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Volume 22, Number 9—September 2016
Letter

Cryptococcus gattii Meningitis Complicated by Listeria monocytogenes Infection

Robert G. DeissComments to Author , Michael Bolaris, Angel Wang, and Scott G. Filler
Author affiliations: Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA (R.G. Deiss); Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda (R.G. Deiss):; Naval Medical Center of San Diego, San Diego, California, USA (R.G. Deiss); Harbor-UCLA Medical Center, Los Angeles, California, USA (M. Bolaris, A. Wang, S.G. Filler); David Geffen School of Medicine at UCLA, Los Angeles (S.G. Filler)

Main Article

Table

Clinical events, management, and parameters for patient with Cryptococcus gattii meningitis complicated by Listeria monocytogenes infection*

Clinical event (day) Therapy (days) Opening pressure, cm H2O (day) Leukocyte count, cells/μL (day) Protein, g/L (day) Glucose, g/L (day) CrAg titer (day) Culture result (day)
Days 1–15: induction therapy AMB 1 mg/kg (1–4); 5FC 2 g q6h (1–14); L-AMB 7/mg/kg (5–14) 52 (1), 12 (12) 1,030 (1), 123 (12) 117 (1), 104 (12) 30 (1), 29 (12) 1:64 (1) Cryptococcus gattii (1), negative (12)
Days 16–30: discharge, outpatient infusion, readmission L-AMB 7/mg/kg M,W,F (15–22);
FLZ 400 mg q12h (15–22); L-AMB 5 mg/kg (23–30); FLZ 600 mg q12h: (23–30); 5FC 3 g q6h (23–30) 46 (23) 111 (23) 81 (23) 34 (23) 1:8 (23) Negative (23)
Days 31–45: inpatient therapy L-AMB 5 mg/kg (31–45); FLZ 600 mg q12h (31–45); 5FC 3 g q6h (31–45) 44 (38) 17 (38) 66 (38) 64 (38) NA Negative (38)
Days 46–60: inpatient therapy L-AMB 5 mg/kg (46–60); FLZ 600 mg q12h (46–60); DEX 2 mg q6h (46–60) 35 (48) 18 (48) 25 (48) 85 (48) NA Negative (48)
Days 61–75: discharge and outpatient infusion L-AMB 5 mg/kg (61–65); FLZ 600 mg q12h (61–75); DEX 2 mg q8h (61–75); L-AMB 7/mg/kg M,W,F (66–75) 13 (63) 8 (63) 28 (63) 91 (63) 1:4 (63) Negative (63)
Days 76–83: readmission/coma 
(80); death (83) L–AMB 7/mg/kg M,W,F (76–79); DEX 2 mg q12h (76–79); FLZ 600 mg q12h (76–83); CRO 2 gm q12h (80–83); AMP 2 gm q4h (80–83); TMP/SMX 320–1,600 mg (2 double-strength tablets) q8h (80–83) >55 (80) 1,010 (80) 258 (80) 17 (80) 1:4 (80) Listeria monocytogenes (80)

*5FC, flucytosine; AMB, amphotericin B; AMP, ampicillin; CrAg, cryptococcal antigen; CRO, ceftriaxone; DEX, dexamethasone; F, Friday; FLZ, fluconazole; L-AMB, liposomal amphotericin; M, Monday; NA, not available; q, every; TMP/SMX, trimethoprim/sulfamethoxazole; W, Wednesday.

Main Article

Page created: August 16, 2016
Page updated: August 16, 2016
Page reviewed: August 16, 2016
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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