scholarly journals Case Report: Cryptococcal meningitis in an apparently immunocompetent patient in Nepal - challenges in diagnosis and treatment

2019 ◽  
Vol 4 ◽  
pp. 55
Author(s):  
Ashish Jha ◽  
Sudeep Adhikari ◽  
Keshav Raj Sigdel ◽  
Buddhi Paudyal ◽  
Buddha Basnyat ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Liposomal Amphotericin ◽  
Care Delivery ◽  
Immunocompetent Patient ◽  
Liposomal Amphotericin B ◽  
Middle Income ◽  
Middle Income Countries ◽  
Csf Analysis ◽  
The Government

A 50 year old woman from Nepal had clinical features suggestive of meningitis. Cerebrospinal fluid (CSF) analysis was normal except for the presence of cryptococcal antigen. The inclusion of test for Cryptococcus in the CSF helped in making the diagnosis of cryptococcal meningitis in our patient who was apparently immunocompetent. Treatment with liposomal amphotericin B could not be started on time due to financial constraints. The patient had a stroke and further deteriorated. Liposomal amphotericin B is stocked by the government of Nepal for free supply to patients with visceral leishmaniasis, but the policy does not allow the drug to be dispensed for other infections. The family members of our patient acquired the drug within a few days from a government center using their political connections and following administering the treatment the patient improved. This case demonstrates the utility of considering cryptococcal meningitis as a differential diagnosis, and including tests for Cryptococcus when dealing with immunocompetent patients presenting with meningitis. It also demonstrates the effects of the sociopolitical situation on health care delivery in low- and middle-income countries (LMICs) such as Nepal.

scholarly journals Case Report: Cryptococcal meningitis in an immunocompetent patient in Nepal - challenges in diagnosis and treatment

2019 ◽  
Vol 4 ◽  
pp. 55
Author(s):  
Ashish Jha ◽  
Sudeep Adhikari ◽  
Keshav Raj Sigdel ◽  
Buddhi Paudyal ◽  
Buddha Basnyat ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Liposomal Amphotericin ◽  
Care Delivery ◽  
Immunocompetent Patient ◽  
Liposomal Amphotericin B ◽  
Middle Income ◽  
Middle Income Countries ◽  
Csf Analysis ◽  
The Government

A 50 year old woman from Nepal had clinical features suggestive of meningitis. Cerebrospinal fluid (CSF) analysis was normal except for the presence of cryptococcal antigen. The inclusion of test for Cryptococcus in the CSF helped in making the diagnosis of cryptococcal meningitis in our patient who was apparently immunocompetent. Treatment with liposomal amphotericin B could not be started on time due financial constraints. The patient had a stroke and further deteriorated. Liposomal amphotericin B is stocked by the government of Nepal for free supply to patients with visceral leishmaniasis, but the policy does not allow the drug to be dispensed for other infections. The family members of our patient acquired the drug within a few days from a government center using their political connections and following administering the treatment the patient improved. This case demonstrates the utility of considering cryptococcal meningitis as a differential diagnosis, and including tests for Cryptococcus when dealing with immunocompetent patients presenting with meningitis. It also demonstrates the effects of the sociopolitical situation on health care delivery in low- and middle-income countries (LMICs) such as Nepal.

Atypical multifocal cutaneous leishmaniasis in an immunocompetent patient treated by liposomal amphotericin B

2005 ◽  
Vol 51 (5) ◽  
pp. e261-e264 ◽  
Author(s):  
A. Paradisi ◽  
R. Capizzi ◽  
A. Zampetti ◽  
I. Proietti ◽  
C. De Simone ◽  
...  
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Immunocompetent Patient ◽  
Liposomal Amphotericin B

scholarly journals Safety and tolerability of intrathecal liposomal amphotericin B (AmBisome) for cryptococcal meningitis: a retrospective study in HIV-infected patients

2018 ◽  
Vol 5 (5) ◽  
pp. 77-81 ◽  
Author(s):  
Gerardo Alvarez-Uria ◽  
Manoranjan Midde ◽  
Jayaram Battula ◽  
Himachandra N.B. Pujari
Keyword(s):  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Liposomal Amphotericin ◽  
Developed Countries ◽  
Intrathecal Administration ◽  
Liposomal Amphotericin B ◽  
Lumbar Pain ◽  
Control Group ◽  
Resource Poor ◽  
Initial Improvement

Background: While mortality of HIV-related cryptococcal meningitis (CM) in developed countries is relatively low, in developing countries over half of patients die within 10 weeks. Current recommended therapies are often not suitable for resource-poor settings, and new shorter regimens are urgently needed. Intrathecal administration of liposomal amphotericin B (lAmB) has shown promising results in animal models. However, the safety and tolerability of intrathecal lAmB in humans are not well known. Methods: In this retrospective observational study, we report the tolerability and safety of intrathecal lAmB in patients with CM from an HIV cohort study in India. Results: In all, 18 patients were included in the analysis. Six were female and the median age was 40 years [interquartile range (IQR): 35–45]. The median CD4 count was 42 cells/µl (IQR: 19–127). Compared with a historical control group, the hazard ratio for mortality was 0.59 (95% confidence interval: 0.26–1.29). Two patients complained of transient lumbar pain in single occasion. One patient had a skin reaction to chlorhexidine, which was used as skin disinfectant. After initial improvement, one patient requested to stop lumbar punctures for the last 2 days of treatment. Conclusion: Intrathecal lAmB was safe and well tolerated in HIV-infected patients with CM.

scholarly journals Visceral leishmaniasis in an immunocompetent patient

2020 ◽  
Author(s):  
Domingos Sousa ◽  
Miguel Seruca ◽  
Ana Isabel Rodrigues ◽  
Mourão Carvalho ◽  
Sara Aleixo Duarte ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Immunocompetent Patient ◽  
Liposomal Amphotericin B ◽  
History Of

A 26-year-old patient was admitted with a 6-month history of fever,fatigue,and unintentional weight loss.Abdominal CT described an heterogeneous hepatosplenomegaly.Laboratory studies revealed leucopenia,anemia and elevated CRP.Bone marrow aspirate revealed amastigotes compatible with Leishmania spp.Was treated with liposomal amphotericin B with favourable outcome.Authors intend to raise awareness of VL in immunocompetentpatients.

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