Sandbox fungal meningitis: Difference between revisions

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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal amphotericin B]] 5 mg/kg/day for 4–6 weeks'''''  
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal amphotericin B]] 5 mg/kg/day IV for 4–6 weeks'''''  
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''Followed  By''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''Followed  By''
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]]400–800 mg (6–12 mg/kg) IV or PO'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 400–800 mg (6–12 mg/kg) IV or PO'''''
|-
|-
|}
|}
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</div></div>
</div></div>
<div class="mw-collapsible mw-collapsed">
===Coccidioides<ref name="pmid16206093">Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Johnson RH, Stevens DA et al. (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16206093 Coccidioidomycosis.] ''Clin Infect Dis'' 41 (9):1217-23. [http://dx.doi.org/10.1086/496991 DOI:10.1086/496991] PMID: [http://pubmed.gov/16206093 16206093]</ref>===
<div class="mw-collapsible-content">
{|
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Coccidioides]]}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[FLuconazole]] 400 mg/day PO'''''<BR>''OR''<BR>▸ '''''[[Itraconazole]] 400–600 mg/day PO'''''
|-
|}
|}
</div></div>
<div class="mw-collapsible mw-collapsed">
===Cryptococcus HIV/AIDS<ref name="pmid24052889">Antinori S (2013) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=24052889 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: [http://pubmed.gov/24052889 24052889]</ref>===
<div class="mw-collapsible-content">
{|
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Cryptococcus, HIV/AIDS]]}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Induction Phrase(for 2 wks)''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amphotericin B deoxycholate]] 0.7 mg/kg/day IV'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[5-Fluorocytosine]] 100 mg/kg/day PO'''''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Consolidation phase(for 8 wks)''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 400 mg/day PO'''''<BR>''OR''<BR>▸ '''''[[Itraconazole]] 400 mg/day PO'''''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Maintenance phase''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 200 mg/day PO'''''
|-
|}
|}




</div></div>
<div class="mw-collapsible mw-collapsed">
<div class="mw-collapsible mw-collapsed">


===Histoplasma===
===Cryptococcus Immunocompetent<ref name="pmid22763808">Jackson A, van der Horst C (2012) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=22763808 New insights in the prevention, diagnosis, and treatment of cryptococcal meningitis.] ''Curr HIV/AIDS Rep'' 9 (3):267-77. [http://dx.doi.org/10.1007/s11904-012-0127-7 DOI:10.1007/s11904-012-0127-7] PMID: [http://pubmed.gov/22763808 22763808]</ref>===


<div class="mw-collapsible-content">
<div class="mw-collapsible-content">
{|
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Cryptococcus, Immunocompetent]]}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Induction Phrase(for 2 wks)''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amphotericin B]] 0.7-1 mg/kg/day IV'''''<BR>''OR''<BR>▸ '''''[[Liposomal amphotericin B]] 5 mg/kg/day PO
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[5-Fluorocytosine]] 25 mg/kg  PO q6h'''''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Consolidation phase(for 8 wks)''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 400 mg/day PO qd'''''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Maintenance phase(for 12 mo)''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 200 mg PO qd'''''
|-
|}
|}
</div></div>
==Viral Meningitis<ref name="pmid23377760">Studahl M, Lindquist L, Eriksson BM, Günther G, Bengner M, Franzen-Röhl E et al. (2013) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23377760 Acute viral infections of the central nervous system in immunocompetent adults: diagnosis and management.] ''Drugs'' 73 (2):131-58. [http://dx.doi.org/10.1007/s40265-013-0007-5 DOI:10.1007/s40265-013-0007-5] PMID: [http://pubmed.gov/23377760 23377760]</ref>==
{|
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Herpes simplex Meningitis]]}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aciclovir]]''''' IV  <BR>''OR''<BR>▸ '''''[[Valaciclovir]]''''' PO
|-
|}
|}
==Parasitic Meningitis==
===Angiostrongyliasis===
{|
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Angiostrongyliasis]]}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[albendazole]] 60 kg or greater： 400 mg twice daily PO with
meals<BR>''OR''<BR> less than 60 kg:7.5 mg/kg PO bid with meals (maximum total daily dose 800 mg)'''''
|-
|}
|}
===Amebic meningoencephalitis===
{|
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Amebic meningoencephalitis]]}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Miltefosine]]'''''
|-
|}
|}
===Eosinophilic myeloencephalitis, Meningitis===
{|
{|
|-
|-
| valign=top |
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Coccidioides]]}}''
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Eosinophilic myeloencephalitis, Meningitis]]}}''
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[albendazole]]'''''
|-
|}
|}


| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[FLuconazole]]400 mg/day PO'''''<BR>''OR''<BR>▸ '''''[[Itraconazole]]400–600 mg/day'''''


