, David; Benjamin, Daniel K.; Calandra, Thierry F.; Edwards, John E.; Filler, Scott G.; Fisher, John F.; Kullberg, Bart-Jan; Ostrosky-Zeichner, Luis; Reboli, Annette C.; Rex, John H.; Walsh, Thomas J.; Sobel, Jack D.; Infectious Diseases Society of America (2009-03-01). "Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 48 (5): 503–535. doi:10.1086/596757. ISSN 1537-6591. PMID 19191635.
  3. ↑ Galgiani, John N.; Ampel, Neil M.; Blair, Janis E.; Catanzaro, Antonino; Johnson, Royce H.; Stevens, David A.; Williams, Paul L.; Infectious Diseases Society of America (2005-11-01). "Coccidioidomycosis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 41 (9): 1217–1223. doi:10.1086/496991. ISSN 1537-6591. PMID 16206093.
  4. ↑ Perfect, John R.; Dismukes, William E.; Dromer, Francoise; Goldman, David L.; Graybill, John R.; Hamill, Richard J.; Harrison, Thomas S.; Larsen, Robert A.; Lortholary, Olivier; Nguyen, Minh-Hong; Pappas, Peter G.; Powderly, William G.; Singh, Nina; Sobel, Jack D.; Sorrell, Tania C. (2010-02-01). "Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 50 (3): 291–322. doi:10.1086/649858. ISSN 1537-6591. PMID 20047480.
  5. ↑ Wheat, L. Joseph; Freifeld, Alison G.; Kleiman, Martin B.; Baddley, John W.; McKinsey, David S.; Loyd, James E.; Kauffman, Carol A.; Infectious Diseases Society of America (2007-10-01). "Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 45 (7): 807–825. doi:10.1086/521259. ISSN 1537-6591. PMID 17806045.
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