DENOUEMENT CONTINUED FROM PAGE 13

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TEYMOURZADEH N.

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Journal: Medical Journal of Mashhad University of Medical Sciences Year:2003 | Volume:46 | Issue:80 Page(s): 93-94

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Title

DENOUEMENT CONTINUED FROM PAGE 13

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TEYMOURZADEH N. | Issue Writer Certificate

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Abstract

The CSF smear stained with Indian ink and showed shining round agents in the dark field resembling fungal infection. CSF culture in commeal media performed and amphotricin B 0.6 mg/kg/bw started. Two periodic CSF cultures in Saboureux and commeal media were positive for cryptococcus and another skul CT scan with contrast was performed. And an increasing density of brain paranchyma along the caudate nucleus was reported indicating hemorrhages or brain calcification!?EEG was performed and low voltage waves in all the zones of brain, indicating diffuse brain parenchyma lesion was reported.An HIV1 antibody assay was non reactive, anti HTLV 1,2, Hepatitis B markers and quantitative immuno globulin's were normal.CSF for mycobacterium tuberculosis antigens with PCR assay was done and it was negative. Flowcytometry of peripheral blood was done and it was at a normal range. Continuing amphotricin B therapy made a high serum creatinine so, with adjusting the dosage, the drug continued with 3 weeks treatment the condition became better but in spite of receiving amphotricin B. the situation of patient gradually got worse and in blood culture for bacteria, citrobacter diversus was grown with sensitivity only to cotrimoxazole. Another blood analysis was done and showed leukocytosis and neutrocytosis. Eventually the patient with concurrent infection (nasocomal sepsis) and renal insufficiency expired.Definitive diagnostic of cryptococcal infections requires cultures of organism. Yield from culture is dependent on the quality and the processing of specimens.Detection of cryptococcus antigen by latex agglutination test in CSF serum or urine is sensitive in 90% or more of patients with cryptococcal meningitis. High titers of cryptococcal antigen in serum and CSF before treatment have been correlated with high mortality and poor outcome. Antigen titer is also useful in monitoring therapeutic response to treatment. Practice guidelines for the treatment of cryptococcal disease have recently been published.Treatment is dependent on the anatomic site of disease and immune status. All individuals with significant cryptococcal infection require evaluation of CSF because of predilection for infection of the CNS. For these patients with CNS disease treatment with Amphotricin B in combination with flucytosine is indicated. For HIV infected persons who develop cryptococcal disease regardless of CNS involvement, lifelong maintenance therapy with fluconazal is recommended.Our patient must be treated with Amphotricin B plus flucytosine 400 mg/day for 6 months but unfortunately flucytosine was not available and on the other hand renal insufficiency and concurrent citrobacter diversus sepsis and multiorgan failure expired the patient.

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APA: Copy

TEYMOURZADEH, N.. (2003). DENOUEMENT CONTINUED FROM PAGE 13. MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES, 46(80), 93-94. SID. https://sid.ir/paper/52295/en

Vancouver: Copy

TEYMOURZADEH N.. DENOUEMENT CONTINUED FROM PAGE 13. MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES[Internet]. 2003;46(80):93-94. Available from: https://sid.ir/paper/52295/en

IEEE: Copy

N. TEYMOURZADEH, “DENOUEMENT CONTINUED FROM PAGE 13,” MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES, vol. 46, no. 80, pp. 93–94, 2003, [Online]. Available: https://sid.ir/paper/52295/en

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