===Toxoplasma gondii, Meningitis===
{|
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Toxoplasma gondii, Meningitis]]}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[albendazole]]'''''
|-
|}
|}
==M. tuberculosis Meningitis <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from Treatment of Tuberculosis guidelines<ref>{{Cite web  | last =  | first =  | title = http://whqlibdoc.who.int/publications/2010/9789241547833_eng.pdf?ua=1 | url = http://whqlibdoc.who.int/publications/2010/9789241547833_eng.pdf?ua=1 | publisher =  | date =  | accessdate = 22 January 2014 }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
{|
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[M. tuberculosis]]}}''
|-! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Intensive Phase(for 9-12 mo)''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampicin]] 8-12 mg/kg/day PO daily max: 600mg<BR> ''OR''<BR> 8-12mg/kg/day PO 3 times per week x:600mg'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Isoniazid]] 4-6 mg/kg/day PO daily max: 300mg<BR>''OR''<BR> 8-12mg/kg/day PO 3 times per week daily max:900mg'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Pyrazinamide]] 20-30 mg/kg/day PO<BR>''OR''<BR> 30-40mg/kg/day PO 3 times per week'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Streptomycin]] 12-18 mg/kg/day IM<BR>''OR''<BR> 25-35mg/kg/day PO 3 times per week daily max:1000mg'''''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Continuation Phase''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampicin]] 8-12 mg/kg/day PO daily max: 600mg<BR>''OR''<BR> 8-12mg/kg/day PO 3 times per week daily max:600mg'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Isoniazid]] 4-6 mg/kg/day PO daily max: 300mg<BR>''OR''<BR> 8-12mg/kg/day PO 3 times per week daily max:900mg'''''
|-
|-
|}
|}
|}
|}


==References==
{{reflist|2}}
[[Category:Needs overview]]
[[Category:Disease]]


</div></div>
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Diseases involving the fasciae]]
[[Category:Inflammations]]
[[Category:Neurological disorders]]

Latest revision as of 06:37, 28 July 2020

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

Blastomyces

Blastomyces
Preferred Regimen
▸ Liposomal amphotericin B 5 mg/kg/day IV for 4–6 weeks
Followed By
▸ Fluconazole 800 mg/day PO
OR
▸ Itraconazole 200 mg PO bid or tid
OR
▸ Voriconazole 200–400 mg IV q12h


Candidiasis

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

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]

Coccidioides
Preferred Regimen
▸ FLuconazole 400 mg/day PO
OR
▸ Itraconazole 400–600 mg/day PO


Cryptococcus HIV/AIDS[2]

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
OR
▸ Itraconazole 400 mg/day PO
Maintenance phase
▸ Fluconazole 200 mg/day PO


Cryptococcus Immunocompetent[3]

Cryptococcus, Immunocompetent
Induction Phrase(for 2 wks)
▸ Amphotericin B 0.7-1 mg/kg/day IV
OR
▸ 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]

Herpes simplex Meningitis
Preferred Regimen
▸ Aciclovir IV
OR
▸ Valaciclovir PO


Parasitic Meningitis

Angiostrongyliasis

Angiostrongyliasis
Preferred Regimen
▸ albendazole 60 kg or greater： 400 mg twice daily PO with

meals
OR
less than 60 kg:7.5 mg/kg PO bid with meals (maximum total daily dose 800 mg)

Amebic meningoencephalitis

Amebic meningoencephalitis
Preferred Regimen
▸ Miltefosine

Eosinophilic myeloencephalitis, Meningitis

Eosinophilic myeloencephalitis, Meningitis
Preferred Regimen
▸ albendazole


Toxoplasma gondii, Meningitis

Toxoplasma gondii, Meningitis
Preferred Regimen
▸ albendazole

M. tuberculosis Meningitis Adapted from Treatment of Tuberculosis guidelines[5]

M. tuberculosis
▸ Rifampicin 8-12 mg/kg/day PO daily max: 600mg
OR
8-12mg/kg/day PO 3 times per week x:600mg
PLUS
▸ Isoniazid 4-6 mg/kg/day PO daily max: 300mg
OR
8-12mg/kg/day PO 3 times per week daily max:900mg
PLUS
▸ Pyrazinamide 20-30 mg/kg/day PO
OR
30-40mg/kg/day PO 3 times per week
PLUS
▸ Streptomycin 12-18 mg/kg/day IM
OR
25-35mg/kg/day PO 3 times per week daily max:1000mg
Continuation Phase
▸ Rifampicin 8-12 mg/kg/day PO daily max: 600mg
OR
8-12mg/kg/day PO 3 times per week daily max:600mg
PLUS
▸ Isoniazid 4-6 mg/kg/day PO daily max: 300mg
OR
8-12mg/kg/day PO 3 times per week daily max:900mg

References

  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)
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