Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

430 Cryptococcus Neoformans Cryptosporidiosis

■Document negative CSF cultures, reassess every 1–2 wks until neg-

ative

■Value of following serial CSF or serum CrAg debatable: most helpful

to run both samples side-by-side as test has some variability during

different runs. Different labs often use different kits, which cannot

be compared.

Routine

■Close clinical follow-up

■At end of therapy, CSF values should be normalized

complications and prognosis

Complications

■High ICP – more common in end-stage AIDS patients. Treatment

somewhat controversial – options: serial LPs, acetazolamide, CSF

shunts

■Neurologic deficits – in up to 40% of AIDS patients

■Death – 25–30% of meningitis cases

■Relapse – prostate can be sequestered focus

Prognosis

■Infections rarely cured in AIDS patients, chronically immunosup-

pressed patients

■20–25% relapse after initial response with Amphotericin B

Cryptosporidiosis....................................

J. GORDON FRIERSON, MD

history & physical

History

■Life cycle: Oocysts excreted in stool, ingested, develop to sporo-

zoites and gameteocytes in intestinal epithelial cells. New zygotes

produced, maturing to oocysts, which complete the cycle.

■Exposure: ingestion of oocysts by fecal-oral route. Water-born out-

breaks occur. Auto-inoculation occurs.

Signs & Symptoms

■In immunocompetent host: Incubation period of 2–12 days (median

7), rapid onset of watery diarrhea, cramps, bloating, often mild fever,

weight loss, sometimes nausea and vomiting. Duration averages