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Guo et al. Diagnosis and treatment of cryptococcal meningitis

intracranial pressure. Release CSF 10-30 mL per day regulation opens up a new way. Anti-fungal drugs
until the intracranial pressure has been normalized combined immunotherapy has been put forward in
may be required for a few days. The treatment recent years.
guideline of IDSA in 2010 points out that this method
is the most effective and rapid way to reduce the In a phase I clinical study overseas, twenty cases of
pressure currently; (3) Lumbar cistern drainage. This cryptococcosis are treated with monoclonal antibody
[24]
method could reduce the number of lumbar puncture from mice aimed at capsule antigen, the result
and avoid patients’ pain. In addition, it is a better method shows that high doses of monoclonal antibodies can
for patients whose intracranial pressure > 3.9 kPa and reduce the level of polysaccharide antigen in serum
cannot be controlled effectively by frequent lumbar temporarily, but there may appear allergic reactions
puncture. Make the open brain pressure fall to 50% by and other side effects. [61]
enough drainage of the cerebrospinal fluid. Regulate
the drainage 300-400 mL per 24 h. It is best no more It has been reported that clinical application of
than 15 days for drainage each time in principle in case interferon in the treatment of fungal resistance
of CSF leakage or secondary infection; (4) Ommaya in 2004. [62] Jarvis et al. [63] conduct a randomized
reservoir. This involves a device that allows for ventricle controlled experiment and show that the rate of
drainage invented by Sheldon and Ommaya in 1963 fungal clearance is accelerated by adding interferon
[60]
and applicated as common treatment in adults with on the basis of AmB combined with 5-FC, and there
cryptococcal meningitis for relief of the symptoms of is no other side effects. But there is no statistical
HICP. The anti-fungal drugs could be injected into significance in mortality of patients between group
ventricles using this device directly and reach effective with interferon 100 μg (Day 1, Day 3) and group with
concentration without influence of BBB. In addition, 100 μg (Day 1, Day 3, Day 5, Day 8, Day 10, Day 12).
we could obtain CSF from the ommaya reservoir The treatment guidelines set out by Infectious disease
expediently and securely that it is useful in the evaluation society of American in 2010 recommended to give
of the state of illness changes and therapeutic formal antifungal agents combined with IFN-γ to
effect advantageously. This method reduces the patients with persistent infection (whose culture result
risk of exogenous infection due to the hermetic type of CSF is positive after 4 weeks of antifungal therapy with
structure. However, percutaneous puncture repeatedly 100 μg/m for more than 50 kg, 50 μg/m for less than
2
2
may lead to the damage of reservoir or secondary 50 kg 3 times a week for 10 weeks. Small-scale phase
infection; (5) Ventriculoperitoneal shunt. We should 2 clinical trials have shown the good curative effect.
consider the ventriculoperitoneal shunt under following However, larger clinical trials are needed to verify.
circumstances: the control of intracranial pressure
is not ideal, recurrent cerebral hernia, occurrence of In recent years, radioimmunotherapy has become
persistent or progressive cranial nerve defects. Anti- an adjuvant immunotherapy for the treatment of
fungal therapy should be used at the same time to Cryptococcus infection. The principle is to use the
avoid peritoneal cavity infection; (6) Lateral ventricle radioactive substances to label monoclonal antibodies,
drainage. If measures above mentioned cannot reduce thus killing the fungi with cytotoxic radiation substance.
the intracranial pressure effectively, or there is an Bryan et al. have performed animal experiment,
[64]
expansion of the ventricles, lateral ventricle drainage demonstrated that RIT is more effective to mice
should be performed in time. But the drainage time infected with C. neoformans than AmB. Besides, RIT
should not be too long (2-3 weeks), otherwise it is easy could prevent the development of fungal resistance. [42]
to cause infection. These surgical techniques above
could not only reduce intracranial pressure but alsobe CONCLUSION
used to intrathecal or ventricular injection to improve
the therapeutic effect. Higher morbidity and mortality has caused great
concern from scholars all over the world. How to make
Immune therapy early diagnosis and effective treatment is the key point
The main infection routes of Cryptococcus is through of the current study. Immunotherapy opens up a new
the respiratory tract, asymptomatic latent state is the way of treatment for CM. But it is in the bud. Therefore,
most common infection state. When there is immune the development of new drugs with effective antifungal
[44]
function defect in people that could not resist the activity and low toxicity as well as effective treatment is
growth and reproduction of the fungi, Cryptococcus still a problem we need to solve.
will proliferate and migrate through the blood to other
organs in the body, leading to the CM eventually. Financial support and sponsorship
Therefore, anti-Cryptococcus infection by immune Nil.
254 Neuroimmunology and Neuroinflammation ¦ Volume 3 ¦ November 18, 2016