Jan 10, 2000
MY SISITER WAS RECENTLY DIAGNOSED 6 WEEKS AGO WITH AIDS. SHE WAS HOSPITALIZED W/PNEUMONIA,CRYPTO-COCCAL DISEMINATED LUNG INFECTION AND TB. AFTER 5 WEEKS IN THE HOSPITAL THEY LET HER COME HOME. SHE WAS HOME A WEEK WHEN SHE BEGAN TO GET CONFUSED AND INCOHERRANT. SHE WAS TAKEN BACK TO THE HOSPITAL AND A SPINAL TAP SHOWED SHE NOW HAD CRYPTO-COCCAL MENNINGITIS. WE WERE TOLD THAT THE MEDICATION,AMPHOTERICIN B, IS VERY TOXIC AND THE DOCTORS FEEL HER BODY WILL NOT TOLERATE THE TREATMENT AND SHE PROBABLY DOESN'T HAVE MUCH TIME LEFT. IS THERE HOPE FOR ANY TYPE OF RECOVERY? ARE THERE ANY OTHER TREATMENTS FOR THIS TYPE OF MENNINGITIS? SHE LOOOKS GREAT BUT THE DOCTORS FEEL SHE IS JUST NOT RESPONDING TO HER MEDICATIONS. ANY ADVICE WOULD BE GREATLY APRECIATED.
Response from Dr. Feinberg
Some patients with very mild cryptococcal meningitis can be treated successfully with a pill called fluconazole. Most experts think that at least 2 weeks of amphotericin B before switching to fluconazole is better. While ampho B has a lot of side effects, most can be prevented or managed if the doctors have enough experience using this drug. It concerns my that her doctors are reluctant to use amphotericin. If they are not comfortable with this drug, then get a referral to an infectious diseases or AIDS doctor who is. No one who "looks good" should die from this infection. The patients who do die from it these days are usually in a coma (or close to it) when they go into the hospital. Push her docotrs on this-- it's very important.
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