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Cryptococcal Meningitis and Herpes Zoster Case
Aug 31, 2000

1. My brother was diagnosed with Cryptococcal meningitis on 6 August 2000. He was prescribed 400mg Diflucan 2 times a day for 7 days plus some pain killers (dyoxpol).

2. Two or three days later he started to develop some blisters on the back of his head and face and the head also became swollen. On 10 August we visited the doctor and he identified the blisters on the head as Herpes Zoster,and put him on a treatment with Acyclovir. The ruptured blisters are very painful and have developed into open wounds which sometimes dry off. He is applying a cream (name could be provided) and an eye ointment as well (name could be provided).

3. He is currently continuing with the treatment for herpes zoster, and medication for meningitis (intraconazolum 200 mg/day

4. Please could you advise on how best to help him. What precautions can us the caregivers take. Is this linked to HIV infection (he has not had an HIV test yet.)?

Response from Dr. Feinberg

These illnesses are certainly compatible with HIV, and especially with low T cell counts meaning his immune system is severely damaged. He should get an HIV test and T cell subsets (a T cell count) as soon as possible. I would not recommend itraconazole for cryptococcal meningitis -- it is better to continue treatment with fluconazole, 400 mg once a day, until he has been treated for 10 weeks, then the dose can be reduced to 200 mg once a day. The best thing of all is to begin anti-HIV combination therapy. He will heal more quickly and will be less likely to come down with another HIV-associated illness.

The only precautions you and other caregivers should take is to avoid contact with his blood. If he has an accident and bleeds, the wound should be cleaned with soap & water and peroxide and then bandaged. Any blood that has leaked onto an inanimate surface can be cleaned up with paper towels and household bleach and discarded into the garbage.

Good luck!


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