Treatment of Cryptococcal Infection

In addition to general treatment and care, cryptococcal infection also requires the use of some antibacterial drugs, such as fluconazole and amphotericin. These drugs can have a bactericidal effect and are common drugs for treating cryptococcal infections.

1. General treatment

(1) Actively treat the primary disease and eliminate the cause.

(2) Strictly follow the indications for the use of antibiotics, glucocorticoids, and immunosuppressants.

(3) Strengthen nursing care and supportive therapy.

2. Antifungal treatment

Fluconazole, itraconazole, flucytosine, amphotericin B and its liposomes can be used. For severe cases, standard treatment is IV amphotericin B followed by oral fluconazole. In mild patients without AIDS, oral fluconazole for 8 to 10 weeks may be effective. Voriconazole has a certain therapeutic effect when other antifungal drugs are ineffective. Caspofungin has limited effect on this disease. In addition to systemic medication, local treatment should be used to treat mucocutaneous cryptococcosis.

(1) Amphotericin B Amphotericin B is a polyene antibiotic that binds to sterols on the fungal cell membrane, changing the membrane permeability, destroying the bacteria and exerting a bactericidal effect. It is currently the drug of choice for the treatment of cryptococcosis, histoplasmosis and systemic candidiasis, but is less effective against aspergillosis.

1) Administration route ① Intravenous drip: It is advisable to start with a small amount. If there are no adverse reactions, the dose can be gradually increased. The course of treatment is 1 to 3 months. For intravenous injection, dilute with 5% glucose solution, the concentration should not exceed 0.05-0.1 mg/ml, and slowly drip intravenously, each dose should be completed in no less than 6 hours. Too high a concentration can easily cause phlebitis, while too fast a drip rate can cause convulsions, arrhythmias, a sudden drop in blood pressure, and even cardiac arrest. ② Intrathecal injection or intraventricular injection is limited to the treatment of severe cases of cryptococcal membrane or failure of intravenous infusion. If there are side effects, the dosage can be reduced or the medication can be discontinued. Too much medication in the cerebrospinal fluid can cause arachnoiditis and an increase in cerebrospinal fluid cells, temporary radiculitis, loss of sensation, urinary retention, and even paralysis and convulsions. Most of the symptoms can be relieved if the medication is discontinued early.

2) Side effects: nausea, vomiting, abdominal pain, fever, chills, headache, dizziness, anemia, thrombocytopenia, thrombophlebitis, etc., which are toxic to the kidney and hematopoietic system. To reduce side effects, aspirin can be given half an hour before treatment and 3 hours after treatment. In severe cases, intravenous drip of hydrocortisone or dexamethasone can be used. During medication, routine blood and urine tests as well as liver and kidney function tests should be performed every 3 to 7 days. When serum creatinine is >2.5 mg/dl, the dosage should be reduced. When urea nitrogen is >40 mg/dl, the medication should be discontinued. The medication should be discontinued for 2 to 5 weeks until normal recovery occurs, and then the medication can be restarted with a small dose. Thrombophlebitis is prone to occur at the injection site, so the initial infusion site should start from the small veins at the distal end of the limbs.