Persistent Cryptococcus neoformans infection of the prostate after successful treatment of meningitis. California Collaborative Treatment Group

Ann Intern Med. 1989 Jul 15;111(2):125-8. doi: 10.7326/0003-4819-111-2-125.

Abstract

Study objective: To assess the frequency of persistent Cryptococcus neoformans infection in patients with the acquired immunodeficiency syndrome (AIDS) after receiving apparently adequate treatment for meningitis.

Design: Blood, urine, and cerebrospinal fluid were cultured at the conclusion of primary therapy to assess the adequacy of treatment.

Setting: Outpatient clinics at three medical centers.

Patients: Patients had C. neoformans grown in culture from cerebrospinal fluid. Primary therapy consisted of either 2.0 g of amphotericin B alone; 6 weeks of combination therapy with flucytosine; or, if flucytosine was poorly tolerated, an adjusted minimum total amphotericin B dose. To meet criteria for adequate treatment of meningitis all patients had two sequential cerebrospinal fluid samples which were culture negative.

Measurements and main results: Nine of forty-one patients grew C. neoformans from urine after completion of primary treatment, but none had urinary symptoms. Fungi were visualized in expressed prostatic secretions in 4 of these patients. One patient refused further treatment and developed cryptococcemia within 5 weeks. Three patients received additional amphotericin B; all had persistent funguria without systemic relapse. Six patients received fluconazole; 4 became urine culture negative, and 2 had systemic relapse.

Conclusion: The persistence of urinary C. neoformans after adequate therapy for meningitis suggests that the urinary tract (probably the prostate) is a sequestered reservoir of infection from which systemic relapse may occur.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / complications
  • Amphotericin B / therapeutic use
  • Antifungal Agents / therapeutic use
  • Cryptococcosis / drug therapy
  • Cryptococcosis / etiology*
  • Cryptococcus neoformans / isolation & purification
  • Drug Therapy, Combination
  • Fluconazole
  • Humans
  • Male
  • Meningitis / complications*
  • Meningitis / drug therapy
  • Meningitis / etiology
  • Prostatic Diseases / microbiology*
  • Recurrence
  • Triazoles / therapeutic use
  • Urine / microbiology

Substances

  • Antifungal Agents
  • Triazoles
  • Amphotericin B
  • Fluconazole