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Six patients with cryptococcal meningitis were admitted to the First Department of Internal Medicine of Yokohama City University Medical School in the last 13 years. Five of 6 patients (83.3%) were cured with intravenous amphotericin B and the remaining one patient died during therapy. They were divided into 3 groups (group I, II, and III, ) according to the treatment schedules with amphotericin B. Group I is composed of 2 patients who could be cured with a single course of intravenous amphotericin B. Amphotericin B therapy was usually started with 1-5mg/day given intravenously and increased every day until 50mg/day was reached. Then the dosage was continued every day until no cryptococci became to be seen in India ink preparation of centrifuged sediment of cerebrospinal fluid. Group II is composed of three patients who could be cured with double courses of intravenous amphotericin B. Group III is composed of one patient who was tried with prolonged and repeated courses of intravenous amphotericin B and additionally with intralumbal and intracisternal amphotericin B. For the successful treatment of this disease it is absolutely necessary to identify Cryptococcus neoformans by demonstration of encapsulated budding yeasts in India ink preparations of cerebrospinal fluid and to initiate the intravenous administration of amphotericin B in as early period of the disease as possible. The examination of the organism in spinal fluid by India ink preparation is very simple, and reliable not only for early diagnosis of the meningitis but also as an important criteria for the completion of the treatment. As to side effects, decrease of serum K, increase of BUN and transaminase, anemia, fever, and nausea were observed in all cases, but they were not permanent and returned to normal after discontinuation of amphotericin B.
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日本医真菌学会 | 論文

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