Cryptococcal meningitis: a review for emergency clinicians.

Autor: Fisher KM; Department of Emergency Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA., Montrief T; Department of Critical Care Medicine, University of Pittsburgh Medical Center, 3550 Terrace St., Pittsburgh, PA, 15261, USA., Ramzy M; Department of Critical Care Medicine, University of Pittsburgh Medical Center, 3550 Terrace St., Pittsburgh, PA, 15261, USA., Koyfman A; Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA., Long B; Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA. brit.long@yahoo.com.
Jazyk: angličtina
Zdroj: Internal and emergency medicine [Intern Emerg Med] 2021 Jun; Vol. 16 (4), pp. 1031-1042. Date of Electronic Publication: 2021 Jan 09.
DOI: 10.1007/s11739-020-02619-2
Abstrakt: Introduction: Cryptococcal Meningitis (CM) remains a high-risk clinical condition, and many patients require emergency department (ED) management for complications and stabilization.
Objective: This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of CM.
Discussion: This review evaluates the diagnosis, management, and empiric treatment of suspected CM in the ED. CM can easily evade diagnosis with a subacute presentation, and should be considered in any patient with a headache, neurological deficit, or who is immunocompromised. As a definitive diagnosis of CM will not be made in the ED, management of a patient with suspected CM includes prompt diagnostic testing and initiation of empiric treatment. Multiple types of newer Cryptococcal antigen tests provide high sensitivity and specificity both in serum and cerebrospinal fluid (CSF). Patients should be treated empirically for bacterial, fungal, and viral meningitis, specifically with amphotericin B and flucytosine for presumed CM. Additionally, appropriate resuscitation and supportive care, including advanced airway management, management of increased intracranial pressure (ICP), antipyretics, intravenous fluids, and isolation, should be initiated. Antiretroviral therapy (ART) should not be initiated in the ED for those found or known to be HIV-positive for risk of immune reconstitution inflammatory syndrome (IRIS).
Conclusions: CM remains a rare clinical presentation, but carries significant morbidity and mortality. Physicians must rapidly diagnose these patients while evaluating for other diseases and complications. Early consultation with an infectious disease specialist is imperative, as is initiating symptomatic care.
Databáze: MEDLINE
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